Health insurance has become increasingly important given the increasing incidence of health-related illnesses. The number of health insurance holders has increased rapidly since the COVID-19 pandemic. To avoid expensive treatment, people are paying higher premiums for health insurance. Companies are increasing premiums every year. Despite this, many people are not receiving their claims. According to a report, in the financial year 2025, approximately one in 12 health insurance claims was rejected.

What do the figures say?

According to a report, in 2024-25, insurance companies filed 32.6 million health insurance claims and disbursed ₹94,248 crore. But about 8% of claims were rejected, meaning that nearly one in every 12 policyholders who filed a claim did not receive a payment.

What has IRDAI said?

Now, the Insurance Regulatory and Development Authority of India (IRDAI) has taken a tougher stance. Under the regulator's new changes, IRDAI has clearly stated that companies must provide compelling reasons for claim rejections and the specific policy conditions that underpinned the decision. This move comes at a time when, despite improvements in claim processing times, claim-related complaints are on the rise.

What will be the benefit of this?
These stricter rules will make it easier for policyholders to determine whether a claim rejection is justified and, if necessary, they can take the matter to the grievance redressal system or the Insurance Ombudsman. This change is based on several claims-related considerations put forward by the regulator. Insurance companies will now have to process cashless pre-authorization requests within one hour and communicate the discharge decision within three hours of receiving the final request from the hospital.

PC: Navarastra