Irdai flags issues at 8 insurers over health master circular norms
Mumbai, Jun 26, 2025
Regulator begins phased inspections of health insurers; issues linked to claims settlement and compliance with the new Health Insurance Master Circular
As part of routine inspections to review the implementation of regulatory norms, the Insurance Regulatory and Development Authority of India (Irdai) initiated inspections at several health insurance companies and flagged concerns with select firms regarding the implementation of certain norms under the new Health Insurance Master Circular, people aware of the development said.
According to a CNBC TV18 report, eight general insurance companies – New India Assurance, ICICI Lombard General Insurance, HDFC ERGO General Insurance, Tata AIG General Insurance, Star Health and Allied Insurance, Niva Bupa Health Insurance, Care Health Insurance and ManipalCigna Health Insurance – were under the scanner for violations around claims settlement and implementing the new Health Insurance Master Circular.
The report said that violations noted by the regulator reportedly involve improper implementation of the Health Master Circular which could lead to enforcement actions.
In response to a Business Standard query, New India Assurance said that, “These inspections are not adversarial, but are intended to promote stronger operational practices and compliance within the insurance sector. We wish to clarify that the Master Circular issued by the Irdai has been fully adopted by New India Assurance, both in principle and in practice.”
The company said that during the course of the inspection, Irdai made a few procedural observations regarding the overly detailed Customer Information Sheet (CIS) which has since been simplified in line with the advice, inclusion of Product Management Committee member representation on the Claims Review Committee, which has been put into effect and timelines associated with portability data submission to Insurance Information Bureau (IIB), for which appropriate systems and protocols are now in place.
The statement added that, “All necessary corrective measures have been taken, and our compliance has been duly communicated to the Regulator. At New India Assurance, we uphold the highest standards of customer service. Our claims process is designed to be fair and responsive, supported by a structured grievance redressal mechanism to resolve any concerns raised by policyholders.”
“In order to review the implementation of health prescriptions, Irdai had initiated inspection of all insurers in a phase-wise manner as part of its regulatory supervision and oversight. Accordingly, regulatory inspections were initiated for eight general and health insurance companies as part of the initial phase. The inspection report was shared with the insurance companies. The observations mainly related to industry-wide challenges in implementing the new prescriptions,” an ICICI Lombard spokesperson said in response to a Business Standard query.
“The company has submitted its response to the inspection report, in keeping with our endeavour and spirit of upholding the regulatory prescriptions. At ICICI Lombard, and as an industry leader, we follow high standards of regulatory compliance and corporate governance in all our operations,” the spokesperson added.
Queries sent to the remaining insurance companies remained unanswered at the time of going to press.
An official at a health insurance company said: “These are part of routine inspections conducted by the regulator to ensure implementation of various norms. We will try to meet all the regulatory prescriptions.”
[The Business Standard]
