In an effort to make health insurance pricing more transparent and claims processing more predictable, the Centre plans to build a public ‘Health Claims Index’ using data flowing through the National Health Claims Exchange (NHCX), according to two officials aware of the development and documents reviewed by Mint.
Such an index would help consumers make more informed choices by offering visibility into how insurers handle claims. For insurers, it would create a common data framework to improve underwriting, reduce inefficiencies, and enable more consistent, risk-based pricing.
The index will use aggregated data flowing through the NHCX—a digital platform for processing health insurance claims—to publish industry-wide benchmarks on claims processing timelines, approval rates and cost patterns across insurers. The data will be anonymised through a “data-blind” architecture to protect patient privacy.
“By making aggregated claims servicing data publicly accessible, the proposed health claims index aims to create accountability among insurers and healthcare providers,” one of the two officials cited above said, requesting anonymity.
A key part of the framework, the officials said, is the adoption of standardised clinical coding systems and treatment protocols, which could reduce billing discrepancies, enable automated claims processing, and help detect fraud.
The development assumes significance for India’s health insurance industry, which is paper-heavy and inefficient, resulting in higher costs for patients at a time when utilisation of health insurance is rising steadily—total claims paid increased 12.9% to ₹94,248 crore in FY25, according to government data.
Queries emailed to the spokespersons of health and family welfare ministry, Insurance Regulatory and Development Authority of India (Irdai), Niva Bupa, Star Health, ICICI Lombard, and HDFC Life, on Monday remained unanswered till press time.
Why NHCX is central to the proposed index
The NHCX will continue to function as the underlying digital infrastructure for the proposed index, processing claims across insurers, hospitals and intermediaries, enabling standardised, real-time data flows across the ecosystem.
The NHCX was conceptualized in the 2018 National Health Stack and developed under the 2021 Ayushman Bharat Digital Mission (ABDM). It scaled significantly in 2024, with the official NHCX Strategy for nationwide adoption formalized in April 2026.
Data from the NHCX Strategy Paper shows 50 entities live on the platform as of April 2026, including 28 insurers and 11 TPAs (third-party administrators). Additionally, more than 150 healthcare providers and payers are currently in the integration pipeline.
All claims under the government’s flagship Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), the world’s largest health assurance scheme, are processed through this digital infrastructure, while another 150 entities are in various stages of integration.
Experts say this enables the NHCX to generate large-scale, standardised data to support underwriting.
“If disease and hospitalisation patterns are available on a countrywide basis, they can be used for underwriting,” said Hari Radhakrishnan, member of the Irdai’s Health Insurance Consultative Committee, and a director at the Insurance Brokers Association of India (IBAI).
“Currently, due to data limitations, insurers and their actuaries are constrained in their analysis of health claims. With more granular and deep data capabilities, insurers would be able to develop and price products better, which will benefit policyholders,” he added.
Industry executives, who have hailed the move as a game changer, say the current largely paper-based claims model costs over ₹500 per transaction, limiting scalability and making it unviable for high-volume, low-value outpatient claims.
Sarbvir Singh, spokesperson and joint group chief executive officer (CEO) of PB Fintech, said streamlining of claims processing could lead to more transparent products, better pricing discovery and a smoother claims experience for customers. PB Fintech is the parent company of Policybazaar and Paisabazaar, India’s largest online platform for insurance and lending products.
“As anonymised, standardised data improves visibility into treatment costs and claim sizes, consumers will better understand the financial implications of healthcare, especially when hospitalisation expenses can run into ₹1 crore or more,” Singh said, adding that insurers, hospitals and policymakers would also benefit.
Indraneel Chatterjee, co-founder and chief operating officer of insurtech platform RenewBuy, sees NHCX and the index as a structural reset of how healthcare financing operates in India.
“This shift moves the industry away from static, one-size-fits-all products toward dynamic, risk-adjusted offerings. For users, this means hyper-personalized benefits—like a 15–20% premium reduction for well-managed diabetes—and real-time approvals in under a minute,” he said.
Dr. Alexander Thomas, founder and patron, Association of National Board Accredited Institutions (ANBAI) and Association of Healthcare Providers India (AHPI), said the index could build trust between patients, hospitals and insurers by anchoring managed care through standardised care pathways, transparent costing and outcome-based incentives.
Other industry executives cautioned that the benefits will depend on scale and execution.
Surinder Bhagat, president—employee benefits, large account practices at Prudent Insurance Brokers, said aggregating anonymised claims data could unlock better pricing and product design, but “until NHCX achieves critical mass, the gap between vision and ground reality will remain. Scale, standardisation and a robust ethical framework will define the success of this initiative.”