Cashless claim settlement for all from Aug 1

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Good news awaits all health insurance policyholders as insurance procedures are set to become smoother and faster. Starting August 1st this year, insurance companies are mandated to settle health insurance claims through cashless transactions, enhancing the experience for policyholders when settling hospital bills. The Insurance Regulatory and Development Authority of India (IRDAI) has instructed insurers to establish necessary systems and procedures by July 31, 2024, ensuring immediate action.

IRDAI emphasised the need for insurers to facilitate cashless requests promptly, both through physical Help Desks at hospitals and digital pre-authorization for policyholders. The directive aims for a seamless transition to cashless claim settlements, with insurers urged to minimize reimbursement cases to exceptional circumstances only, newspaper Indian Express has reported.

According to the IRDAI’s Master Circular on health insurance, insurers must decide on cashless authorizations within one hour of receiving requests and provide final authorizations within three hours of discharge authorization requests from hospitals. Any delay beyond this timeframe will require insurers to cover additional charges incurred by the hospital.

In unfortunate instances of policyholder demise during treatment, insurers are required to expedite claim settlements and facilitate the immediate release of mortal remains from hospitals.

Claim settlement has historically posed challenges for policyholders, with a significant portion facing difficulties, including claim rejections and lengthy processing times. In response, IRDAI mandates that no claim be repudiated without proper approval, and insurers must communicate claim details along with policy terms and conditions to claimants promptly.

Moreover, policyholders now have the option to transfer their policies from one insurer to another, with insurers mandated to seamlessly transfer underwriting details and claim history. The process, facilitated through the Insurance Information Bureau of India (IIB), ensures policyholders retain benefits like sum insured, no claim bonus, and specific waiting periods with the acquiring insurer.

IRDAI’s directives aim to streamline health insurance processes, providing policyholders with faster claim settlements and smoother policy transitions.