A sub-committee on health insurance headed by Insurance Regulatory and Development Authority of India (IRDAI) Chairman Ajay Seth has underscored the need to make health covers simpler, more transparent and easier for policyholders to understand and use.Simplification of policy wording, strengthening underwriting at the point of sale to minimise claim issues arising from inadequate disclosures and facilitating hassle-free claim settlements were discussed by the Sub-Committee, of the Insurance Advisory Committee (IAC), at its meeting on August 28. The role of insurers, intermediaries, agents and TPAs in supporting policyholders at hospitals was also discussed, IRDAI said.It also considered measures that will encourage insurers and hospitals to join the National Health Claims Exchange (NHCX), including possible incentives linked to on-boarding, payments and faster settlement. Similarly, incentivising policyholders who undergo periodic health check-ups and adopt healthy practices was discussed while on the subject of preventive healthcare.The meeting, third such of the sub-committee, emphasised the need for standardisation and enriching industry data to support evidence-based policy interventions. Noting assessment of claims and grievance outcomes should not focus solely on settlement ratios but also consider absolute values, it wanted insurers to consider publishing standard treatment guidelines (STGs) and treatment package rates towards facilitating more informed choices by policyholders. Among other things, the sub-committee comprising four-members and a few invitees from the insurance sector review of exclusions in favoured a further review of exclusions in the Customer Information Sheet to improve clarity and customer trust.Setting the backdrop for the meeting was the report of the Parliamentary Standing Committee on Health and Family Welfare, headed by Rajya Sabha MP Ram Gopal Yadav, on ‘Affordability and accessibility of healthcare facilities in public and private sector’.The Standing Committee, in the report presented earlier this month to the Parliament, noted the concerns around rising insurance premiums, exclusions and waiting periods, co-payments, claim rejections and the limited coverage of outpatient care, diagnostics and chronic disease management. An official note on the report said the Committee is concerned insurance claims charges very steeply for the same procedure between various hospitals. It strongly recommended for a transparent, well regulated health insurance sector where claim settlements date is integrated onto a common portal with open access as a measure to ensure transparency in the settlement of the claims.It also recommended mandatory integration of all stakeholders-insurers, TPAs and healthcare providers into the NHCX to guarantee real-time, transparent claims processing even while calling for stringent regulatory penalties for arbitrary pricing and claim manipulation by insurers or empanelled hospitals, an official release on the report had said. Published - August 29, 2026 09:00 pm IST