IRDAI Rules for Insurance Apps and Digital Claims

Only insurers and licensed intermediaries can solicit and sell insurance: corporate agents, brokers, web aggregators and insurance marketing firms, among others. A technology company without a licence can build and run software for them but cannot itself solicit. Online sales run on an Insurance Self-Network Platform under IRDAI's e-commerce guidelines, and the app must show the licensed entity's name and registration details.

The purchase flow has required content at specific points.

IRDAI's 2024 master circular on health insurance set tight timelines for cashless claims. Claims software has to track these clocks and escalate before they expire.

A three-hour discharge rule is not met by people working faster. It is met by a workflow that routes, reminds and escalates.

Whether for an insurer, a TPA or a hospital desk, a claims system needs the following.

IRDAI's Information and Cyber Security Guidelines, issued in 2023, apply to insurers and to intermediaries, with requirements scaled by type. They cover governance, data classification, access control, application security, vendor risk, incident reporting and an annual independent assurance audit. Policyholder records must be held in data centres located in India. The DPDP Act applies in addition.

Apps must show how to complain to the insurer's grievance officer and how to escalate to IRDAI's Bima Bharosa portal and the Insurance Ombudsman. Two industry platforms are changing integrations: Bima Sugam, a common marketplace for policies and services being rolled out in phases, and the National Health Claims Exchange for health claims. Design integrations so these can be added as channels.