IRDAI HEALTH INSURANCE ANNOUNCED CASHLESS CLAIM IN 3 HOURS

After the Notable step of removing the age limit for purchasing health insurance for senior citizens; IRDAI has announced now big relief news!  Now they have upfront their steps towards Insurance companies and their claim facilities.
In IRDAI’s Health Insurance Circular, the insurer has asked to grant the final authorization to the willing person within three hours of receiving the discharge request from the hospital.




 

What is IRDAI 100% Cashless Claim Regulation?

The Insurance Regulatory and Development Authority of India (IRDAI) has directed insurers to aim for 100% cashless claim settlements in a timely manner. For emergency situations, insurers must make decisions on cashless authorizations within one hour of receiving the request.

To achieve this goal, IRDAI has asked insurers to implement the necessary procedures by July 31, 2024. Insurers are encouraged to set up dedicated help desks at hospitals to assist with cashless requests.

On May 29, 2024, New Update of IRDAI

The Insurance Regulatory and Development Authority of India publicized that In the event of the death of the policyholder for the time being the treatment, the insurer will be provided with:

• Urgently process the policyholder’s Cashless claim settlement request.
• Released the mortal from the hospital on a prior basis.

Key Changes by IRDAI in 2024

• Wider Choices for Policyholders

Insurers must offer diverse insurance products, including various add-ons and riders. Products should cater to all ages, regions, occupational categories, medical conditions, treatments, and types of hospitals and healthcare providers.

• Choice of Policy for Multiple Insurance Holders

Policyholders with multiple health insurance policies can choose one of the best of their health insurance policies for claim settlement.

• Customer Information Sheet (CIS)

Insurers must provide a Customer Information Sheet with every policy document.

• No Claim Bonus Options

For policyholders with no claims during the policy period, insurers may offer a No Claim Bonus. The bonus can be in the form of an increased sum insured or a discounted premium amount.

• Premium Refund on Policy Cancellation

Policyholders can receive a refund of the premium or a proportionate amount for the unexpired policy period if they choose to cancel their policy at any time during the policy term.

Over To You, Policyholders and Health Insurance

A survey by Local Circles found that 43% of Health insurance policyholders faced difficulties processing their health insurance claim settlement over the past three years.

The survey indicated that claiming health insurance is often time-consuming, with many policyholders and their families spending the last day of hospital admission trying to get their claims processed.

FAQs

Q1. When can people use IRDAI's new claim regulation facilities?

Ans: Indefinitely. Insurers must implement the new regulations by July 31, 2024, ensuring ongoing access to the facilities introduced.

Q2. What steps must health insurance companies take regarding claim processing and authorization times?

Ans: Insurers must grant final authorization within three hours of receiving a discharge request from the hospital. In the event of the policyholder’s death during treatment, insurers must urgently process the claim settlement and release the body from the hospital on a priority basis.

Q3. How does the new regulation benefit policyholders with multiple health insurance policies?

Ans: Policyholders with multiple health insurance policies can choose which policy to use for their claim settlement, providing more flexibility and control over their health insurance benefits.

Q4. What changes has IRDAI introduced to offer wider choices to policyholders?

Ans: Insurers should offer a diverse range of health insurance products, including add-ons and riders, catering to various ages, regions, occupational categories, medical conditions, treatments, and types of hospitals and healthcare providers.