The body most likely to set your tariff is not a regulator, a court or a parliamentary panel

Two tariff stories have had the headlines this year. The Supreme Court matter on Rule 9(ii) of the Clinical Establishments Rules, and a parliamentary panel suggesting private room rates be capped at three-star hotel tariffs. We wrote about both in Two arms of the state are converging on the same thing.

Neither is the mechanism most likely to actually set what you are paid.

What happened in March

The IRDAI chairman, Ajay Seth, said in March 2026 that health insurance premiums had been rising at 10 to 12 per cent a year against general inflation of five to six, and that another three or four percentage points above inflation would make cover unaffordable. He described holding separate rounds of meetings with payers and with providers, then bringing them together.

That combined meeting took place on 17 March 2026. It produced five working groups, each co-chaired by an insurance-industry and a hospital-industry leader, with most work beginning in April and running two to four months:

• Joint Code of Conduct — discharge streamlining, empanelment standardisation, dispute resolution
• Categorization of Providers — data-driven classification of hospitals using accreditation and geography
• Scale-up of the National Health Claims Exchange
• Focused Analytical Studies — claim trends, cashless against reimbursement, drivers of medical inflation
• Simplified Products and Wellness

And in August

In August 2026 it was reported that IRDAI was convening a reform panel on rising medical costs, chaired by the regulator's chief and including insurers, hospitals and CII. Four items were described as on the table: benchmarked treatment rates agreed between insurers and hospitals, a standardised health product every insurer would offer, a uniform list of admissible treatments, and expansion of the claims exchange. Medical inflation was put at 12 to 14 per cent, and industry estimates that 10 to 15 per cent of health claims are unwarranted or fraudulent were cited.

Recommendations are expected by the end of the year. Implementation would follow.

Why hospitals are resisting

The opposition is on the record and it is not subtle. AHPI's director general has said that hospitals would be forced to accept rates like Ayushman Bharat's, and that this is damaging. The IMA's hospital board argued that around 80 per cent of India's beds sit in small and medium hospitals, and that mandatory common empanelment would end many of them.

That resistance has already had teeth. In 2025, AHPI directed members to suspend cashless services for one insurer's policyholders, and four insurers separately delisted Max Healthcare, which was reported as saying its tariffs had been stagnant at 2022 levels. Most of those disputes were resolved within weeks, and notably without regulatory intervention. We have found no reported cashless suspension dated 2026, though we cannot tell whether that means the disputes settled or simply stopped being covered.

What this means for your hospital

If you are small or mid-sized, the categorisation exercise is the thing to watch, because it will decide which band you are paid in and the inputs are accreditation and geography. Accreditation is the one you control. That is now the third payer mechanism in eighteen months to price it directly.

More immediately, know your own costs. When a benchmark rate is proposed for a procedure, the hospitals that fare worst are those that can only respond that the rate is too low. The ones that fare best can show what the procedure costs them and why. Very few Indian hospitals below the large chains can currently do that, and the working groups are running on a two to four month clock.

One caution on the record itself: one account reports five working groups formed on 17 March, another reports ten established on 19 March. We could not reconcile the two against an IRDAI document and have used the earlier, more specific account.