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The Indian health insurance industry is experiencing rapid growth, with increasing premiums and a rising number of policyholders. However, beneath the surface, there are concerns that the system is becoming inefficient and prioritizing profits over patient care. The Medical Loss Ratio (MLR), which measures the percentage of premiums spent on patient claims, is a key indicator of an insurance system’s efficiency. In India, the MLR is alarmingly low, with some companies spending as little as 58% of premiums on medical care.
An analysis of the financial disclosures of standalone health insurance companies in India reveals that a significant portion of premiums is being absorbed by commissions, administration, and management overhead. For example, Star Health Insurance spent 15% of premiums on commissions and 17% on management expenses, while Care Health Insurance spent 20% on commissions and 22% on management expenses. This leaves a relatively small amount for actual medical care.
In contrast, global benchmarks suggest that at least 80-85% of premiums should be spent on patient care. In countries like the US, Germany, France, and the Netherlands, regulatory measures are in place to ensure that administrative and sales costs are capped, allowing the bulk of contributions to flow towards treatment.
The Indian health insurance industry’s focus on selling policies rather than funding care has led to a breakdown of trust between customers, hospitals, and insurers. Patients are often forced to pay out of pocket or battle for approvals, despite paying rising premiums. To address this issue, regulators must set MLR thresholds, forcing insurers to spend at least 80-85% of premiums on patient care. Additionally, costs of customer acquisitions and management expenses must be reduced to single digits.
The article concludes that the Indian health insurance industry needs to shift its focus from aggressively selling policies to transparently funding care. Unless efficiency improves and regulations enforce higher MLR thresholds, the promise of health insurance will remain unfulfilled, leaving patients and hospitals short-changed. The industry must prioritize funding healthcare over corporate profits and move towards a more transparent and patient-centric model.
AHPI seeks immediate restoration of cashless services by Star Health
The Association of Healthcare Providers of India (AHPI) has appealed to Star Health and Allied Insurance to reinstate cashless services at their member hospitals. This decision comes after the insurance company suspended these facilities, resulting in growing distress and inconvenience for patients. Several prominent hospital chains and tertiary care centers have been affected, including Care Hospitals, Manipal Hospitals, Max Hospitals, and Medanta Hospital, among others.
The AHPI has also highlighted the issue of delays or refusals in empaneling new hospitals, which restricts patient choice and forces them to opt for reimbursement claims instead of cashless treatment. This defeats the purpose of health insurance, which patients buy with the expectation of receiving cashless treatment at quality hospitals. According to Girdhar Gyani, Director General of AHPI, and Abul Hasan, Chairman of the Indian Medical Association Hospital Board, it is unjust for insurers to withhold cashless facilities after collecting premiums.
The AHPI has demanded that cashless services be restored immediately and that the empanelment of new hospitals be expedited to ensure uninterrupted access to healthcare. The association has clarified that its decision is a response to Star Health’s actions and not a unilateral move, as suggested by the General Insurance Council (GIC). The AHPI remains open to engagement with stakeholders but has emphasized that protecting patient welfare must remain the top priority.
The suspension of cashless services has significant implications for patients, who may be forced to bear the financial burden of medical treatment out of pocket. The AHPI’s appeal highlights the need for insurance companies to prioritize patient welfare and ensure that policyholders receive the benefits they are entitled to. By reinstating cashless services and expediting empanelment, Star Health and Allied Insurance can help alleviate the distress and inconvenience caused to patients and restore trust in the healthcare system. Ultimately, the AHPI’s efforts aim to ensure that patients have access to quality healthcare without financial hardship.
The latest claim settlement ratio of health and general insurance companies was released by IRDA in 2025. According to the data, Navi and Acko have taken the lead, while Star Health and Zuno have fallen below the 90% mark.
The rising medical inflation has made it challenging for individuals to bear medical expenses without a comprehensive health insurance policy. In India, the Insurance Regulatory and Development Authority (IRDAI) releases an annual list of claim settlements by health and general insurance companies. The claim settlement ratio, which refers to the percentage of claims paid or settled by an insurer, is a reliable way to assess an insurer’s efficiency.
According to the latest figures for 2023-2024, the general insurers paid out a total of 71,200,854 claims, with 81.13% of total claims paid within 3 months of claim intimation. Among private general insurers, Acko General Insurance and Navi General Insurance Ltd led with claim settlement ratios of 99.91% and 99.97%, respectively. Zuno General Insurance Co. Ltd had the lowest claim settlement ratio among private sector insurers, with 83.12% of claims paid within 3 months.
