Health insurance is reaching more people in India, but understanding and using a policy can still be difficult.
General and health insurers recorded 1,37,361 grievances through IRDAI's Bima Bharosa portal in FY2024–25, compared with 94,843 the previous year. Claims were a significant source of those grievances, with 88,841 claim-related grievances recorded across general and health insurance.
This makes the digital experience increasingly important. Against this backdrop, IRDAI’s Insurance Advisory Committee Sub-Committee on Health Insurance recently discussed measures aimed at making health insurance simpler, more transparent and easier for policyholders to understand and use. The discussion covered policy wording, point-of-sale underwriting, claims, hospital support and the National Health Claims Exchange (NHCX), among other areas.
These discussions are not themselves new binding regulations. But they provide a useful indication of where the digital products supporting it could be heading.
What did IRDAI Discuss About Health Insurance?
The sub-committee’s latest discussions covered several areas that directly touch the policyholder experience.
The timing is significant, you see. The latest National Sample Survey shows that the share of people covered by some form of health insurance or financing scheme increased from 14.1% to 47.4% in rural India and from 19.1% to 44.3% in urban India between 2017–18 and 2025. As health insurance reaches more people, making the system easier to understand and navigate becomes increasingly important.
Against that backdrop, the sub-committee discussed several measures, including:
- Simplifying policy wording to make health insurance easier to understand
- Strengthening underwriting at the point of sale to reduce claim issues arising from inadequate disclosures
- Facilitating hassle-free claim settlements
- Improving the role of insurers, intermediaries, agents and TPAs in supporting policyholders at hospitals
- Encouraging insurers and hospitals to onboard onto the National Health Claims Exchange (NHCX)
- Exploring preventive healthcare incentives
- Improving standardisation and industry data
- Considering publication of Standard Treatment Guidelines and treatment package rates
- Reviewing exclusions in the Customer Information Sheet to improve clarity and customer trust
Taken together, these discussions point towards a health insurance experience that needs to be clearer, more transparent and easier to navigate at every major customer touchpoint.
How can Health Insurance Products Make Complex Information Easier to Understand?
Health insurance comes with a lot of information: exclusions, waiting periods, deductibles, co-payments, sub-limits, room-rent limits, and eligible hospitals, among other conditions.
IRDAI's consumer guidance specifically asks policyholders to pay attention to these details when choosing health insurance.
The challenge is to present the important parts in a way people can understand and act on.
Imagine opening an insurance platform and seeing:
₹10 lakh cover
Waiting period: 2 years
Co-pay: 10%
Room rent: No limit
Key exclusions: View
The full policy document can still be available for detailed reading. But the customer gets a clear starting point.
The idea is almost like a nutrition label for insurance, like a quick picture of what someone is buying before they get into the finer details.
This principle is familiar across financial products. In our work with HDFC Invest Right, for example, the experience was designed around a more premium stock-broking proposition while retaining the information users need to navigate investment decisions.
Similarly, our work with Motilal Oswal involved creating a persona-driven platform where information adapts to the needs of clients and relationship managers, helping users navigate complex wealth journeys with greater clarity and control.
The products are different, but the underlying challenge is similar. Complex financial information has to become usable information. And health insurance needs the same treatment.
What Should Point-of-sale Underwriting Look Like?
One of IRDAI's discussion points was strengthening underwriting at the point of sale to minimise claim issues arising from inadequate disclosures. This has an obvious digital product implication.
Health insurance disclosures can involve medical history, previous conditions, and terminology that customers may not immediately understand. Putting everything into a long form can make it easy to rush, skip, or misunderstand a question.
A better approach would be to turn disclosure into a guided journey.
A digital experience could:
- break complex questions into smaller steps
- explain medical and insurance terms in context
- identify incomplete information before submission
- flag potentially contradictory answers
- explain why a particular disclosure matters
- clearly capture consent and acknowledgement
The same principle appears in our work across BFSI.
