Latest news with #Irdai
Time of India
3 days ago
- Business
- Time of India
Leaderless and lagging: India's insurance overhaul stalls without Irdai head since March
Key reforms in India's insurance sector are stuck in limbo following the departure of Insurance Regulatory and Development Authority of India ( Irdai ) chairman Debashish Panda in March. With the top post still vacant since March, the sector is left without regulatory leadership at a time when several major initiatives are awaiting rollout, Times of India reported. The most ambitious of these is Bima Sugam , a centralised digital platform designed to allow customers to compare, purchase, and manage insurance policies online. Although each insurance company has already invested a few crore rupees into the development of this platform, the date of its official launch has still not been finalised. Alongside Bima Sugam, two other major initiatives—Bima Vistaar and Bima Vahaak—are also facing delays. Bima Vistaar is meant to offer bundled insurance coverage to rural populations, while Bima Vahaak is a distribution model driven by women. Both are facing technical and operational hurdles that have stalled their progress. by Taboola by Taboola Sponsored Links Sponsored Links Promoted Links Promoted Links You May Like An engineer reveals: 1 simple trick to get all TV channels Techno Mag Learn More Undo Plans to shift to a risk-based capital framework and align insurance accounting practices with the International Financial Reporting Standards (IFRS) are also in suspension. These changes were intended to modernise the sector's regulatory oversight and financial disclosures. However, industry unreadiness and lack of clarity around implementation have halted progress. Meanwhile, proposals to allow 100% foreign direct investment in the sector, permit composite licences, and introduce differentiated capital requirements have yet to be passed into law. Plans to list state-run insurers on the stock market are also stuck, facing pushback from within the public sector. Live Events Even as reforms stall, regulatory scrutiny has increased in some areas. The Reserve Bank of India and the finance ministry have raised concerns over banks and automobile dealers forcing customers to purchase bundled insurance products. Regulatory audits have uncovered several worrying practices in retail health insurance, including unclear reasons for claim rejections, steep premium increases, and poor portability. 'If the insurance industry is to grow the way mutual funds did after 2010, we need greater transparency, lower costs, and rebuilt trust,' said Kamesh Goyal, co-founder of Go Digit General Insurance . 'Sebi introduced direct plans and standard charges. Insurance could adopt similar guidelines—such as mandating refunds with interest when loss ratios fall below a certain level.' Goyal said that retail customers were effectively subsidising corporate clients. 'We're not saying distributors shouldn't earn, but loss ratios at 10% are unsustainable. A level of 60-65% is more realistic, accounting for costs and investment income. Once a fair value proposition is in place, mis-selling naturally comes down,' he said. Public sector insurers are also under pressure. Three have breached solvency norms. Even though insurance premiums have grown, the number of individual policyholders has stayed flat, which limits any real gains in financial inclusion. Surety bonds are another area that now demands regulatory attention. These bonds were introduced as substitutes for traditional bank guarantees. But insurers argue they come with higher risk as they lack the protections banks enjoy under existing bankruptcy laws. The delay in appointing a new Irdai chairman has slowed down reform at a time when the insurance industry is in urgent need of clear and forward-looking regulation. (with ToI inputs)
Time of India
3 days ago
- Business
- Time of India
Irdai chief post vacant since March, reforms stall
MUMBAI: Plans to revamp the insurance sector are in limbo, with key reforms stalling after Irdai chairman Debashish Panda left office in March. The post remains vacant, leaving the sector without regulatory leadership at a time when several major initiatives are awaiting rollout. Tired of too many ads? go ad free now The most ambitious among them is Bima Sugam, a unified digital marketplace for policy comparison, purchase, and servicing. With each insurer having invested a few crore in the platform, its launch plan is yet to be finalised. Bima Vistaar, aimed at rural bundled coverage, and Bima Vahaak, a women-led distribution model, are also facing technical and operational delays. Moves to shift to a risk-based capital framework and align insurance accounting with IFRS remain incomplete. These efforts, meant to modernise regulatory oversight and financial disclosures, have not progressed due to a lack of industry readiness and clarity on implementation. Proposals to allow 100% FDI, issue composite licences, and introduce differentiated capital norms have yet to be legislated. Plans to list state-run insurers have also not advanced amid resistance from within the public sector. At the same time, regulatory scrutiny of mis-selling and poor distribution practices has increased. RBI and the finance ministry have flagged concerns over banks and auto dealers forcing customers to buy bundled insurance. Regulatory audits have revealed issues such as opaque claim rejections, sharp premium hikes, and poor portability in retail health insurance. "If the insurance industry is to grow the way mutual funds did after 2010, we need greater transparency, lower costs, and rebuilt trust," said Kamesh Goyal, co-founder of Go Digit General Insurance. Tired of too many ads? go ad free now "Sebi introduced direct plans and standard charges. Insurance could adopt similar guidelines-such as mandating refunds with interest when loss ratios fall below a certain level." Goyal added that small retail customers are often subsidising large corporate groups. "We're not saying distributors shouldn't earn, but loss ratios at 10% are unsustainable. A level of 60-65% is more realistic, accounting for costs and investment income. Once a fair value proposition is in place, mis-selling naturally comes down," he said. Public sector insurers are also under pressure, with three of them breaching solvency norms. While insurance premiums have increased, the number of individual policies has remained flat, limiting its impact on financial inclusion. Another area needing regulatory attention is surety bonds. Though these now substitute bank guarantees, insurers say they carry higher risk due to a lack of protection under bankruptcy laws-unlike banks. The delay in appointing a new chairman has slowed reform at a time when the sector needs urgent regulatory clarity.
Time of India
29-05-2025
- Business
- Time of India
Irdai seeks wider insurance coverage to prevent distress
Photo/Agencies Mumbai: The Insurance Regulatory and Development Authority of India (Irdai) urged insurance companies to prioritise expanding the number of people covered under insurance, not just improving insurance penetration metrics. The regulator's call came at a time when the non-life insurance industry committed over Rs 300 crore over three years to an awareness campaign with the tagline 'Achha kiya insurance liya' (Did well by buying insurance). Irdai member Deepak Sood told industry leaders that companies should address new risks. "The face of risk is changing every day," said Sood, citing a shift from traditional physical and business risks to emerging threats such as cyber risks that now "sit in our pocket, in our mobile phones." "Premium could be anything," Sood said. "If we can keep those premiums low, make it affordable for our people, it doesn't matter what penetration percentage is, as long as we can reach out." Tapan Singhel, chairman of General Insurance Council, warned that India's low insurance penetration was heightening its economic fragility. "Every time a catastrophe hits, millions remain unprotected," he said. Singhel cited data to show that general insurance has a lower grievance ratio - 0.35 complaints per 10,000 policies - compared to 0.7 for banking and 4 for e-commerce. Stay informed with the latest business news, updates on bank holidays and public holidays . AI Masterclass for Students. Upskill Young Ones Today!– Join Now
Economic Times
19-05-2025
- Health
- Economic Times
Mental health insurance problems continue: 5 things to check before buying a cover
Getty Images All general and standalone health insurers do abide by the Mental Healthcare Act, 2017, and include mental illnesses in their health plans There has been a 30-50% rise in mental health-related claims in the past 2-3 years, claims a recent study by Policybazaar (see graphic). 'We've also seen a 41% year-on-year growth in mental health insurance searches in 2025,' says Siddharth Singhal, Head of Health Insurance, Policybazaar. The surge is corroborated by Bhaskar Nerurkar, Head, Health Administration Team, Bajaj Allianz General Insurance: 'We've seen a steady increase in mental health related claims, with a CAGR of about 33% from 2021-22 to 2024-25. In the last year alone, there was a 23% rise in such claims over the previous year.' These figures seem reassuring in the face of grim societal stigma and the fact that 10.6% of adults in India suffer from mental disorders and the lifetime prevalence of mental disorders is 13.7%, as per the National Mental Health Survey 2015-16 by Anuradha Sriram, Chief Actuarial Officer, Aditya Birla Health Insurance, strikes a discordant note. 