Health insurance cashless claims to be settled in 3-hours: IRDAI
What's the story
The Insurance Regulatory and Development Authority of India (IRDAI) has issued a new master circular to expedite health insurance cashless claims settlement.
This directive, which replaces 55 previous ones, mandates insurers to grant final authorization within three hours of receiving the discharge request from the hospital.
The regulator stated, "In no case, the policyholder shall be made to wait to be discharged from the hospital."
Claim efficiency
IRDAI stresses timely cashless claim settlement
The IRDAI has emphasized the necessity for insurers to achieve 100% cashless claim settlement within a predefined timeframe.
In emergency situations, decisions on cashless authorization requests must be made within one hour of receipt.
To ensure effective implementation, insurers have been directed to establish necessary procedures by July 31, 2024.
Customer support
IRDAI encourages insurers to assist policyholders
The regulator has urged insurers to set up dedicated help desks at hospitals and through other channels to assist policyholders with the cashless claim process.
Insurers are also required to display a list of hospitals and healthcare service providers on their websites where policyholders can avail cashless claim settlement.
If services are used outside these empaneled facilities, policyholders may need to file for reimbursement.
Claim review
IRDAI sets guidelines for claim rejections and mortal remains
The circular states that in the unfortunate event of a policyholder passing away during treatment, hospitals must immediately release the mortal remains.
Additionally, no claim can be rejected without the approval of the Claims Review Committee.
This committee is responsible for carefully reviewing and deciding on every claim rejection.
Industry response
Industry leaders express optimism over new directive
Industry leaders have expressed positivity about these changes.
Sharad Mathur, CEO at Universal Sompo General Insurance Company, anticipates increased adoption of health insurance and higher levels of trust between insurers and policyholders due to this circular.
Anuj Parekh, CEO at Bharatsure, highlighted the significance of faster cashless authorizations and stricter review processes.