Technology Trends in Health Insurance — Telemedicine, Wearables, AI
How technology is changing health insurance: telemedicine, wellness plans linked to wearable devices, artificial intelligence in underwriting and claims, and the regulatory sandbox — and what stays the same, namely that the policy wording decides cover and the insurer stays accountable.
Telemedicine
Telemedicine lets a patient consult a doctor remotely, without visiting a clinic. In India the Telemedicine Practice Guidelines were issued in 2020 by the Board of Governors acting in supersession of the Medical Council of India. They recognised teleconsultation as a valid way to practise medicine.
Recognition of the practice is one thing; payment under a policy is another. Whether a health policy pays for a teleconsultation depends on the policy wording.
Wearables and wellness
Wellness-linked plans use data from a wearable device, such as a step count or activity record, to reward healthy behaviour by the policyholder. The idea is that the reward gives a reason to stay active.
The form of the reward, whether a premium discount, reward points or another benefit, and its size are set by each policy's wording. There is no standard figure.
Artificial intelligence
Insurers use artificial intelligence to assess risk at the proposal stage, to speed up routine claims and to flag possible fraud for a closer look. These are tools for sorting and screening.
The decision stays with the insurer. Under IRDAI's 2024 Master Circular no claim can be repudiated without the approval of the insurer's Product Management Committee or Claims Review Committee, and the claimant has to be given reasons that refer to the policy terms. Keeping automated decisions explainable and open to human review is good practice.
Testing new ideas
A regulatory sandbox lets insurers and others test innovations in a controlled way under IRDAI's oversight before wider use. The IRDAI (Regulatory Sandbox) Regulations, 2025, in force from 3 January 2025, replaced the 2019 regulations.
A sandbox is not a general exemption from regulation. It is a supervised trial, and the rules that protect policyholders continue to matter within it.
Rules at a glance
Illustration: a flag is not a decision
An insurer's screening software marks Nikhil's hospital claim as unusual because the bill is higher than similar claims. The mark sends the file to a claims officer; it does not reject the claim.
If, after review, the insurer wishes to repudiate, the approval of its Product Management Committee or Claims Review Committee is needed, and Nikhil has to be told the reasons with reference to the policy terms. If the review finds nothing wrong, the claim is paid under the policy as usual.
Key points
- The Telemedicine Practice Guidelines of 2020 recognised teleconsultation as a valid form of medical practice in India.
- Whether a teleconsultation is paid for depends on the policy wording.
- Wellness-linked plans use wearable-device data to reward healthy behaviour; the form and size of the reward are set by each policy.
- Insurers use AI to assess risk, speed up routine claims and flag possible fraud.
- A claim can be repudiated only with the approval of the insurer's Product Management Committee or Claims Review Committee.
- The IRDAI (Regulatory Sandbox) Regulations, 2025 allow supervised testing of innovations and replaced the 2019 regulations.
Common misunderstandings
- The 2020 guidelines did not make teleconsultations payable under every policy: they recognised the practice, and cover depends on the policy wording.
- There is no fixed discount for wearing a fitness device: the reward's form and size are whatever the policy states.
- An AI tool cannot be the final word on a rejection: repudiation needs the approval of the insurer's designated committee.
- A sandbox is not a zone without rules: it is controlled testing under IRDAI's supervision.
Questions people ask
Who issued the Telemedicine Practice Guidelines?
The Board of Governors acting in supersession of the Medical Council of India, in 2020.
Does a wellness plan reduce the premium?
Only if the policy's reward takes that form. It may instead be reward points or another benefit, as the wording provides.
Are the 2019 sandbox regulations still in force?
No. The 2025 regulations replaced them from 3 January 2025.
What this lesson relies on
- Telemedicine Practice Guidelines (2020)
- IRDAI Master Circular on Health Insurance Business (29 May 2024)
- IRDAI (Regulatory Sandbox) Regulations, 2025
This lesson was reviewed independently against these sources on 8 October 2026. Rules change: check the current regulation, scheme document or policy wording before relying on any figure. This is education, not advice.