Health insurance: IRDAI sets 3-hour time limit to clear cashless claims. Details here

Health insurance: The IRDAI said that in emergency cases, the insurer should decide on the request for cashless authorisation immediately. Details here

The Insurance Regulatory and Development Authority of India (IRDAI) made major changes in the regulatory norms for health insurance policies and issued a comprehensive Master Circular on Health Insurance Products repealing 55 circulars. IRDAI said that the insurer must grant final authorisation within three hours of receiving receipt of discharge request from the hospital.

Health insurance: The IRDAI issued a comprehensive Master Circular on Health Insurance Products repealing 55 circulars. Details here

The regulator noted, "In no case, the policyholder shall be made to wait to be discharged from the hospital. If there is any delay beyond three hours, the additional amount if any charged by the hospital shall be borne by the insurer from shareholder’s fund."

The IRDAI said that in emergency cases, the insurer should decide on the request for cashless authorisation immediately. To do the same, the regulator ordered insurers to put necessary producers in place immediately by July 31, 2024. The insurers can also arrange dedicated help desks in physical mode at the hospital to deal with cashless requests, the regulator said.

What are some other changes IRDAI announced?

1. IRDAI said policyholders should be provided wider choices by the insurers by making available products/add-ons/riders. To serve the same purpose, insurers must offer diverse insurance products catering to all ages, regions, occupational categories, medical conditions/ treatments, all types of Hospitals and Health Care Providers.
2. Policyholder with multiple health insurance policies will get the option of choosing the policy under which he/she can get the admissible claim amount.
3. Insurers will need to provide a Customer Information Sheet (CIS) along with every policy document.
4. In case of no claims during the policy period, insurers may reward the policyholders by providing an option to choose like increasing the sum insured or discounting the premium amount.
5. Policyholder will get refund of premium/ proportionate premium for the unexpired policy period, in case they choose to cancel the policy at any time during the policy term.

Earlier, a survey by Local Circles found that 43 per cent of insurance policyholders had difficulties processing their “health insurance” claims. The survey noted, "In several cases cited by policyholders, it took 10-12 hours after the patient was ready for discharge for them to get discharged because the health insurance claim was still getting processed. If they stay back at the hospital another day to do so, the cost of that additional night's stay has to be borne by them. According to several patients, this is the experience where the insurance company has already provided a pre-approval to the hospital's TPA desk before admission of the patient."