Among public insurers, The Oriental Insurance Co. Ltd had the lowest claim settlement ratio, with only 65.08% of claims paid within 3 months. United India Insurance Co. Ltd had the highest claim settlement ratio among public insurers, with 96.33% of claims paid within 3 months.
For stand-alone health insurers, Aditya Birla Health Insurance Company had the highest claim settlement ratio within 3 months, at 92.97%. Care Health Insurance and Niva Bupa Health Insurance followed closely, with claim settlement ratios of 92.77% and 92.02%, respectively. Star Health and Allied Insurance Co. Ltd had the lowest claim settlement ratio among stand-alone health insurers, with 82.31% of claims paid within 3 months.
While checking the claim settlement ratio is necessary, it should not be the sole basis for finalizing a health or general insurance company. Other factors such as the sum insured, waiting period for various illnesses, and network of hospitals offered should also be considered.
The IRDAI data also reveals that during 2023-24, 16.3% of total claims were paid out between 3-6 months, indicating that some insurers may have delayed claim settlements. It is essential for policyholders to review the claim settlement ratio and other factors before selecting an insurer to ensure they receive adequate and prompt financial assistance in case of medical emergencies.
Overall, the claim settlement ratio is a crucial factor in assessing an insurer’s efficiency, and policyholders should carefully evaluate this metric along with other factors before making an informed decision. By doing so, they can ensure that they have a comprehensive health insurance policy that provides them with the necessary financial protection in case of medical emergencies.
Star Health under IRDAI scrutiny over health insurance claim settlement practices
The Insurance Regulatory and Development Authority of India (IRDAI) has discovered significant lapses in the claim settlement practices of Star Health and Allied Insurance, a stand-alone health insurer. The regulator is likely to take action against the company, although official investigations are still ongoing. IRDAI has also scrutinized 8-10 other general and health insurers, but no action has been reported against them. The regulator examined various claim-related aspects, including the number of claims repudiated and accepted, deductions, and queries raised by policyholders.
According to IRDAI’s handbook of insurance statistics, Star Health’s incurred claim ratio for the year 2023-2024 was 66.47%, which means that for every Rs 100 collected as premiums, the company paid approximately Rs 67 towards honoring policyholder claims. This is marginally higher than the total incurred claim ratio of stand-alone health insurers, but significantly lower than the cumulative incurred claim ratio for all health and general insurers.
Star Health also recorded the lowest claim settlement ratio within 3 months among all stand-alone health insurers, at 82.31% for the year 2023-24. The company repudiated or rejected 2,96,356 claims between 2023-24, which is significantly more than other insurers in the same category. Additionally, Star Health received the maximum number of complaints during the year, at 16,804, which is the highest amongst all general and health insurers in the country.
In response to the allegations, Star Health stated that they have not received any communication from IRDAI on this matter and that they are committed to a customer-centric approach. The company claimed that IRDAI’s audits and inspections are a routine process to ensure compliance across the industry and that the media statement appeared to be speculative and motivated in nature.
The findings of IRDAI’s investigation have raised concerns about Star Health’s claim settlement practices and its commitment to policyholders. The company’s low incurred claim ratio and high number of claim rejections and complaints suggest that it may not be honoring its policyholders’ claims in a fair and timely manner. As a result, IRDAI’s potential action against Star Health could have significant implications for the company and its policyholders.
Non-life insurers record 2% premium growth in September, Bajaj Allianz General Insurance leads the way
The non-life insurance sector in India has reported a modest 1.94% year-on-year growth in gross direct premium to Rs 23,430 crore in September. This growth was driven primarily by an increase in standalone health insurance premiums. The largest general insurer, New India Assurance, saw a 3.5% rise in premiums, while ICICI Lombard General Insurance reported a 6.2% increase. Other state-owned insurers, such as United India Insurance and Oriental Insurance, also reported significant growth, with increases of 23.36% and 4.45%, respectively.
Private general insurers, including Bajaj Allianz General and HDFC Ergo, also reported varying degrees of growth, with Bajaj Allianz General seeing a 31.35% increase and HDFC Ergo experiencing a decline of 3.78%. Standalone health insurers, such as Niva Bupa Health Insurance and Star Health and Allied Insurance, reported growth of 1.45% and 3.36%, respectively.
