India's health insurance market may be seeing stronger consumer demand, but policyholders continue to face significant problems when they actually need their insurance. About four in 10 policyholders who made a claim reported at least one issue, with problems involving hospital and provider networks, delayed payouts and pre-authorisation emerging as key pain points, according to the second edition of Hansa Research's Health Insurance Customer Experience Score (CuES) 2026.
The findings highlight a growing gap between what consumers expect from health insurance and the experience they receive during critical moments such as claims, renewals and interactions with hospitals. Hansa Research found that the industry's net promoter score (NPS) declined to 50% in 2026 from 55% in 2025, even as protection against rising medical expenses became a stronger reason for consumers to purchase health insurance.
“Health insurance consumers are becoming increasingly discerning about protection and value. Their expectations now extend beyond the policy itself to the simplicity, responsiveness and confidence they experience throughout the customer lifecycle,” said Praveen Nijhara, chief executive officer (CEO) of Hansa Research.
The study, based on responses from 4,000 consumers across more than 12 health insurance brands, indicates that having a policy is no longer enough to ensure customer confidence. Consumers increasingly expect insurers to make healthcare easier to access, simpler to navigate and more reassuring when they need to use their coverage.
Insurance Claims Emerge as a Critical Pain Point
According to the report, the claim process remains one of the most important tests of an insurer's customer experience. While a majority of claimants said their cases were processed within two weeks, four in 10 reported encountering at least one problem.
Hospital- and provider-network-related issues were the most commonly reported concerns, followed by delayed payouts and difficulties with pre-authorisation. These issues can become particularly significant for policyholders at a time when they are already dealing with hospitalisation, medical expenses and uncertainty over treatment.
Hansa Research said technology and artificial intelligence (AI) could play an important role in improving the claims journey by enabling faster processing, strengthening fraud detection and supporting more personalised engagement. However, technology alone may not resolve the underlying customer experience problems if policyholders continue to face uncertainty about coverage, documentation, approval status, or hospital access.
Piyali Chatterjee, executive vice president, CX, Hansa Research, said the claims journey is a defining moment in the policyholder relationship. Faster settlements, she noted, need to be accompanied by wider cashless hospital networks, simpler pre-authorisation procedures, timely payouts and clearer communication about coverage, documentation and claim status.
A dependable and connected claims experience can therefore have a direct bearing on consumer confidence in the insurer.
Rising Medical Costs Driving Demand for Health Cover
Financial protection against rising medical expenses has become an increasingly important reason for purchasing health insurance. The proportion of consumers citing this as a key purchase motivation rose to 54% in 2026 from 48% in 2025, the study said.
However, the increase in demand has been accompanied by higher expectations. Consumers are not only looking for financial protection but also want their policies to deliver when they need medical care.
This creates a challenge for insurers as competition, technology and regulatory attention continue to reshape the health insurance market. Consumers increasingly assess insurers on factors such as trust, transparency, ease of dealing, value, digital capability, innovation and the strength of hospital networks.
Employer Cover Leaves Gaps for Policyholders
The study also found that 32% of consumers use additional health insurance policies to address coverage gaps provided by their employers.
This indicates that employer-sponsored health insurance may not always be sufficient for policyholders' perceived needs. Consumers are therefore increasingly using additional policies to strengthen their protection and manage potential gaps in corporate coverage, the report said.
Digital services are also becoming more important. Mobile applications and self-service tools are gaining traction for activities such as policy renewals and claim tracking, particularly among younger consumers.
Premium Transparency Becomes Important for Retention
Transparency around premiums and policy terms is another area where insurers face pressure from consumers, the report said, adding that unannounced premium increases and hidden terms were identified as leading factors behind policyholders' consideration of policy porting or switching. Clear communication at the time of renewal can, therefore, be an important factor in retaining customers.
For consumers, the issue is not simply the price of the policy but whether they understand what they are paying for and what protection they can reasonably expect when they make a claim.
Faster Claims and Better Hospital Networks Top Consumer Demands
When asked what improvements they want from health insurers, consumers ranked faster claims processing and stronger hospital networks among their top priorities.
The findings suggest that the customer experience is increasingly determined by what happens after a policy is purchased. An insurer's ability to provide access to hospitals, smooth cashless treatment, clear communication, and timely claim decisions can influence whether consumers view their coverage as genuinely useful.
The decline in the industry's NPS from 55% to 50% reinforces this challenge. While consumers may be more willing to purchase health insurance because of rising healthcare costs, their expectations of insurers are also increasing.
Tata AIG Leads Customer Experience Rankings
In the Hansa Research rankings, Tata AIG emerged as the top-performing health insurer, with an NPS of 59%, followed by ICICI Lombard at 55% and Bajaj Allianz at 54%.
Tata AIG was particularly strong on perceptions of trustworthiness and innovation, as well as accessibility and responsiveness.
The rankings, however, sit within a broader industry-wide challenge: insurers must translate brand promises into consistent experiences across the policyholder lifecycle, from purchase and onboarding to customer support, claims and renewals.
For health insurance customers, the ultimate measure of value is increasingly whether the policy works smoothly when it is needed most. As demand for health cover grows, the study suggests that insurers will need to focus not just on selling protection but on making it easier to understand, access, and use.
they do not worry to respond to calls and even writing to their ceo does not bring replies.Life insurance companies are also no better.Govt should impose stiff punishments on these companies who do not respond to customer complaints and irdai should bring in legislation to punish them with monetary and also not to take new policies from customers for 3 to 5 years so that they can put these companies to be more responsive to customers complaints.Even writing to IRdai have not evinced good response i have seen.Organisations may be good but people working make it bad and the management team do not take necessary actions against them.Laws need to made strict.I can give various instances of the issues with various companies.