The Insurance Regulatory and Development Authority of India (IRDAI), in collaboration with industry stakeholders, convened a high-level meeting on 17 March 2026 to address systemic challenges in the health insurance ecosystem. Hosted by CII, the interaction brought together insurers, hospitals, and healthcare associations to establish five specialized Working Groups aimed at improving coordination, transparency, and patient experience. Key focus areas include developing a joint code of conduct to streamline discharge and dispute resolution, creating a standardized classification system for healthcare providers, accelerating adoption of the National Health Claims Exchange (NHCX), conducting analytical studies on claims trends and medical inflation, and designing simplified “no-frill” insurance products with wellness components. These initiatives seek to enhance insurance penetration and operational efficiency. Scheduled to commence from April 2026, the groups’ recommendations will guide future regulatory frameworks and establish industry-wide best practices centered on patient welfare and data-driven policymaking.
Insurance Regulatory and Development Authority of India
Press Release – 17th March 2026
New Delhi
IRDAI and Industry Leaders Collaborate to Enhance Health Insurance Ecosystem
through Strategic Working Groups
The Insurance Regulatory and Development Authority of India (IRDAI) on 17th March, 2026 held a high-level industry interaction led by Chairman Shri Ajay Seth to address critical challenges in the healthcare and insurance sectors. Hosted by the Confederation of Indian Industry (CII), the event brought together top executives from major hospitals, representatives of the Association of Health Providers India (AHPI), NatHealth, the Private Hospitals & Nursing Homes Association (PHANA), various state level health providers associations along with insurance companies to formalize a roadmap for systemic reforms through five specialized Working Groups. Each working group will be co-chaired by leaders from hospitals and insurance industry.
The initiative aims to improve insurance penetration, transparency, and the overall patient experience by addressing long-standing operational gaps and coordination issues between insurers and healthcare providers.
Key Working Group Initiatives:
- Joint Code of Conduct: Working Group will work towards developing a practical framework to strengthen trust and transparency. This group will focus on streamlining the discharge process, standardizing empanelment, and ensuring amicable dispute resolution.
- Categorization of Providers: Working Group will aim to establish a data-driven methodology for classifying healthcare providers. By identifying relevant parameters like accreditation and geography, the group aims to bring consistency to empanelment and operational processes across the industry.
- Scale-up of NHCX: To accelerate the adoption of the National Health Claims Exchange (NHCX), Working Group will identify and resolve process bottlenecks.
- Focused Analytical Studies: Working Group will conduct structured studies on claim trends, the dynamics of cashless versus reimbursement claims, and the drivers of medical inflation. These studies are intended to provide a shared analytical base for future policy reforms.
- Simplified Products and Wellness: Working Group will work towards designing a scalable, “no-frill” health insurance framework. The objective is to increase penetration by integrating wellness components, such as OPD-to-IPD conversion pathways and proactive health engagement models.
“The collaboration between payers and providers is essential for a sustainable healthcare ecosystem,” stated Chairman Shri Ajay Seth during his initial remarks. “These Working Groups represent a coordinated effort to put the patient at the centre of our care journey while ensuring operational efficiency and data-backed policy making”.
Most Working Groups are scheduled to begin their activities in April 2026, with durations ranging from two to four months. The findings and recommendations from these groups will serve as a reference model for future industry standards and regulatory frameworks.
