**Executive Summary**
The Indian health insurance sector achieved 9% growth in FY 2024-25, with total premiums exceeding ₹1.2 lakh crore. To enhance efficiency and policyholder support, the IRDAI has mandated strict new timelines for cashless claim authorizations. The report outlines these regulatory measures alongside claims settlement data and reasons for claim disallowances to ensure a transparent ecosystem.
**Key Points / Main Content**
**Sector Growth and Performance**
* The health insurance market recorded a growth rate of approximately 9%, driven by increased awareness and demand for financial protection.
* Total premium volume for FY 2024-25 exceeded ₹1.2 lakh crore.
* The claims paid ratio (by number of claims) reached 87.50% in FY 2024-25, up from 82.46% the previous year.
**Mandated Settlement Timelines**
* IRDAI has prescribed specific limits to minimize medical care delays:
* **Cashless pre-authorization:** Must be processed within one hour.
* **Final authorization:** Must be completed within three hours.
**Pricing and Regulatory Standards**
* Premium increases are 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 risk factors and remain value-driven.
* Appointed Actuaries must conduct periodic reviews of pricing using credible data and customer feedback.
**Grievance Redressal and Claim Disallowance**
* During FY 2024-25, the Bima Bharosa portal reported 1,37,361 grievances, of which 93% (1,27,755) were disposed of.
* Common reasons for claim repudiation or disallowance include:
* Exceeding the sum insured.
* Policy clauses such as co-payments, sub-limits, and deductibles.
* Non-medical expenses, room rent capping, and proportionate charges.
**Impact Analysis**
**Policyholders**
**Impact**
Policyholders benefit from significantly faster access to medical care through the 1-hour and 3-hour authorization mandates. They also face potential premium increases due to enhanced features and demographic shifts.
**Action Required**
Policyholders should review specific policy conditions, such as co-payment clauses and sub-limits, to understand potential grounds for claim disallowance.
**Insurance Companies**
**Impact**
Insurers are under increased pressure to streamline their operational workflows to meet IRDAI’s strict authorization timelines. They must also ensure pricing remains fair and viable under 2024 regulations.
**Action Required**
Insurance companies must ensure their Appointed Actuaries perform periodic reviews of product pricing and maintain high disposal rates for grievances reported on the Bima Bharosa portal.
Key Entities Referenced
Insurance Regulatory and Development Authority of India (IRDAI): The primary regulator that prescribed specific timelines for processing cashless health insurance claims and issued measures to enhance claim settlement efficiency.
IRDAI’s 2024 regulations: Regulatory guidelines specifying that insurance products must be priced fairly based on risk factors and undergo periodic reviews by an Appointed Actuary.
Bima Bharosa portal: An online platform managed by IRDAI for reporting and disposing of general and health insurance grievances.
Ministry of Finance
Health insurance sector records Strong growth
momentum with premiums exceeding ₹1.2 lakh
crore in 2024-25
Prescribed timelines and regulatory measures aim to ensure
efficiency and fairness in Health insurance claim settlements
Posted On: 26 MAR 2026 12:34PM by PIB Delhi
India’s health insurance sector continues to witness robust growth, growing at a rate of around 9%, with
total health insurance premiums volume exceeding ₹1.2 lakh crore in 2024–25. This growth reflects
increasing awareness, improved access to healthcare financing, and a rising demand for financial
protection against medical expenses.
In order to enhance efficiency and ensure timely support to policyholders, the Insurance Regulatory and
Development Authority of India (IRDAI) has prescribed specific timelines for the processing of cashless
health insurance claims.
Time taken for cashless settlement
The following timelines have been prescribed by IRDAI: -
i. Cashless pre-authorization - Within one hour.
ii. Final authorization - Within three hours.
These timelines are aimed at minimizing delays and ensuring that patients receive timely access to
medical care.
Increase in health insurance premiums:
The increase in health insurance premiums is driven by factors such as ageing policyholders, higher
coverage, enhanced features, among others.
IRDAI’s 2024 regulations specify that insurance products are priced fairly, based on all relevant risk
factors, and remain viable and value-driven, with periodic review by the Appointed Actuary using credible
data and customer feedback.
Health claims settlement
The claims paid ratio (by number of claims) for Year 2022-23, 2023-24 and 2024-25 is shown below:Financial Year Claims Paid Ratio
(by number of claims)
2022-23 85.66%
2023-24 82.46%
2024-25 87.50%
Further, as per Bima Bharosa portal of IRDAI, during FY 2024-25, 1,37,361 general and health insurance
grievances were reported, out of which 1,27,755 (93%) were disposed of during FY 2024-25 itself.
Instances of claims disallowance or repudiation are largely attributable to specific policy conditions and
limitations. Some of the reasons for claims disallowance or repudiation include exceeding sum insured,
co-payment clause, sub-limits in policies, deductible in top-up policies, room rent capping, proportionate
charges, non-medical expenses etc.
Additionally, several measures have been taken by the IRDAI to enhance clarity, streamline claims
processing, and strengthen policyholder trust. In essence, a balanced, informed approach from all
stakeholders would be crucial in fostering a transparent and trustworthy health insurance ecosystem.
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