The government’s recent clarification on Goods and Services Tax (GST) has also had an impact on the industry. Premiums for individual life and health insurance policies are now exempt from GST, making them more affordable for individuals and families. However, this exemption does not apply to group insurance policies, which are typically offered by employers to their employees. Reinsurance services, which insurers purchase to protect themselves, are also exempt from GST.
However, insurers will face a significant adjustment regarding Input Tax Credit (ITC). They will no longer be able to claim ITC for essential input services such as agent commissions, brokerage, and administrative services. This change may have a significant impact on the industry, as insurers will need to adjust their business models to account for the loss of ITC. Overall, the non-life insurance sector is experiencing moderate growth, driven primarily by increases in standalone health insurance premiums, and is adapting to changes in the tax landscape.
Stock Market Updates for Star Health And Allied Insurance
Recent Updates
AHPI issues notice to Star Health Insurance, warns of suspension of cashless services from September 22, 2025 – Express Healthcare
The Association of Healthcare Providers India (AHPI) has issued a notice to Star Health Insurance, warning of a potential suspension of cashless services starting from September 22, 2025. This move is likely a result of unresolved issues between the two parties, although the specific reasons behind the notice are not explicitly stated.
As a representative body of healthcare providers, AHPI plays a crucial role in facilitating cashless services for patients with insurance coverage. Cashless services enable policyholders to receive medical treatment without having to pay out-of-pocket expenses, as the insurance company directly settles the bills with the healthcare provider.
The suspension of cashless services would significantly impact policyholders, causing inconvenience and potential financial hardship. Patients may be required to pay for medical expenses upfront and then submit claims for reimbursement, which could lead to delays and additional administrative burdens.
It is essential for Star Health Insurance and AHPI to resolve their differences and find a mutually beneficial solution to avoid disrupting cashless services. The suspension of these services could damage the reputation of both parties and erode trust among policyholders.
In the interests of patients and healthcare providers, it is crucial for insurance companies and healthcare associations to maintain a collaborative and efficient relationship. This includes ensuring timely payments, transparent communication, and fair reimbursement rates.
The notice issued by AHPI serves as a warning, allowing Star Health Insurance time to address the concerns and work towards a resolution. If the issues are not resolved, the suspension of cashless services could have far-reaching consequences for the entire healthcare ecosystem.
As the deadline of September 22, 2025, approaches, it is essential for both parties to engage in constructive dialogue and find a solution that benefits all stakeholders, including policyholders, healthcare providers, and the insurance company itself. The outcome of this situation will be closely watched, as it may have implications for the broader healthcare and insurance industries.
Healthcare providers’ body demands immediate restoration of cashless services by Star Health Insurance
The Association of Healthcare Providers (AHPI) has suspended cashless services in several hospitals across India, including prominent chains like Care Hospitals, Manipal Hospital, and Max Hospitals, among others. This move is in response to a dispute with Star Health Insurance, one of the leading health insurance companies in the country. AHPI claims that Star Health has been taking “arbitrary” actions, such as de-empanelling hospitals and withdrawing cashless services, which has prompted the association to take this step.
However, the General Insurance Council (GIC) has come out in support of Star Health, stating that AHPI’s actions are “unilateral” and “unwarranted”, and could undermine trust in the health insurance ecosystem. The GIC has expressed concern that these actions could prejudice the interests of policyholders.
Star Health has also issued a statement denying that it has received any notice of cashless suspension from its network partners. The company has accused AHPI of issuing threats and creating unnecessary confusion among policyholders. Star Health has reassured its customers that their access to healthcare will remain unaffected and that they will ensure claim payments are made even in the event of a disruption.
The dispute between AHPI and Star Health has sparked a war of words, with both parties accusing each other of taking arbitrary actions. The situation has created uncertainty among policyholders, who are concerned about their access to cashless services at hospitals. The General Insurance Council has urged both parties to resolve their differences and find a solution that does not harm the interests of policyholders. The government’s efforts to promote healthcare as a basic necessity by exempting GST on health insurance may be undermined by this dispute, which highlights the need for greater transparency and cooperation between healthcare providers and insurance companies.
