The IRDAI Rolls Out Shared Hospital Network

• 22 Apr 2025
• 614 Views

The Insurance Regulatory and Development Authority of India (IRDAI) has launched a shared hospital network and streamlined cashless claim process. This has been done to make health insurance more accessible and affordable to the citizens of India. 

This step is expected to speed up insurance services for clients and improve transparency in treatment costs. Under this plan, general insurance companies began combining hospitals into a single network in cooperation with the General Insurance Council.

With the goal of growing the network to 5,000 hospitals in the next months, more than 600 eye hospitals and 150 general hospitals have already been approached for this facility. To ensure consistent and clear costs for medical operations, the treatment prices inside this shared network will be based on the pricing models of government health programs like Ayushman Bharat (PMJAY). It is anticipated that policyholders' out-of-pocket costs will be greatly decreased by this development.

The government, in a parallel effort, is developing a regulation that would require insurance companies to settle final claims within three hours of the conclusion of treatment and accept requests for cashless care within an hour. With the help of an expert organization, the claims forms will be streamlined and standardized to facilitate this expedited procedure.

Additionally, there are efforts to apply standards similar to those of the Bureau of Indian Standards (BIS) throughout the insurance ecosystem in an effort to enhance stakeholder responsibility and service delivery. 

A significant increase in pending claims over time has prompted calls for quicker and more effective claim settlements:

• 8.5 million pending claims in 2022

• 17.5 million pending claims in 2023

• 25 million pending claims in 2024

The insurance regulator has also outlined a long-term goal to make insurance coverage available and reasonably priced for all citizens by 2047.

Benefits to policyholders

The following are some advantages for policyholders:

• Greater availability of cashless care at a wider range of hospitals

• Treatment prices that are predetermined, encouraging openness and cost management

• Streamlined and expedited resolution of claims

• Increased responsibility from health care providers and insurers

• Enhanced customer confidence and nationwide insurance coverage expansion

Sources: 

• ZeeBiz 
• Economic Times