Health Insurance In India: A Legal Analysis

Mahendra Soni, Assistant Prof. (Sr. Scale), National Law Institute University, Bhopal

ABSTRACT

The Health (Mediclaim) insurance segment is rapidly growing in India and provides critical financial support for increasingly expensive medical treatments in our country. While endeavouring to conduct a detailed analysis of the health insurance sector in India, the author has highlighted its importance in terms of social security for citizens and role of health insurance in protecting individuals from the financial burdens of unforeseen medical expenses due to illnesses or injuries. Health insurance in India is regulated by the Insurance Regulatory and Development Authority of India (IRDAI), which has established various regulations and guidelines to ensure consumer protection and market efficiency, including the Health Insurance Regulations 2016, guidelines on product standardization and Third Party Administrators (TPAs). This article also comprehensively examines the legal issues pertaining to Pre-existing disease and Renewal of Insurance Policies with the help of decided cases. The author has also highlighted several challenges and intricacies before stakeholders of Insurance sector in India. The article suggests for the pro-active role of government in promoting health insurance through product standardization and improving consumer protection and trust. Lastly, the article emphasizes the need for a robust regulatory mechanism to prevent unfair practices and ensure fair competition among insurers.

Keywords: Health Insurance, Mediclaim Insurance, Insurance Renewal, Pre-existing disease.