Rising Health Insurance Complaints in India: Key Data Insights
Complaints against health insurers in India are on the rise, indicating growing consumer awareness and the importance of effective grievance redressal mechanisms. According to Insurance Samadhan, a grievance platform, there was a 45% increase in complaints in Q2 2025 compared to the previous quarter, with 974 cases involving claims worth over ₹119 crore. The majority of these grievances (67.5%) related to health insurance, followed by life insurance (25.5%) and general insurance (6.9%). Endowment policies were the most commonly mis-sold products, often leaving policyholders with reduced returns or penalties.
The Council of Insurance Ombudsman (CIO) data for FY2023-24 provides further insight into the sector’s challenges. The ombudsman received the highest number of complaints against Star Health & Allied Insurance, with 13,308 cases, mostly regarding partial or complete claim rejection. Other insurers with high complaint volumes included CARE Health Insurance, Niva Bupa, and public sector insurers National Insurance and The New India Assurance. Star Health’s complaint volume was significantly higher than its peers, with 63 complaints per lakh policyholders.
Experts attribute the high complaint volume to mis-selling, driven by aggressive agent commissions and sales targets. Many consumers are sold unsuitable policies, which can lead to higher premiums or outright rejections due to pre-existing conditions. The data highlights the need for consumers to proactively evaluate their coverage and understand complaint mechanisms to ensure adequate protection. Additionally, the trend of Indians first experiencing insurance through employer-provided group health policies, and then purchasing retail policies triggered by claims or life events, emphasizes the importance of early adoption and careful policy selection.
The increasing complaints against health insurers in India underscore the need for improved grievance redressal mechanisms and consumer awareness. As the insurance sector continues to grow, it is essential for consumers to be aware of their rights and options for resolving disputes. By understanding the common issues and challenges in the sector, consumers can make informed decisions and ensure they have adequate protection. Ultimately, the rising complaints against health insurers in India highlight the need for a more transparent and consumer-centric approach to insurance sales and claims settlement.
Sharp premium drop hits general insurers in August; New India Assurance down 47% MoM
The Indian insurance sector experienced a decline in premium collections in August, with several leading insurers reporting sharp drops on a month-on-month (MoM) basis. In the general insurance segment, New India Assurance saw the steepest decline, with premiums falling 47% MoM to ₹2,197 crore. However, the company attributed this drop to the timing of policy receipts, citing the receipt of a quarterly installment of a government health policy in the previous month. Despite this, New India Assurance reported an 8.67% growth in premiums on a year-on-year (YoY) basis and a 14.66% growth up to the month on a YoY basis.
Other insurers also reported declines in premium collections. ICICI Lombard saw a 12% MoM decline in premiums to ₹2,182 crore, while Go Digit General Insurance registered a 16% MoM drop to ₹738 crore. Health insurers Niva Bupa Health Insurance and Star Health Insurance also reported contractions, with premiums declining 4% and 6% MoM, respectively.
This decline comes after a period of steady expansion in the insurance sector, with many insurers reporting strong inflows in July. In fact, New India Assurance, ICICI Lombard, Go Digit, Niva Bupa, and Star Health all posted double-digit MoM growth in July, highlighting a sharp contrast with the August figures. The decline in premium collections may be a temporary blip, and the sector is expected to continue growing in the long term. The insurance sector’s performance is closely watched, as it is a key indicator of the overall health of the economy. The decline in August may be attributed to various factors, including seasonal fluctuations and changes in policy receipts. However, the sector’s growth on a YoY basis suggests that it is still on a positive trajectory.
HDFC Ergo and Tata AIG have joined other insurers in reducing distributor commissions.
The Indian government has introduced a significant change in the Goods and Services Tax (GST) on individual health and life insurance premiums, reducing it from 18% to 0% effective September 22, 2025. However, this change also means that insurance companies can no longer claim Input Tax Credit (ITC) on services such as brokerage and commission for individual health and life insurance. As a result, insurance companies are reducing commission payouts to distributors to absorb the loss of ITC benefit.
Several major insurance companies, including HDFC Ergo General Insurance, Tata AIG General Insurance, ICICI Lombard General Insurance, Aditya Birla Health Insurance, Niva Bupa Health, Star Health, and Care Health, have already cut commissions to distributors. The commission paid to distributors is now inclusive of 18% GST, effective October 1, 2025. This change is expected to impact the profitability and operating expenses of insurance companies.
