Mumbai: In an effort to improve policyholder experience and penetration of health insurance in the country, the Insurance Regulatory and Development Authority of India (Irdai) has constituted a sub-committee of the Insurance Advisory Committee. The insurance regulator notified the establishment of the committee and its members on 2 April, and then its role and scope, as well as the issues it will address. Mint looks at the major hurdles that the committee could address:
What is the scope and objective of the sub-committee?
The committee will evaluate private health insurance, from claims and pricing to fraud control, to recommend innovations that expand coverage and boost consumer trust. It will also explore aligning private insurers with public health schemes to improve efficiency and portability.
The panel has been constituted for a year. It will have to prepare and submit its first report with specific, actionable recommendations within 4 months.
Why was there a need to set up a health-specific committee?
Health insurers, especially standalone health insurance companies, are grappling with the operational impact of losing input tax credits. Friction with healthcare providers has exposed issues such as delayed payments for cashless claims, the need to streamline processes between hospital administrations and insurers, and surging medical inflation. These challenges underscore the need for better coordination and uniform pricing for medical treatments.
Who will be a part of the health sub-committee?
Irdai chairman Ajay Seth will head the seven-member committee, which will also include Deepak Sood, member (Non-Life) from the regulatory body. Indu Bhushan, former chief executive officer of the National Health Authority (NHA), and Monika Halan, a financial writer, speaker, author, and adjunct professor at Banasthali Vidyapeeth, Rajasthan, will also be members. Two insurance chiefs—Sanjeev Mantri, managing director and chief executive officer of ICICI Lombard General Insurance and Krishnan Ramachandran, managing director and chief executive officer of Niva Bupa Health Insurance, will be permanent invitees to the committee. The secretary of the Irdai Board Secretariat will convene panel meetings.
What issues will the committee attempt to solve?
The sub-committee will investigate barriers to health insurance access and affordability, and evaluate whether current retail and group products meet consumer needs. It aims to streamline claims, transparency, and grievance redressal to strengthen policyholder protection and industry trust.
The key priorities include ensuring fair product pricing and establishing a master data repository that combines private and public data for better governance. The panel will also integrate industry recommendations on medical inflation, a unified code of conduct, and the expansion of the National Health Claims Exchange.