Health insurance: Decoding the mismatch between claims filed and settled

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4d ago 31:30

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What is going on with health insurance claims? According to recent data from the Insurance Regulatory and Development Authority of India (IRDAI), the volume of claims filed rose 21.8% in the financial year 2025, but the total amount settled by insurers increased by only 12.88 %. This stark mismatch has spilled over social media – where stories of claims going unsettled, settled for lower amounts of being endlessly delayed, are rife.

Adding to this issue is the steep rise in health insurance premiums. Earlier this year, the IRDAI, had directed that premiums for senior citizens not be revised by over 10% a year – this came after senior citizen premiums were going up by 50 or 60% in many cases.

Why is there a growing mismatch between claims filed and settled? How much of an effect does the rising cost of medical services play in this? Do both the insurance sector and private hospitals need better, more stringent regulation?

Guest: Prof. Indranil M., professor and health economist, at OP Jindal Global University, Sonipat

Host: Zubeda hamid

Edited by Sharmada Venkatasubramanian

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