IRDA wants health claims settled in 3 hrs, wants to go fully cashless

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One of the irritants of health insurance policyholders is the frequent delay in settling claims and the extent to which cashless commitments are honoured.

The Insurance Regulatory and Development Authority of India (IRDAI) has issued a new circular concerning health insurance which seeks to address both. It wants that settlement times are brought down and cashless claims are honoured, leading to 100% cashless claim settlement in a time-bound manner, The Economic Times has reported.

The regulator wants that the need for reimbursement claims to arise only in exceptional situations.

Authorisation requests for cashless claims should be decided in an hour of the receiving the communication, and settlement of the same in three hours, said IRDAI. The regulator has further directed insurance companies to have in place all the necessary systems and procedures to meet the new guidelines by July 31 this year.

The final authorisation from the insurer should also be issued within three hours of the company getting a discharge request from any hospital, the regulator has said. If, by any chance, a delay occurs beyond this prescribed time limit, the insurance company must cover additional costs, if any, incurred by the hospital from their shareholders’ funds.

The new rules also allow inurers to give discounts on premium for no claims during the previous policy period. It can also offer higher cover in lieu of no claims.

The IRDAI directive also empowers policyholders to cancel their policies at any point of time during the term by serving a seven-day notice in writing. The current practice requires a period of 15 days.

The regulator has also fixed a grace period of 15 days for monthly premium payments and 30 days for quarterly payment.