Working and Challenges of National Health Insurance Companies in India

Abstract

Health insurance has become a vital component of India’s financial and social protection framework, especially in the context of rising medical costs and increasing disease burden. National health insurance companies, particularly public sector insurers, play a critical role in implementing government schemes and expanding healthcare coverage to underserved populations. This research paper examines the operational functioning and major challenges faced by national health insurance companies in India using recent data from the Insurance Regulatory and Development Authority of India for the financial year 2024–25. The study highlights that while these insurers have expanded coverage and improved claim settlement mechanisms, issues such as rising claims, fraud, operational inefficiencies, and increasing customer grievances continue to affect their performance and sustainability.