Report reveals 80% of Indians with disabilities lack health insurance
A new report by the National Centre for Promotion of Employment for Disabled People (NCPEDP) has revealed that over 80% of persons with disabilities (PwDs) in India are excluded from health insurance coverage. The findings, released during a national consultation, highlight widespread structural discrimination in both public and private health insurance schemes, which fail to adequately address the needs of the disabled community.
The report, titled “Health Insurance and Disability: A Study of Exclusion”, shows that many policies either outright exclude pre-existing disabilities or offer limited and unclear benefits. In some cases, insurance companies even ask for additional medical documents or impose discriminatory clauses that prevent PwDs from availing proper coverage.
Arman Ali, Executive Director of NCPEDP, stated, “The systemic denial of healthcare financing to PwDs is not just exclusionary — it’s a violation of their rights.”
The report calls for regulatory interventions by IRDAI, including mandatory disability-inclusive product guidelines, awareness campaigns, and better grievance redressal systems.
India’s health insurance sector loses Rs. 10,000 crore annually to fraud and abuse
India’s health insurance sector is grappling with an estimated Rs. 10,000 crore in annual losses due to fraudulent claims and abuse, according to recent industry assessments. This figure represents a significant drain on insurers and highlights systemic issues in claim processing, hospital billing, and data transparency.
A key concern is the rise in non-standard or exaggerated claims, often facilitated by unscrupulous agents, third-party administrators (TPAs), and collusive healthcare providers. Fraudulent activities range from unnecessary diagnostic tests and inflated bills to admission under false pretenses and multiple claims for the same illness. Insurers are now intensifying the use of data analytics, artificial intelligence, and hospital audits to detect and prevent such practices.
Industry executives note that beyond direct financial loss, fraud undermines policyholder trust and threatens the affordability of insurance products. To combat this, IRDAI has urged insurers to strengthen their fraud detection frameworks and adopt proactive risk mitigation measures.
As health insurance penetration increases post-pandemic, industry experts stress the urgency of curbing fraud to sustain long-term sector viability and consumer confidence.
More health policyholders opt for AYUSH after IRDAI mandate
There has been a notable surge in health insurance policyholders availing treatments under AYUSH—Ayurveda, Yoga, Unani, Siddha, and Homeopathy—since the Insurance Regulatory and Development Authority of India (IRDAI) mandated its inclusion in standard health policies. According to Chennai-based insurers and hospitals, both awareness and acceptance of AYUSH treatments have grown significantly in the past year.
Earlier, AYUSH coverage was limited to specific health plans or add-ons, leading to low utilisation. However, the IRDAI’s directive to integrate AYUSH in all health insurance offerings has brought these treatments into the mainstream. Insurers report a marked increase in claims related to Ayurvedic and Siddha treatments, particularly for chronic conditions such as arthritis, skin diseases, and lifestyle disorders.
Hospitals with AYUSH wings have also seen higher footfall from insured patients, reflecting growing trust in traditional systems. Industry experts say that rising medical costs and the search for holistic, long-term wellness solutions are driving the trend.
The move also supports the government’s broader goal of promoting traditional medicine and integrating it into the healthcare system.
Star Health Insurance Q2 profit slips 50%
Star Health and Allied Insurance reported a sharp 50 per cent decline in profit for the quarter ended September 2025, posting net earnings of Rs 55 crore compared with Rs 111 crore a year earlier. The standalone health insurer saw modest growth in Gross Written Premium (GWP), which rose to Rs 4,424 crore from Rs 4,371 crore in the corresponding quarter last year.
Investment income dropped to Rs 182 crore from Rs 208 crore a year ago, weighing on profitability. However, total income increased to Rs 4,266 crore, up from Rs 3,914 crore in the same quarter last year.
The company said its performance was affected by the industry-wide shift to the 1/n method of premium recognition, which began in October 2024, and the absence of crop business that contributed Rs 383 crore in the year-ago period.
Star Health said it settled more than three lakh claims during the quarter across business segments. Managing Director V. Suryanarayanan said the company continues to prioritise profitable growth while accelerating its digital transformation initiatives, including the rollout of a new motor own-damage claims management platform during the quarter.
Niva Bupa Health Insurance reports Rs 35 crore net loss in Q2
Niva Bupa Health Insurance reported a net loss of Rs 35.27 crore for the second quarter of FY26, reversing the Rs 13.02 crore profit recorded in the same period last year. The standalone health insurer posted an operating loss of around Rs 62 crore in Q2, compared with an operating profit of Rs 58.47 crore a year ago.
Sequentially, the company reduced its losses, narrowing from the Rs 145.22 crore net loss reported in Q1FY26, according to a stock exchange filing. Despite the quarterly loss, the insurer said operating profit for the period more than doubled to Rs 62 crore from Rs 24 crore in Q2FY25.
Gross Written Premium (GWP) rose 3.69 per cent year-on-year to Rs 1,843.07 crore, while net premium income increased 4.07 per cent to Rs 1,450.06 crore. On a without-1/n basis, overall GWP stood at Rs 2,108 crore.
Managing Director and CEO Krishnan Ramachandran said the performance reflects “disciplined execution and strong operating leverage,” adding that a claims settlement ratio of 95.2 per cent highlights improvements driven by data-science-based underwriting and integrated risk controls.
Health insurers record strong October surge as GST cut boosts demand
Health insurers posted their strongest monthly expansion in October, significantly outperforming the rest of the non-life industry as the GST cut on health premiums led to a surge in new purchases and renewals. Standalone health insurers (SAHIs) saw premiums rise 38.3 per cent year-on-year to Rs 3,738 crore, compared with Rs 2,703 crore a year earlier, according to the General Insurance Council’s Flash Report.
The sharp rise has pushed cumulative growth for SAHIs to 11.5 per cent in the first seven months of FY26, well ahead of the industry’s overall 6.1 per cent rise. Up to September, SAHIs had written premiums of Rs 19,271 crore, up 8.1 per cent from the previous year.
Star Health led the expansion in October with an increase of Rs 266 crore, followed by Niva Bupa and Aditya Birla Health Insurance, which grew 67 per cent and 54 per cent, respectively.
While the overall non-life segment recorded flat growth of 0.1 per cent in October, health insurance accounted for 38.9 per cent of non-life premiums in H1 and is expected to approach 40 per cent after the GST cut.
HC interim order on GST offers respite to bank retirees
A Kerala High Court interim order granting temporary relief from Goods and Services Tax (GST) on group health insurance policies for bank retirees has brought significant comfort to senior citizens struggling with rising medical costs. Although the GST Council has not exempted group health policies from tax, the court last week directed that policies under the Indian Banks’ Association (IBA) scheme for retired bankers be renewed without GST, pending further hearings.
The petition, filed by the All India Bank Pensioners & Retirees Confederation and several individuals, concerns the IBA–National Insurance Co. group policy, which covers around two lakh retired bankers. In its order dated October 17, the court instructed banks—including Bank of Baroda, Bank of India, Canara Bank, Central Bank of India, Indian Bank and Indian Overseas Bank—to renew the retirees’ policies without GST until the next hearing on October 31.
So far, only Indian Overseas Bank has issued a circular implementing the order. Pensioners have urged the IBA to advise all member banks to comply, arguing that retirees pay the entire premium themselves and deserve the same GST treatment as individual policyholders.
Legal experts described the ruling as a “welcome relief,” though they cautioned that the final outcome will depend on further judicial scrutiny and alignment with GST Council guidance.
