The Insurance Regulatory and Development Authority of India (IRDAI) inspected both private and public sector insurers as part of its compliance review of the Health Master Circular — a comprehensive directive issued to streamline health insurance processes and enhance policyholder protection.
The insurers inspected include Niva Bupa Health Insurance, Star Health and Allied Insurance, Care Health Insurance, ManipalCigna Health Insurance, New India Assurance, Tata AIG General Insurance, ICICI Lombard General Insurance, and HDFC ERGO General Insurance, according to the sources.
Violations noted by the regulator reportedly involve improper implementation of the Health Master Circular, particularly around the rejection of valid claims, delays in processing, and the deduction of inadmissible costs.
“The lapses identified could lead to enforcement actions,” one of the sources said, adding that IRDAI may ask insurers to either refund amounts to affected policyholders with applicable interest or impose financial penalties.
The inspection marks one of the most comprehensive reviews in the health insurance sector this year and comes amid growing consumer complaints about claim processing.
CNBC-TV18 said it had reached out to the companies for comment but had not received a response at the time of publication.
IRDAI has not issued a public statement on the findings.
(Edited by : Poonam Behura)
