Page 13 - The Insurance Times September 2025

for health insurance, es- AHPI revokes suspension GST break on health insur-
sential commodities to of cashless services for ance premiums pitched to

curb inflation Bajaj Allianz, Care policy- boost affordability; deci-
The Institute of Cost Accountants of holders sion pending
India (ICMAI) has urged the Central
Government to bring the medical in- The Association of Healthcare Provid- A proposal to exempt health insurance
ers-India (AHPI) has withdrawn its ad-
surance sector under the ambit of cost premiums from the 18% GST has
audits through Section 148 of the Com- visory asking member hospitals to gained traction among insurers and
pause cashless treatment for custom-
panies Act, 2013. ICMAI President policy experts, who argue the relief
Bibhuti Bhusan Nayak argued that ers of Bajaj Allianz General Insurance would lower costs for families, expand
and Care Health Insurance. The move,
there is a visible gap between premium coverage among seniors and first-time
effective immediately, followed discus-
paid and benefits received in medical buyers, and signal that health cover is
insurance, and mandated cost audits sions with stakeholders and aims to an essential service.
could offer greater transparency. avert disruption to patients.
Supporters say a waiver could improve
The institute also recommended the AHPI said cashless services will con- persistency and widen the risk pool,
inclusion of essential commodities and tinue across its network while a joint easing out-of-pocket burdens.
the banking sector to help contain working group tackles pending issues The idea faces trade-offs: without GST,
price inflation. ICMAI council member such as package rates, pre-
Chittaranjan Chattopadhyay cited the authorisation timelines, claim deduc- insurers would lose input tax credits on
sharp rise in retail prices of goods like tions and payment delays. Hospitals technology, distribution and opera-
biscuits post-pandemic as justification have been urged not to deny cashless tions, potentially prompting some to
for greater cost scrutiny. admissions, and insurers have commit- load costs into base premiums.
ted to faster approvals and grievance Industry voices are urging transparent
He stressed that mandatory cost au-
dits could unearth high profit margins redress. pricing and regulatory oversight to
masked by heavy discounts. The appeal The decision eases concerns of policy- ensure consumers get the full benefit
aligns with the broader objective of holders who feared out-of-pocket pay- if a waiver is approved.
protecting consumer interests and en- ments. Both sides said patient interest Policy watchers expect further discus-
suring fair pricing in crucial sectors like remains paramount and further up- sions at the GST Council, alongside
healthcare and daily-use goods. dates will be shared as talks progress. complementary measures such as OPD
coverage expansion and standardised
India's Health Insurance Model Must Shift 'From products, to strengthen protection
and improve access. A final decision
Commissions to Care': Expert
has not yet been announced.
India's health insurance market channels too much premium to commissions
and administrative costs, leaving a smaller share for patient care, a leading
health-policy expert has argued in a new commentary. The piece calls for
an 80-85% medical loss ratio floor, single-digit acquisition costs, and caps Join
on admin expenses to ensure premiums translate into treatment. Online Certificate
Key proposals include standardised pre-authorisation formats with public
SLAs and penalties, wider OPD and preventive benefits, multi-year policies Course on
with transparent, rules-based repricing, shared data rails across insurers/ Probable Maximum
TPAs/hospitals to cut delays and fraud, and stronger grievance mechanisms
with internal ombudsmen and time-bound decisions.
Loss
The commentary warns that rising premiums without commensurate claim
payouts are eroding trust and straining hospital finances, and urges the For details please visit
regulator to re-anchor incentives around "care funded" rather than "poli- www.smartonlinecourse.co.in
cies sold." Industry responses to the recommendations are awaited.

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