The government’s intention behind this move is to make insurance policies more affordable for individuals. However, it has created pressure on insurance companies’ margins, as they have lost the benefit of ITC that they could earlier claim on their expenses. Insurance companies are now absorbing the ITC disallowance impact on non-commission costs to keep premiums affordable for customers.
The reduction in commission payouts to distributors may affect their earnings, but insurance companies are encouraging them to focus on selling more policies to increase their volumes and earnings. The new guidelines have created a challenging environment for insurance companies, and they are awaiting responses from relevant authorities to address their concerns. Meanwhile, insurance companies are revising their commission rates to align with the GST changes, and distributors can expect updated commission grids soon. Overall, the GST exemption on individual health and life insurance premiums has created a complex situation for insurance companies, distributors, and policyholders, with both positive and negative implications.
Insurance premium collections rose in August, driven by Bajaj Allianz and New India Assurance.
The Indian general insurance sector experienced modest year-on-year growth in premium collections for August, according to data from the General Insurance Council. However, several major players reported significant sequential declines in premiums compared to July.
ICICI Lombard General Insurance saw a 2.1% year-on-year increase in gross direct premium underwritten, reaching ₹2,182 crore. Nonetheless, its premiums dropped 12% compared to the previous month. New India Assurance reported an 8.7% annual increase, with premiums totaling ₹2,197 crore, but experienced a substantial 47% month-on-month decline, the steepest among major insurers.
Star Health and Allied Insurance’s premium rose 1.9% year-on-year to ₹1,426 crore. In contrast, Go Digit General Insurance achieved a 13.6% annual jump, with premiums reaching ₹738 crore, but slipped 16% on a sequential basis. Bajaj Allianz General Insurance posted the strongest annual growth, with premium collections up 18.8% year-on-year at ₹2063.2 crore.
The declines in premiums for several major insurers may indicate a slowdown in the Indian general insurance sector. The significant drop in premiums for New India Assurance, in particular, may be a cause for concern. Despite the year-on-year growth, the sequential declines suggest that the sector may be experiencing a temporary downturn.
Overall, the data from the General Insurance Council highlights the mixed performance of Indian general insurers in August. While some insurers reported strong annual growth, others experienced substantial sequential declines. The sector’s performance will be closely watched in the coming months to determine if the declines are a one-time phenomenon or a sign of a larger trend. The Indian general insurance sector will need to adapt to changing market conditions to maintain growth and stability.
A consumer panel in Chandigarh has ordered an insurance company to pay Rs 25 lakh to a policyholder for unjustly denying a claim.
The District Consumer Disputes Redressal Commission-I in Chandigarh has ordered Star Health and Allied Insurance Company to pay Rs 25 lakh to the heirs of a deceased policyholder, Sarita Dutta alias Sarita Sharma, whose medical claim was wrongly repudiated. The policyholder had purchased a health insurance policy from Star Health in 2018 for a sum of Rs 25 lakh, which was renewed annually until 2023. In 2024, she was diagnosed with cancer and underwent medical treatment before passing away on September 6, 2024.
The insurance company rejected the claim and cancelled the policy, citing non-disclosure of a prior ovarian cyst surgery conducted in 2017. However, the complainants’ counsel argued that the surgery had revealed a benign cystadenoma with no evidence of malignancy, and that the company had wrongly repudiated the claim after five years of continuous renewals, violating IRDAI regulations.
The Commission found that the insurer’s repudiation was unjustified, as the 2017 medical records indicated the absence of cancer or malignancy. The Commission also observed that the IRDAI regulations prohibit contesting health policies after a 60-month “moratorium period” except in cases of established fraud. Since the policy had been in force for over six years, the Commission ruled that the insurance company’s actions violated these provisions.
The Commission directed the company to pay Rs 25 lakh as the insurance amount, along with Rs 25,000 as litigation cost and compensation. The order stated that the claim was wrongly repudiated by the insurance company by misinterpreting the terms and conditions of the policy, amounting to deficiency in service and unfair trade practice. This ruling upholds consumer rights in insurance matters and highlights the importance of insurance companies adhering to regulatory provisions and treating policyholders fairly. The Commission’s decision provides relief to the heirs of the deceased policyholder and sets a precedent for similar cases in the future.
India: Cashless hospital services resume through AHPI and Star Health partnership, as reported by Asia Insurance Review.
