IRDAI Sets New Guidelines for Faster Health Insurance Claims

May 30, 2024

The Insurance Regulatory and Development Authority of India (IRDAI) recently put out a very important statement that aims to make health insurance services in India more efficient and effective. This change is meant to make the cashless claim process easier and faster for policyholders and to make insurance companies follow strict reaction times.

100% Cashless Claim Settlements

The new rule says that all insurance companies must try to settle all claims without using cash. That is, deals that need cash should only happen very rarely and in very special situations. The main goal of these rules is to make it much less necessary for policyholders to get reimbursed after treatment. This will make the process easier and more patient-friendly.

Strict Timelines for Claim Processing

With the new rules, insurance companies have to answer requests for cashless claims authorization within an hour of getting them. In medical situations, where time is often of the key, this quick response is very important. Also, for release procedures, the final approval should be given within three hours of getting the request from the hospital in question.

Penalty for Delays

If an insurance company doesn’t meet the three-hour limit for discharge authorizations, IRDAI makes them pay for any extra costs that arose because of the delay. The insurer’s own funds, especially the funds from its shareholders, will pay for these costs. This is to make sure that policyholders don’t lose money because of the delay.

Policy Cancellation and Grace Period Adjustments

Additionally, the circular makes it easier for customers who want to cancel their insurance. The time you have to give to stop has been cut from 15 days to 7 days. A written notice is now enough. For monthly premiums, you have 15 days to make up for late payments. For quarterly premiums, you have 30 days. This clause gives consumers some freedom in how they handle their finances without affecting their insurance coverage right away.

Facts About IRDAI

Establishment and Purpose:

Founded in 1999.
Located in Hyderabad, India.
Regulates and promotes the insurance and re-insurance industries in India.

Mission and Objectives:

Protects policyholder interests.
Ensures growth and development of the insurance sector.

Consumer Protection Initiatives:

Launched the “Bima Bemisaal” consumer education website.
Instituted a 15-day “Free Look Period” for policy cancellations, which increased customer rights.

Technological Advancements: