What Does IRDAI's Master Circular on Health Insurance Business (2024) Actually Say?

1. What this document is

The circular is short. Its English text runs from page 19 to page 30, after a two-page covering letter and a Hindi version of the same rules ^[1]. It is addressed to insurers, not to you, and it is written as instructions: what products must offer, how claims and renewals must be handled, how a product gets approved and how it gets withdrawn.

It replaced a long run of older health circulars at once, including the 2020 standardisation master circular, through the repeal list in Annexure 6 ^[1,3,4]. That is why it gets quoted so often. For most health rules made before 2024, this is now the document that carries them, or the reason they no longer apply.

4. Chapters II and III: the insurer's side

Chapter II is mostly governance. Parts of it still reach the policyholder: insurers must publish on their websites the hospitals where cashless works, a warning that anywhere else means a reimbursement claim, both claim procedures, their turnaround times for servicing and claims, and the products they have withdrawn ^[1]. One small drafting slip is worth knowing about. Item (5)(a)(ii) points to "para VI of Chapter 2" for a common hospital network, and Chapter II has no para VI; the idea appears instead as something insurers "may endeavor" to build, in part A.IV.

For employer cover, A.II says no claim may be denied because the employer had not yet sent member details ^[1]. Part B stops insurers paying TPAs according to claim ratios. A TPA paid more when it pays out less would be a bad incentive, and the circular rules it out ^[1].

Parts C and D move product approval inside the insurer. The insurer's own Product Management Committee approves new products and changes, then files only the name and approval date with IRDAI to get a UIN ^[1]. That matters at renewal. Repricing is signed off by the same committee, not by IRDAI ^[1,3,5]. Chapter III requires a specific cover for people with disabilities, HIV/AIDS or mental illness that may be widened but never narrowed ^[1], and limits ABHA health-ID sharing to cases with your express consent ^[1].

5. What the circular does not tell you

It does not cap premium increases ^[1]. The 10% a year limit for senior citizens came in a separate circular in January 2025 ^[7], explained on can your insurer raise a senior's premium by more than 10%.

It does not list standard exclusions either. The old closed list of permanently excludable conditions went with the 2020 circular this one repealed, and nothing replaced it ^[1,3,4]. Exclusions now appear only as something an insurer declares when filing a product and summarises in the Customer Information Sheet ^[1]. The sheet's own format is in the separate annexures PDF, and it words the post-moratorium rule more loosely than clause 13 does ^[3,1].

Nor does it give the porting window. That is the 30-to-60-day rule in the policyholder-protection circular ^[2,5]. Our view is that the health circular is best read as the headline list and the September circular as the working detail, so in a complaint to an insurer, its grievance officer or the Ombudsman it is worth quoting the clause number from both, which leaves nobody room to argue that you relied on the wrong document. It probably will not decide a case on its own, but it makes a vague reply harder to send.

The official copy remains on IRDAI's site at irdai.gov.in, document 4942918. For how senior health policies compare on the terms this circular governs, see the best and worst senior health insurance in India.