The health insurance sub-committee of IRDAI’s Insurance Advisory Committee met for the third time on 28 August 2026 and returned to a problem policyholders know from the claims counter. Cover fails because of something that was never disclosed when the policy was sold.
What the sub-committee discussed
IRDAI’s press release notes that the four-member sub-committee, chaired by IRDAI chairman Ajay Seth, discussed ways to simplify policy wording and strengthen underwriting at the point of sale, so that fewer claims run into trouble over inadequate disclosures. The committee also discussed measures to make claim settlements easier. The role of insurers, intermediaries, agents and third-party administrators in supporting policyholders at hospitals also came up.
The meeting carried forward discussions from the sub-committee’s second sitting on 17 July 2026. Nothing in the release is binding. It records deliberations and areas for further work. No implementation dates are prescribed, and no regulation has been amended.
The rest of the agenda
The sub-committee considered ways to encourage insurers and hospitals onto the National Health Claims Exchange, including incentives linked to onboarding, payments and faster settlement. It suggested insurers may publish Standard Treatment Guidelines and treatment package rates so policyholders can compare before they commit.
It also observed that claims and grievance outcomes should not be judged on settlement ratios alone, but on absolute values as well. Rizwan Koita of NABH presented on hospital certification and Digital Health Standards. Further work is flagged on health savings accounts, treating ported policies as a separate cohort, and reviewing exclusions in the Customer Information Sheet.
What a policyholder can do about disclosure risk today
Tighter underwriting at sale is the insurer’s job. Two rules already in force belong to the policyholder: the moratorium, and the ground on which an insurer can refuse renewal.
Moratorium: Clause 13 of the IRDAI Master Circular on Health Insurance Business of 29 May 2024 says no health policy or claim is contestable on grounds of non-disclosure or misrepresentation after 60 months of continuous coverage, with established fraud the only exception. Credits gained under ported and migrated policies count towards that period, so a switch of insurer does not restart it. Whether the incoming insurer has recorded it correctly is worth confirming in writing.
Renewal: Under clause 10, a health policy is renewable unless the insured has committed established fraud, non-disclosure, or misrepresentation. An omission on the proposal form therefore stays live at every renewal.
Two more points help. The free-look period runs 30 days from receipt of the policy document, long enough to correct a disclosure rather than discover the gap in a hospital. And the Customer Information Sheet must set out exclusions, sub-limits, waiting periods and the moratorium in plain words, with the insurer obliged to obtain acknowledgement and to supply it in a local language on request. Checking a proposal form against a medical history is unglamorous work that most buyers skip. MyRupia reviews existing policies on exactly that basis, holding no insurer tie-ups.
Exclusions in that same information sheet are on the sub-committee’s list for further review.
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