'While awareness and conversation around mental health have increased in recent years, we have not observed a significant rise in mental health related hospitalisation claims,' she says. This is because most treatments for mental health continue to be outpatient-based, which are generally not captured in the scope of hospitalisation plans, she explains. The in-patient focus of most plans is only one of the several problems faced by people seeking mental health covers despite the insurance regulator's proactive approach in widening the scope of coverage. Though the Mental Healthcare Act, 2017, was enforced in May 2018, Irdai was forced to issue circulars in August 2018 and then again in October 2022, requesting compliance by insurers and removal of mental illnesses from their list of exclusions. The guidelines stated that mental illnesses had to be treated at par with physical illnesses when it came to providing insurers eventually started offering mental health coverage in their plans by the end of 2022, in February 2023, Irdai was again forced to issue a circular to 'mandatorily launch and immediately offer' an 'appropriate product' and a 'specific cover' for persons with mental illnesses, disabilities and HIV/AIDS, which translated to a standardised, standalone cover.A crucial inclusion was the need to put in place a 'Board-approved underwriting policy that ensures no proposal is denied'. This meant the insurers could not refuse a cover to a person with pre-existing mental all general and standalone health insurers do abide by the Mental Healthcare Act, 2017, and include mental illnesses in their health plans. 'We offer mental health coverage as part of our health insurance plans in alignment with Irdai guidelines. The plans typically cover hospitalisation expenses arising from mental illnesses, including depression, anxiety, bipolar disorder and schizophrenia,' says Priya Deshmukh, Head, Health Product, Operations & Services, ICICI Lombard. Other insurers too cover mental illnesses under their comprehensive not OPD plans: The problem with most such covers is that these are indemnity plans that only cover hospitalisation or in-patient expenses, whereas most mental disorders require periodic doctor consultations, therapies, counselling, medication and psychiatric evaluations, which are out-patient features. Policybazaar data shows that conditions like anxiety (30-35%) and depression (25-30%) are the top reasons for claims, which are usually managed through out-patient care rather than inpatient admission. Without these features and benefits, the insurance policy may not be of much use to you. 1. Does it have a pre-existing disease waiting period? If the applicant already suffers from a mental illness, buying a plan may be a challenge, depending on the severity of the disorder. In all probability, he will have to clear the waiting period for pre-existing diseases, which is 2-3 years for most insurers, before he can be covered for the disorder. 2. Does it offer OPD benefit? Doctor consultations and medication are an integral part of mental health treatments, which can only be covered by a plan with an OPD feature. So, if OPD benefit is missing, either as a part of the base cover or as an optional feature, the plan won't be of much use to you. 3. Does it cover therapy & counselling? Even if the OPD benefit is included in the plan, not all insurers offer all the features that are crucial for mental health treatments, such as therapy, counselling and psychiatric evaluations, which can be very expensive. Make sure these are a part of the cover. 4. Is your therapist or health care centre in the network? Most insurers require the treatment to be conducted by a qualified practitioner in a recognised institute, hospital or clinic that falls in its network. If these don't fulfill the insurer requirements, you will not be able to make a claim. 5. Is your illness covered? You will need to ensure that your particular mental illness is included in the plan. The disorders usually covered by insurers include anxiety, depression, bipolar disorder, schizophrenia, PTSD and dementia. If the illness is not covered, there's no point buying the cover. Agrees Sriram: 'Our flagship products are hospitalisation-focused indemnity plans, covering in-patient treatment for mental health conditions. However, many mental health treatments, like therapy or consultations, are outpatient in nature and are not covered under the base plan.''OPD coverage is crucial even as an addon because a plan that only covers hospitalisation may not suffice for real-world needs,' says Singhal. So, either the policy buyer needs to find a plan that has an in-built OPD feature, or buy an OPD rider along with the base cover, both of which require additional expense due to higher premiums that these entail. Underwriting hurdles: For people with existing mental conditions, especially with a high degree of severity, it can be difficult to buy a plan despite Irdai specifying that insurers cannot refuse it. 'While Irdai has mandated insurers to cover mental health conditions, underwriting still applies. This means that individuals with a known history of mental illness may face medical assessments, loading on premiums, or specific exclusions,' says Deshmukh. This could mean either expensive plans, limits on coverage, or long waiting periods, usually between two and three years, and sometimes even rejection for severe disorders. Network practitioners: Since the treatment for many mental illnesses requires therapy and counselling, many people pick private therapists or clinics, which may not be in the insurer networks or empanelled. Besides, correct diagnosis and effective therapy can often mean sifting through various doctors and counsellors before finding the right one that suits the patient, and not every such practitioner may be a part of the insurer network. Standardised plans: Many general and standalone health insurance companies offer a standardised plan that provides a cover of `4-5 lakh and includes mental illnesses among other disabilities and disorders. This standardised plan is an affordable base plan with similar offerings across insurers, but is available under different names and varying premiums, which is typically low. However, since it is not a comprehensive plan and offers low coverage, it means the policyholders would need to pad it up, besides buying another cover for other illnesses as well. 