India’s health insurance market is expanding, but the fastest-growing retail segment is not necessarily translating into equivalent growth for traditional third-party administrators (TPAs). According to Value Research, health insurance premiums grew 15.6% in FY26, with retail premiums rising 19.9% to ₹56,696 crore, compared with 12.9% growth in group premiums. Yet claims paid through TPAs increased only 6.2% to ₹55,091 crore in FY25, while in-house claims processing rose 23.8% to ₹39,157 crore. Medi Assist’s retail premium managed as a TPA also declined 8.5% to ₹1,164 crore in H1 FY27, highlighting the structural challenge for its traditional retail business.
Medi Assist is responding by shifting from being primarily a claims administrator towards becoming a technology platform for insurers that retain claims processing in-house. Its MAtrix platform allows insurers to use Medi Assist’s technology and hospital network while processing claims through their own teams. Premiums managed through the platform reached ₹9,648 crore in H1 FY27, growing 24.8%, compared with 18.8% growth in traditional TPA premiums. The transition is significant for India’s health-insurance ecosystem because TPAs handled nearly 69% of health insurance claims in FY25, even as insurers increasingly explore greater control over retail claims.
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