Regulating the Clock: Health Insurance Claims Settlement in Sri Lanka and the Lessons of India's Time Bound Cashless Rules

Health insurance is not marginal to Sri Lanka's health system anymore, even if it remains small. Out of pocket spending makes up roughly half of current health expenditure, and health insurance, including the Agrahara scheme for public employees, has been estimated at only around 2.4 per cent (1). A 2024 study put voluntary health insurance at about 5 per cent of private financing while noting considerable recent growth in the market (2). Employer schemes and private policies together cover something like a tenth of the population, mostly formal sector workers and their families (3). As public facilities came under strain after 2022, more middle-income households have turned to private care, and insurance determines whether that choice is affordable. This paper asks a narrow question. How does Sri Lankan law treat the speed and fairness of health claims settlement, and what can be learned from other countries, which in 2024 put an explicit clock on insurers?