'Consumers should look for comprehensive plans that include mental health as part of their base coverage and evaluate whether the insurer offers any additional riders/add-ons that support out-patient care or wellness programs,' says Nerurkar. 'It's advisable to consider whether the policy offers OPD benefits for consultations, therapy sessions, and medication. Some plans also provide wellness programs or teleconsultation services, which can be highly valuable for ongoing support. Transparency regarding waiting periods, exclusions (like illnesses related to substance abuse), and pre-existing condition disclosures is critical to ensuring seamless claims later,' he should also check whether the insurer has a strong hospital network with the required facilities. 'Ensure that the insurer's network hospitals include facilities offering psychiatric services and that these are accessible in your area,' says Deshmukh.
Time of India
19-05-2025
- Health
- Time of India
Mental health insurance problems continue: 5 things to check before buying a cover
There has been a 30-50% rise in mental health-related claims in the past 2-3 years, claims a recent study by Policybazaar (see graphic). 'We've also seen a 41% year-on-year growth in mental health insurance searches in 2025,' says Siddharth Singhal, Head of Health Insurance, Policybazaar. The surge is corroborated by Bhaskar Nerurkar, Head, Health Administration Team, Bajaj Allianz General Insurance: 'We've seen a steady increase in mental health related claims, with a CAGR of about 33% from 2021-22 to 2024-25. In the last year alone, there was a 23% rise in such claims over the previous year.' These figures seem reassuring in the face of grim societal stigma and the fact that 10.6% of adults in India suffer from mental disorders and the lifetime prevalence of mental disorders is 13.7%, as per the National Mental Health Survey 2015-16 by NIMHANS. However, Anuradha Sriram, Chief Actuarial Officer, Aditya Birla Health Insurance, strikes a discordant note. 'While awareness and conversation around mental health have increased in recent years, we have not observed a significant rise in mental health related hospitalisation claims,' she says. This is because most treatments for mental health continue to be outpatient-based, which are generally not captured in the scope of hospitalisation plans, she explains. The in-patient focus of most plans is only one of the several problems faced by people seeking mental health covers despite the insurance regulator's proactive approach in widening the scope of coverage. Live Events Irdai guidelines Though the Mental Healthcare Act, 2017, was enforced in May 2018, Irdai was forced to issue circulars in August 2018 and then again in October 2022, requesting compliance by insurers and removal of mental illnesses from their list of exclusions. The guidelines stated that mental illnesses had to be treated at par with physical illnesses when it came to providing coverage. While insurers eventually started offering mental health coverage in their plans by the end of 2022, in February 2023, Irdai was again forced to issue a circular to 'mandatorily launch and immediately offer' an 'appropriate product' and a 'specific cover' for persons with mental illnesses, disabilities and HIV/AIDS, which translated to a standardised, standalone cover. A crucial inclusion was the need to put in place a 'Board-approved underwriting policy that ensures no proposal is denied'. This meant the insurers could not refuse a cover to a person with pre-existing mental disorders. Problems in getting coverage Today, all general and standalone health insurers do abide by the Mental Healthcare Act, 2017, and include mental illnesses in their health plans. 'We offer mental health coverage as part of our health insurance plans in alignment with Irdai guidelines. The plans typically cover hospitalisation expenses arising from mental illnesses, including depression, anxiety, bipolar disorder and schizophrenia,' says Priya Deshmukh, Head, Health Product, Operations & Services, ICICI Lombard. Other insurers too cover mental illnesses under their comprehensive plans. In-patient, not OPD plans: The problem with most such covers is that these are indemnity plans that only cover hospitalisation or in-patient expenses, whereas most mental disorders require periodic doctor consultations, therapies, counselling, medication and psychiatric evaluations, which are out-patient features. Policybazaar data shows that conditions like anxiety (30-35%) and depression (25-30%) are the top reasons for claims, which are usually managed through out-patient care rather than inpatient admission. 