For Capri Loans, we redesigned a digital experience serving a diverse audience across more than 100 loan products. One of the challenges was making navigation robust enough to handle a large product portfolio without overwhelming users. The experience also used relatable communication and interactive tools to help users understand their options and make decisions.
How can Insurers Make the Health Insurance Claims Experience Clearer?
Claims are where customers often need the most information and support.
In FY2024–25, general and health insurers recorded 88,841 claim-related grievances through Bima Bharosa. Separately, IRDAI's annual report indicates that claims accounted for 69% of grievances within general insurance.
A claim can involve multiple stages: submission, document verification, assessment, approval or rejection, and settlement.
For the customer, however, the experience can sometimes be reduced to a message such as: “Claim under review.”
That doesn't answer the questions they actually have. A better claims experience should make five things visible:
- What has been completed?
- What is happening now?
- Is anything needed from me?
- What happens next?
- When should I expect an update?
This doesn't mean making the underlying claims process artificially simple. Well, it means giving customers enough visibility to understand where they are in it.
What Could NHCX Mean for the Digital Claims Experience?
The National Health Claims Exchange (NHCX) is another important part of the direction emerging from the sub-committee's discussions.
The committee considered measures to encourage insurers and hospitals to onboard onto NHCX, including possible incentives linked to onboarding, payments, and faster settlement. It also discussed strategies to accelerate healthcare-provider and insurer participation.
The broader opportunity is better connectivity and information exchange across the health claims ecosystem. But a connected ecosystem does not automatically create a connected customer experience.
The information flowing between hospitals, insurers and other participants still needs to be translated into useful customer-facing interactions. That could mean clearer:
- document requirements
- claim status
- pre-authorisation updates
- notifications
- next-step guidance
- escalation and support options
The backend may become more connected. The interface needs to make that connectivity visible and useful to the customer.
How Should Digital Products Support Customers at the Hospital?
The sub-committee also discussed how insurers, intermediaries, agents and TPAs can better support policyholders at hospitals. This is crucial because the hospital journey is fundamentally different from the policy-buying journey.
Someone may be sitting in a hospital, worried about a family member and trying to figure out:
- whether the hospital is covered
- whether cashless treatment is available
- whether pre-authorisation has been approved
- whether additional documents are required
- what happens next
- who they can contact for help
At a moment like that, people need quick answers and the right help. A health insurance product could bring policy details, hospital information, claim status, and support closer together instead of making customers move between disconnected channels.
What Changes Should Insurers and Insurtechs Start Thinking About?
The discussions around health insurance point towards several areas where digital products could evolve.
| Area |
What the digital experience could do |
| Policy clarity |
Surface coverage, exclusions, waiting periods, and key conditions upfront |
| Point-of-sale underwriting |
Guide customers through disclosures and explain important implications |
| Claims |
Show status, pending actions, next steps and expected updates |
| Hospital support |
Make network hospitals, cashless information, and help easier to access |
| NHCX ecosystem |
Turn better backend connectivity into visible customer-facing updates |
| Customer trust |
Make important information easier to find, understand and act on |
The value of IRDAI’s current direction is that it gives insurers and insurtechs a clearer picture of the experience issues that may need attention as the ecosystem evolves.
The Next Insurance Experience Starts With Clarity
IRDAI’s latest health insurance discussions point towards a simpler and more connected experience, from understanding a policy and completing disclosures to tracking a claim and getting support when it matters most.
The opportunity for insurers and insurtechs is to turn that direction into digital experiences that feel clear and trustworthy at every step.
At Onething Design, we’ve spent years designing complex financial experiences across BFSI, working with brands including HDFC Securities, HDFC Tru, Motilal Oswal, Capri Loans and Equentis. Each product, audience, and business challenge has been different, but we have been committed to the goal of making complexity easier to navigate and helping people move forward with confidence. That’s the kind of thinking we believe health insurance needs, too.
Building a new insurance experience or rethinking an existing one? Get in touch with our team. We’d love to hear what you’re working on.