IRDAI mandates faster cashless claim approvals | Fusion - WeRIndia

In a significant move, the Insurance Regulatory and Development Authority of India (IRDAI) has mandated health insurance companies to finalize authorizations for cashless claims within three hours of receiving a patient discharge request from the hospital.

The new directive, issued in a master circular on Wednesday, aims to prevent policyholders from waiting unnecessarily for discharge.

According to the IRDAI, any delay beyond the three-hour deadline will require insurers to cover any additional charges incurred by the hospital.

Insurers need to establish the necessary infrastructure to implement these changes by July 31, 2024.

Here are the key changes in health insurance policies:

Insurers must approve cashless claims within three hours of receiving a discharge request from a hospital. This measure ensures that policyholders are not delayed unnecessarily.

If the approval process exceeds three hours, insurers will be responsible for any extra charges levied by the hospital.

In the event of a policyholder’s death during treatment, insurers are now required to ensure the immediate release of the mortal remains from the hospital.

For emergency cases, insurers must decide on cashless authorization requests within one hour of receiving the request, facilitating faster treatment.

Insurers can offer a pre-authorization process digitally for faster approval. This process ensures that an initial amount is sanctioned and acknowledges that the claim will be paid subject to the final invoice from the hospital.

Here are some additional benefits for policyholders:

Policyholders who do not make any claims during the year will be rewarded with a ‘No Claims Bonus’. They can choose between an increased sum insured or a discount on the premium at renewal. This is an enhancement over the current system, which only offers a cumulative bonus.

Customers can cancel their policy at any time and receive a refund of the premium for the remaining period. This provides greater flexibility and value for policyholders.

Insurers must offer a variety of products, add-ons, and riders to cater to different ages, medical conditions, treatments etc.

Policyholders can avail of a discount on the premium if no claims were made in the previous year. At renewal, they can choose between increasing the sum insured or getting a premium discount.

These changes aim to enhance the efficiency and responsiveness of health insurance services, ensuring better support and benefits for policyholders across India.

Image by Mohamed Hassan from Pxhere (Free for commercial use / CC0 Public Domain)

Image Published on January 1, 2019

Image Reference: https://pxhere.com/en/photo/1541055