India’s health segment is growing rapidly and is now the largest segment of the market in terms of premium, according to the Insurance Regulatory and Development Authority of India (IRDAI). In this white paper, we outline the implications of the IRDAI initiatives for medtech companies, firms that develop and manufacture products, services, or solutions used to diagnose, monitor, treat, or prevent diseases and medical conditions through technological innovation. The circular’s provisions aim to improve accessibility, affordability, and efficiency in healthcare, creating new opportunities for medtech companies to incorporate into their market access strategy.

Highlights and implications

• Product availability and customization: The broad objective of ensuring insurance protection for all creates significant opportunities for medtech companies.
• Coverage of technological advancements and treatments: 12 modern treatments previously excluded must now be included in insurance plans when medically indicated.
• Customer information sheet: Companies must include detailed coverage information, requiring insurers to clearly declare their coverage for new technologies.
• Cost clarity: The circular emphasizes the importance of clear agreements between payers and healthcare providers on the clinical needs and costs of services to ensure claims are processed within the required timelines.
• Settlement of claims: Insurance companies will need to bolster their capabilities to effectively manage the eligibility, clinical, and cost-related challenges of claims.