30th May 2024 (13 Topics)
1
May
2
May
3
May
4
May
6
May
7
May
8
May
9
May
10
May
11
May
13
May
14
May
15
May
16
May
17
May
18
May
20
May
21
May
22
May
23
May
24
May
25
May
27
May
28
May
29
May
30
May
31
May
IRDAI Introduces New Rules to Speed Up Health Insurance Claims
Context
Delays in settling health insurance claims by insurance companies or third-party administrators (TPAs) have often caused significant stress for patients and their families. To address these issues, the Insurance Regulatory and Development Authority of India (IRDAI) has introduced new rules to streamline the health insurance claim process.
The Need for New Rules
- Policyholders have frequently faced long waiting times for their health insurance claims to be processed, even when pre-approval was already given before hospital admission.
- This delay not only causes inconvenience but also imposes extra financial burdens on patients who have to pay for additional nights in the hospital due to claim processing delays.
- These issues highlight the need for a more efficient and timely claim settlement process.
About the New Rules
- Time Limit for Approving Cashless Claims: IRDAI has mandated that insurers must grant final authorisation within three hours of receiving the discharge request from the hospital. If there is any delay beyond three hours, the additional amount charged by the hospital will be borne by the insurer from the shareholder’s fund.
- Immediate Processing in Case of Death: In the event of a policyholder’s death during treatment, the insurer is required to:
- Immediately process the claim settlement request.
- Ensure the immediate release of the mortal remains (dead body) from the hospital.
- Striving for 100% Cashless Claims: IRDAI has directed insurers to achieve 100% cashless claim settlement in a timely manner.
- Digital Pre-Authorisation Process: Insurers must provide a pre-authorisation process through digital means.
Fact Box: About IRDAI
|
More Articles
Courses
Study
Notes
Home
Resources
More