5 questions to ask before buying a mental health plan Without these features and benefits, the insurance policy may not be of much use to you. 1. Does it have a pre-existing disease waiting period? If the applicant already suffers from a mental illness, buying a plan may be a challenge, depending on the severity of the disorder. In all probability, he will have to clear the waiting period for pre-existing diseases, which is 2-3 years for most insurers, before he can be covered for the disorder. 2. Does it offer OPD benefit? Doctor consultations and medication are an integral part of mental health treatments, which can only be covered by a plan with an OPD feature. So, if OPD benefit is missing, either as a part of the base cover or as an optional feature, the plan won't be of much use to you. 3. Does it cover therapy & counselling? Even if the OPD benefit is included in the plan, not all insurers offer all the features that are crucial for mental health treatments, such as therapy, counselling and psychiatric evaluations, which can be very expensive. Make sure these are a part of the cover. 4. Is your therapist or health care centre in the network? Most insurers require the treatment to be conducted by a qualified practitioner in a recognised institute, hospital or clinic that falls in its network. If these don't fulfill the insurer requirements, you will not be able to make a claim. 5. Is your illness covered? You will need to ensure that your particular mental illness is included in the plan. The disorders usually covered by insurers include anxiety, depression, bipolar disorder, schizophrenia, PTSD and dementia. If the illness is not covered, there's no point buying the cover. Agrees Sriram: 'Our flagship products are hospitalisation-focused indemnity plans, covering in-patient treatment for mental health conditions. However, many mental health treatments, like therapy or consultations, are outpatient in nature and are not covered under the base plan.' 'OPD coverage is crucial even as an addon because a plan that only covers hospitalisation may not suffice for real-world needs,' says Singhal. So, either the policy buyer needs to find a plan that has an in-built OPD feature, or buy an OPD rider along with the base cover, both of which require additional expense due to higher premiums that these entail. Underwriting hurdles: For people with existing mental conditions, especially with a high degree of severity, it can be difficult to buy a plan despite Irdai specifying that insurers cannot refuse it. 'While Irdai has mandated insurers to cover mental health conditions, underwriting still applies. This means that individuals with a known history of mental illness may face medical assessments, loading on premiums, or specific exclusions,' says Deshmukh. This could mean either expensive plans, limits on coverage, or long waiting periods, usually between two and three years, and sometimes even rejection for severe disorders. Network practitioners: Since the treatment for many mental illnesses requires therapy and counselling, many people pick private therapists or clinics, which may not be in the insurer networks or empanelled. Besides, correct diagnosis and effective therapy can often mean sifting through various doctors and counsellors before finding the right one that suits the patient, and not every such practitioner may be a part of the insurer network. Standardised plans: Many general and standalone health insurance companies offer a standardised plan that provides a cover of `4-5 lakh and includes mental illnesses among other disabilities and disorders. This standardised plan is an affordable base plan with similar offerings across insurers, but is available under different names and varying premiums, which is typically low. However, since it is not a comprehensive plan and offers low coverage, it means the policyholders would need to pad it up, besides buying another cover for other illnesses as well. What to look for in a plan 'Consumers should look for comprehensive plans that include mental health as part of their base coverage and evaluate whether the insurer offers any additional riders/add-ons that support out-patient care or wellness programs,' says Sriram. Agrees Nerurkar. 'It's advisable to consider whether the policy offers OPD benefits for consultations, therapy sessions, and medication. Some plans also provide wellness programs or teleconsultation services, which can be highly valuable for ongoing support. Transparency regarding waiting periods, exclusions (like illnesses related to substance abuse), and pre-existing condition disclosures is critical to ensuring seamless claims later,' he says. One should also check whether the insurer has a strong hospital network with the required facilities. 'Ensure that the insurer's network hospitals include facilities offering psychiatric services and that these are accessible in your area,' says Deshmukh.
