Now health insurance will have to allow cashless treatment within one hour, claim settlement is mandatory within 3 hours of discharge
The Insurance Regulatory and Development Authority (IRDAI) on Wednesday issued a master circular on health insurance, making it clear that the insurance company will have to decide on allowing cashless treatment within one hour of the request. IRDA said in a statement that the master circular on health insurance products has repealed 55 circulars issued earlier and is an important step towards empowering policyholders and strengthening inclusive health insurance.
Big decision in the interest of the policyholder
The insurance regulator said, “The circular brings the entitlements in the health insurance policy available to the policyholder/potential in one place for their easy reference and also emphasizes on measures to provide seamless, faster claim experience to the policyholder purchasing health insurance and to ensure advanced service standards in the health insurance sector.” It said that cashless authorization requests must be decided immediately and within one hour and the final settlement on discharge from the hospital must be given within three hours of the request from the hospital.
Cashless payment within three hours
Earlier, a lot of efforts had to be faced for cashless payment in health insurance, but now it will be done within three hours of receiving the discharge request from the hospital. In the circular issued by the insurance regulator IRDAI on 29 May 2024, it has been said that in any case, the health insurance company will have to make cashless payment of the claim made by the policyholder within three hours of receiving the discharge request from the hospital.
Along with this, in any case, the policyholder will not have to wait till discharge from the hospital. If there is a delay of more than three hours, then in such a situation any additional charge taken by the hospital will be funded by the insurance company to the shareholder.
If the insured dies during treatment…
IRDAI has clearly stated in its Master Circular that under the new guidelines, if a health insurance holder dies during treatment in the hospital, then in this situation the insurance company will have to start the process of payment of the claim immediately. Not only this, the body of the deceased will also have to be removed from the hospital as soon as possible.
The insurance regulator has also changed the rules for emergency cases. The insurance company will have to take an immediate decision on cashless payment within one hour of receiving the request by the insurer. Along with this, IRDAI has directed the insurance companies to complete this work by 31 July 2024, as well as for the convenience of the people, insurance companies should also create a help desk in the hospital if possible so that the process of cashless payment can be made easier.
