The General Insurance Council (GI Council) on August 3 clarified that its advisory on hospital admission criteria for fever and infectious diseases is not a binding directive but an evidence-based framework intended to curb unnecessary hospitalisation and rising healthcare costs. Responding to criticism from sections of the medical fraternity, the Council said the advisory does not restrict doctors' clinical autonomy and is based on existing clinical guidelines from the ICMR, the Ministry of Health and Family Welfare, and the National Vector Control Board.
According to the Council, health insurance claims have risen sharply in recent years — total health claims settled touched Rs 94,247.6 crore in 2024-25, with cashless hospitalisations accounting for 66.4% of admission volume. The industry says it receives hundreds of cases every month involving admissions for minor fever, unnecessary diagnostic tests and prolonged stays not supported by clinical evidence.
The Council said avoidable admissions expose patients to hospital-acquired infections, increase medical expenses, inflate premiums and strain healthcare resources. It described the advisory as a 'living framework' that will be updated in line with revisions to ICMR and MoHFW guidelines, and invited clinical experts, hospital associations and medical societies to provide evidence-based feedback.
Doctors and nursing home owners have previously expressed fears that insurers could use the guidelines to deny legitimate cashless claims, particularly at smaller hospitals.
Source: Moneycontrol (August 3, 2026)