India’s health insurance sector has recorded strong growth momentum, with total premiums exceeding ₹1.2 lakh crore in 2024-25, reflecting rising demand for financial protection against medical expenses.
According to a statement issued by the Ministry of Finance on Thursday, 26 March, the sector grew at around 9 per cent, driven by increasing awareness, improved access to healthcare financing, and broader coverage uptake.
To improve efficiency and ensure timely support to policyholders, the Insurance Regulatory and Development Authority of India (IRDAI) has prescribed strict timelines for processing cashless health insurance claims.
Cashless pre-authorisation must be completed within one hour, while final authorisation must be issued within three hours.
The ministry said these timelines are aimed at minimising delays and ensuring patients receive timely access to medical care.
The rise in health insurance premiums has been attributed to factors such as ageing policyholders, higher coverage levels, and enhanced product features.
IRDAI’s 2024 regulations require that insurance products are priced fairly based on relevant risk factors, with periodic review by appointed actuaries using credible data and customer feedback.
On claims performance, the claims paid ratio (by number of claims) stood at 85.66 per cent in 2022-23, declined to 82.46 per cent in 2023-24, and improved to 87.50 per cent in 2024-25.
Data from the IRDAI’s Bima Bharosa portal showed that 1,37,361 general and health insurance grievances were reported in FY 2024-25, of which 1,27,755 cases, or 93 per cent, were resolved within the same financial year.
The ministry noted that claim disallowances or repudiations are largely linked to specific policy conditions including exceeding sum insured, co-payment clause, sub-limits in policies, deductible in top-up policies, room rent capping, proportionate charges, non-medical expenses etc.
It added that regulatory measures introduced by IRDAI are aimed at enhancing transparency, streamlining claim processes, and strengthening trust among policyholders, with a balanced and informed approach seen as key to building a reliable health insurance ecosystem.
