India’s health insurance sector has continued its strong upward trajectory, recording a growth rate of around 9 per cent, with total premium collections surpassing ₹1.2 lakh crore in the financial year 2024–25, according to the Health Ministry.
The expansion reflects rising awareness about health coverage, better access to healthcare financing, and increasing demand for financial protection against medical expenses.
To improve efficiency and ensure timely assistance to policyholders, the Insurance Regulatory and Development Authority of India has introduced strict timelines for processing cashless claims. Insurers are now required to approve cashless pre-authorisation within one hour and provide final authorisation within three hours, a move aimed at reducing delays and ensuring quicker access to treatment.
The growth in premiums has been driven by factors such as an ageing population, higher coverage uptake, and the addition of enhanced policy features. As per IRDAI’s 2024 regulations, insurance products are required to be priced fairly based on risk factors, with periodic reviews conducted by appointed actuaries using credible data and customer feedback.
Data on claims settlement indicates an improving trend, with the claims paid ratio standing at 87.50 per cent in 2024–25, up from 82.46 per cent in 2023–24 and 85.66 per cent in 2022–23. Meanwhile, the Bima Bharosa portal reported 1,37,361 grievances during 2024–25, of which 93 per cent were resolved within the same financial year, highlighting improved grievance redressal mechanisms.
However, claim rejections or partial settlements continue to occur due to policy-specific conditions such as exceeding the sum insured, co-payment clauses, sub-limits, deductibles in top-up plans, room rent caps, proportionate charges, and exclusions for non-medical expenses. Authorities emphasise that greater awareness and transparency among policyholders and insurers will be key to building a more reliable and trustworthy health insurance ecosystem.