A recent dispute between hospitals and insurance providers in India has been resolved, with cashless hospital services set to resume from October 10. The dispute, which had been ongoing, had left many patients without access to cashless medical treatment. The Association of Healthcare Providers (India), or AHPI, which represents hospitals, had been at odds with insurance providers, including Star Health, over tariffs and payment rates.
As a result of the dispute, many hospitals had stopped offering cashless services, forcing patients to pay out of pocket for medical expenses and then claim reimbursement from their insurance providers. This had caused significant hardship for many patients, who were already struggling with the financial burden of medical treatment.
However, following negotiations between the AHPI and Star Health, the two parties have reached an agreement, and cashless services are set to resume. The agreement is seen as a major relief for patients, who will once again be able to access medical treatment without having to worry about the financial burden.
The dispute between hospitals and insurance providers had highlighted the need for a regulator to oversee the healthcare industry and resolve disputes between providers and insurers. The hospital group has urged the creation of a regulator to prevent such disputes in the future and ensure that patients are not caught in the middle.
The resumption of cashless services is expected to benefit thousands of patients who were affected by the dispute. Hospitals had complained that insurance providers were not paying them adequately for medical services, leading to a significant shortfall in revenue. Insurance providers, on the other hand, had argued that hospitals were charging exorbitant rates for medical services.
The resolution of the dispute is seen as a positive step for the healthcare industry in India, and patients can once again access medical treatment without worrying about the financial burden. The agreement between the AHPI and Star Health is expected to set a precedent for other insurance providers, and cashless services are expected to resume across the country. The creation of a regulator to oversee the healthcare industry is still being debated, but the resolution of the dispute is a major step forward for patients and healthcare providers alike.
Tata AIG has joined Star Health and Niva Bupa in discontinuing cashless claim settlement at Max Hospitals.
Tata AIG General Insurance has suspended its cashless settlement arrangement with Max Hospitals, effective September 10, 2025. This move comes after a dispute over tariffs, with Tata AIG seeking further rate cuts and Max Healthcare refusing to comply. The hospital chain had signed a two-year tariff agreement with Tata AIG, but the insurer requested additional reductions in July, threatening to suspend cashless services if its demands were not met.
As a result, policyholders will now be required to pay upfront for medical treatment at Max Hospitals and then seek reimbursement from Tata AIG. Max Healthcare has set up an express desk to support reimbursement claims and ensure that patients are not inconvenience. The hospital chain has stated that further rate reductions would be “unviable” and could compromise patient care.
Tata AIG has assured its customers that it has made special arrangements to ensure they face no inconvenience. The insurer has prioritized and fast-tracked claims, allowing policyholders to continue receiving uninterrupted treatment and care. Tata AIG’s dedicated service teams are monitoring every case closely to provide complete support and ensure zero disruption for customers.
This dispute is not an isolated incident, but rather part of a wider industry flashpoint between insurers and hospitals over tariffs and settlement terms. Earlier, Star Health had suspended cashless services at several hospitals, including Manipal, Medanta, and Max, sparking criticism from the Association of Healthcare Providers of India (AHPI). However, after negotiations, Star Health and AHPI member hospitals agreed to restore cashless services. Similarly, a standoff between AHPI hospitals in north India and Bajaj Allianz over cashless withdrawals was resolved earlier this month. The suspension of cashless services by Tata AIG is the third such incident, following Star Health and Niva Bupa, highlighting the growing tensions between insurers and hospital chains.
Insured, yet unprotected.
The Indian government’s decision to reduce GST on insurance premiums to zero percent is a relief for millions, but it only scratches the surface of a deeper crisis in the insurance sector. According to the Council of Insurance Ombudsman’s 2023-24 annual report, the top three firms with the most complaints are Star Health, CARE Health Insurance, and Niva Bupa. Star Health leads with 13,308 complaints, with 10,196 related to claim rejections or slashes. CARE Health’s COO, Manish Dodega, defended his company’s position, stating that the number of complaints does not represent the true picture and that the industry has robust systems in place to address issues.
The scale of problems in the insurance sector is staggering, with 2,15,569 complaints filed on IRDAI’s platforms in FY 2023-24. Nearly 95% of health insurance complaints were about claim rejections, while 59% of life insurance complaints concerned misrepresentation or mis-selling. The financial impact on consumers is significant, with health insurance claim rejections rising to Rs 26,000 crore in FY24. Mis-selling is a major issue, with 26,107 life insurance complaints filed against unfair business practices, including mis-selling.
