Published Paper Details:

India's health insurance landscape has undergone notable transformation in recent years, fuelled by policy interventions, rising health awareness, and increasing healthcare costs. While flagship schemes like Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and the growth of private health insurance have broadened coverage, significant barriers remain in achieving universal, equitable, and affordable healthcare access. This paper examines the current legal and policy structures governing health insurance in India, focusing on core legislations such as the Insurance Act, 1938, and the IRDA Act, 1999, alongside regulations set by the Insurance Regulatory and Development Authority of India (IRDAI). Key issues explored include regulatory gaps, insufficient coverage for marginalised communities, high out-of-pocket expenses, inconsistency across insurance products, and limited mechanisms for grievance redressal. The dual nature of public and private schemes has also led to inefficiencies and overlapping benefits. Further, the paper discusses how judicial pronouncements and constitutional provisions, especially Articles 21 and 47, have shaped the recognition of health as a fundamental right. Looking ahead, the study advocates for integrated policy planning, stronger regulation of private insurers, improved health literacy, digital innovation, and bolstered primary healthcare systems. It calls for the enactment of a comprehensive national health insurance law and a transparent, rights-based framework to close existing coverage gaps. The paper concludes that a cohesive and inclusive approach is vital to achieving Universal Health Coverage (UHC) and ensuring that no citizen is left behind in accessing essential health services.