Indian general insurers and standalone health insurers settled a record 32.6m health insurance claims in financial year 2024-25 according to Insurance Regulatory and Development Authority of India's (IRDAI) annual report for the financial year.
The annual report for 2024-25 released in December 2025 reveals that about 87% of all registered claims were settled during the year, up from 83% in the previous financial year 2023-24. Though the settlement ratios improved, the average payout per claim fell.
Total payouts rose to INR942.48bn ($10.5bn) compared with INR834.93bn in 2023-24. However, the average amount paid per claim declined to INR28,910 from INR31,086, driven by a higher proportion of lower-ticket claims as retail and group health insurance penetration widened.
During 2024-25, the general and health insurance companies covered 580m lives under 26.5m health insurance policies (excluding policies issued under PA and Travel Insurance).
Health insurance business is classified into three classes of business namely government sponsored, group and individual. In terms of number of lives covered, 42.3% of the lives were covered under government sponsored health insurance schemes, 47.4% in group business and the remaining about 10.3% under individual policies issued by general and health insurers.
In terms of amount of premium, the share of group business was the highest (52.3%), followed by Individual (39.7%) and Government business (8%).
The share of repudiated claims dropped to around 8% in 2024-25 from about 11% a year earlier, while pending claims edged down to roughly 5% from 6%, reflecting faster processing and tighter oversight of claim decisions.
Cashless settlement continued to dominate outgo, accounting for about 66.35% of the total claim amount in 2024-25. In 2023-24 it was 66.17%. Reimbursement claims made up around 29.34% of payouts, down from 31.35% a year ago, while roughly 3% of claims were settled through a combination of cashless and reimbursement modes.
Third-party administrators (TPAs) continued to handle most claims, but their share declined modestly. In 2024-25 about 69% of claims by number were processed through TPAs, down from 72% in the previous year, while in-house settlement rose to 31% from 28% as insurers invested in internal claims capabilities.