The root cause of mis-selling is the commission structure, which incentivizes selling expensive products over suitable coverage. Experts advocate for dramatic reforms, including overhauling the commission structure and banning upfront commissions in life insurance. The industry needs to focus on term insurance and fundamentally change its product mix. Regulatory transformation is also necessary, with experts criticizing IRDAI’s functioning and calling for a more market-consultative approach.
The cumulative effect of these problems has created a massive trust deficit, with 65% of policyholders not fully understanding their policies and 43% facing hurdles in health claim processing. This erosion of trust is pushing people away from insurance altogether. While the zero GST move addresses affordability concerns, it doesn’t tackle the fundamental issues of transparency, fair claim settlement, and honest selling practices. The industry needs comprehensive reforms, and until then, millions of Indians will continue to find themselves insured but unprotected.
Star Health has introduced ‘Know Your Policy’, a simplified guide to understanding health insurance coverage, as reported by the Press Trust of India.
Star Health and Allied Insurance, a leading health insurance provider in India, has launched a new initiative called ‘Know Your Policy’. This program aims to educate policyholders about the various aspects of their health insurance coverage, making it easier for them to understand and navigate their policies.
The ‘Know Your Policy’ initiative is designed to provide policyholders with a comprehensive and simplified guide to their health insurance coverage. The guide will cover key aspects of the policy, including the sum insured, deductible, co-pay, and pre-existing disease coverage. It will also explain the claims process, including how to file a claim, what documents are required, and how to track the status of a claim.
The initiative is part of Star Health’s efforts to increase transparency and improve customer satisfaction. By providing policyholders with a clear understanding of their coverage, the company hopes to reduce confusion and misunderstandings, and ultimately, improve the overall customer experience.
The ‘Know Your Policy’ guide will be made available to policyholders through various channels, including the company’s website, mobile app, and customer service helpline. Policyholders will be able to access the guide at any time, and it will be regularly updated to reflect any changes to the policy or coverage.
Star Health believes that the ‘Know Your Policy’ initiative will not only benefit policyholders but also help to increase awareness about health insurance in general. By educating policyholders about their coverage, the company hopes to promote a better understanding of the importance of health insurance and the role it plays in protecting individuals and families from financial risk.
The launch of ‘Know Your Policy’ is a significant step forward for Star Health, as it demonstrates the company’s commitment to customer-centricity and transparency. By providing policyholders with a simplified guide to their health insurance coverage, the company is empowering them to make informed decisions about their healthcare and financial well-being.
Overall, the ‘Know Your Policy’ initiative is a positive development for policyholders and the health insurance industry as a whole. It highlights the importance of transparency and customer education in health insurance, and sets a new standard for customer-centricity in the industry.
LIC is reportedly making an entry into the health insurance market by acquiring a stake in ManipalCigna.
According to a recent report, Life Insurance Corporation of India (LIC) is considering a foray into the health insurance market by acquiring a stake in ManipalCigna Health Insurance Company. This move is seen as a strategic expansion of LIC’s business portfolio, which currently dominates the life insurance market in India.
ManipalCigna Health Insurance is a joint venture between Manipal Group and Cigna Corporation, a global health insurance company. The company offers a range of health insurance products and services in India, including individual and group health insurance plans, critical illness coverage, and top-up plans.
If the deal goes through, LIC’s acquisition of a stake in ManipalCigna Health Insurance would mark its entry into the health insurance market, which is currently dominated by private players such as Max Bupa, Apollo Munich, and Star Health. The move would also enable LIC to leverage its vast distribution network and customer base to sell health insurance products.
The report suggests that LIC is looking to acquire a significant stake in ManipalCigna Health Insurance, which could range from 20% to 40%. The deal is expected to be valued at around Rs 1,000-1,500 crore (approximately $137-$204 million USD).
LIC’s foray into the health insurance market is seen as a natural extension of its business, given the growing demand for health insurance products in India. The company’s vast distribution network, which includes over 2,000 branches and a large network of agents, would provide a significant advantage in selling health insurance products.
The acquisition would also enable LIC to diversify its revenue streams and reducing its dependence on the life insurance business. The health insurance market in India is expected to grow rapidly in the coming years, driven by increasing healthcare costs, rising awareness about health insurance, and government initiatives to promote health insurance.
