New Delhi, March 27 (BNP): India’s health insurance sector continued its strong growth trajectory in 2024–25, with total premium collections crossing ₹1.2 lakh crore, reflecting rising awareness, improved access to healthcare financing, and increasing demand for financial protection against medical expenses.
The sector recorded an approximate growth rate of around 9 per cent during the financial year, underlining sustained expansion driven by demographic shifts, higher coverage uptake, and evolving consumer needs.
To enhance efficiency and ensure timely support for policyholders, the Insurance Regulatory and Development Authority of India has prescribed specific timelines for the settlement of cashless health insurance claims. As per the norms, insurers are required to provide cashless pre-authorisation within one hour and final authorisation within three hours, aimed at reducing delays and facilitating quicker access to treatment.
The rise in health insurance premiums has been attributed to factors such as ageing policyholders, expanded coverage, and the inclusion of enhanced features in insurance products. The regulator’s 2024 guidelines mandate that insurance products be priced fairly, based on relevant risk factors, while ensuring long-term viability and value for customers. Pricing is subject to periodic review by appointed actuaries using credible data and customer feedback.
On claims performance, the claims paid ratio (by number of claims) improved to 87.50 per cent in 2024–25, compared to 82.46 per cent in 2023–24 and 85.66 per cent in 2022–23, indicating better settlement outcomes.
According to data from IRDAI’s Bima Bharosa portal, a total of 1,37,361 general and health insurance grievances were reported during FY25, of which 1,27,755 cases, or 93 per cent, were resolved within the same financial year.
Industry data suggests that instances of claim disallowance or repudiation are largely linked to specific policy conditions, including exceeding the sum insured, co-payment clauses, sub-limits, deductibles in top-up policies, room rent caps, proportionate charges, and exclusions such as non-medical expenses.
The regulator has also undertaken multiple measures to improve transparency, streamline claims processing, and strengthen policyholder confidence. Experts note that a balanced and informed approach by all stakeholders will be key to building a more transparent and trustworthy health insurance ecosystem in the country.