Overall, LIC’s potential acquisition of a stake in ManipalCigna Health Insurance is seen as a strategic move to expand its business portfolio and tap into the growing demand for health insurance products in India. The deal would also provide a significant boost to the health insurance market in India, which is expected to witness rapid growth in the coming years.
Max Healthcare: No cashless claims for Tata AIG health insurance policyholders in Max Hospitals, becomes 3rd insurer to do so.
Tata AIG Insurance has suspended its cashless claim settlement facility with Max Hospitals, following in the footsteps of Star Health and Niva Bupa. This means that policyholders of these insurance companies will no longer be able to receive cashless treatment at Max Hospitals, and will instead have to pay out of pocket and claim reimbursement later. While Star Health and Niva Bupa have suspended cashless claim settlement with all 22 Max Hospitals across the country, Tata AIG’s suspension is currently in effect.
According to Max Hospitals, the suspension is due to a dispute over tariffs. Max Hospitals claims that Tata AIG demanded a downward revision of the agreed-upon tariffs, which Max Hospitals was not willing to accept. As a result, Tata AIG suspended cashless services at Max Hospitals effective September 10, 2025. Max Hospitals has stated that it will continue to provide an express desk to help policyholders claim reimbursements from insurers without having to make upfront payments.
However, sources at Tata AIG have indicated that discussions are ongoing and that the situation may be resolved in the near future. In the meantime, Tata AIG has put in place special arrangements to ensure that its customers face no inconvenience, including prioritizing and fast-tracking claims. The company has also stated that its dedicated service teams are monitoring every case closely to provide complete support and ensure zero disruption for its customers.
The dispute between Max Hospitals and the insurance companies is not limited to Tata AIG. Niva Bupa has also suspended cashless claim settlement with Max Hospitals, citing a desire to further reduce tariffs. Max Hospitals has stated that it is not willing to reduce tariffs below the 2022 levels, as it believes that doing so would compromise patient safety and the quality of care. CARE health insurance policyholders are also affected, with cashless claim settlement services not available at Max Hospitals in the Delhi-NCR region.
Overall, the suspension of cashless claim settlement facilities by multiple insurance companies is likely to cause inconvenience for policyholders who rely on Max Hospitals for medical care. However, both Max Hospitals and the insurance companies are working to find a resolution and minimize disruption for patients.
AHPI requests Star Health to reinstate cashless services at hospitals
The Association of Healthcare Providers of India (AHPI) has expressed concerns over the suspension of cashless treatment by Star Health Insurance in several hospitals. According to AHPI, cashless services have been disrupted in numerous hospitals, including Care Hospitals in Vizag, Manipal in Delhi and Gurugram, and Max in North India. Other hospitals such as Metro in Faridabad, Medanta in Lucknow, Rajiv Gandhi Cancer Hospital in New Delhi, Sarvodaya in Faridabad, and Yatharth Hospitals have also reported disruptions.
AHPI has stated that Star Health Insurance has not only suspended cashless treatment but has also slowed down or denied empanelment to several hospitals. This includes Fortis Manesar, Jupiter Indore, Max Dwarka, Medanta Noida, and Care Hospitals in Hyderabad and Vizag. As a result, families are being forced to opt for reimbursement claims instead of cashless treatment, which can be a lengthy and cumbersome process.
The association has urged Star Health Insurance to immediately restore cashless services and expedite empanelments. This move is expected to benefit patients who rely on cashless treatment for medical emergencies. By restoring cashless services, Star Health Insurance can ensure that patients receive timely and hassle-free treatment, without the added burden of reimbursement claims.
AHPI’s concerns highlight the importance of cashless treatment in the healthcare sector. Cashless treatment allows patients to receive medical care without having to pay out-of-pocket expenses, which can be a significant financial burden. By suspending cashless treatment, Star Health Insurance is not only causing inconvenience to patients but also undermining the trust and confidence that patients have in the healthcare system.
As a reliable and trusted news source, it is essential to report on such issues and bring them to the attention of the relevant authorities. The disruption of cashless services by Star Health Insurance is a matter of concern, and it is crucial that the insurer takes immediate action to restore these services and expedite empanelments. By doing so, Star Health Insurance can ensure that patients receive the medical care they need, without any unnecessary delays or hardships.