Saturday, June 15, 2024

Health Insurance: IRDAI Advocates for 100% Cashless Claim Settlement

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Health Insurance Regulatory and Development Authority of India (IRDAI) has issued a new circular aimed at improving health insurance services for policyholders. This initiative focuses on reducing settlement times and ensuring a seamless cashless claim process. The regulator’s goal is to achieve 100% cashless claim settlement, thereby minimizing the need for reimbursement claims, which will be reserved for exceptional circumstances.

One of the key directives in the circular is that insurers must decide on authorisation requests for cashless claims within one hour of receipt. This expedited process is intended to provide faster access to necessary medical treatments without the financial burden on policyholders. Furthermore, insurance companies are required to give final authorisation within three hours of receiving a discharge request from the hospital. Should there be any delay beyond this timeframe, the insurer must cover any additional costs incurred by the hospital, using their shareholders’ funds.

The circular also introduces a new grace period for premium payments, providing 15 days for monthly premiums and 30 days for quarterly premiums. This extension aims to offer policyholders more flexibility in managing their premium payments, thereby reducing the risk of policy lapses due to financial constraints.

In addition to these measures, IRDAI has mandated that insurance companies implement the necessary systems and procedures to comply with the new guidelines by July 31, 2024. This includes ensuring that all processes related to cashless claim settlements are streamlined and efficient, enhancing the overall customer experience.

Policyholders now have the flexibility to cancel their policies at any time during the term by providing a 7-day notice in writing. This is a reduction from the previous 15-day notice period, offering more freedom and control over their health insurance policies.

Health Insurance

Health Insurance Sector Sees Improvements with New IRDAI Regulations for Faster Settlements and Cashless Claims

The introduction of these new regulations reflects IRDAI’s commitment to improving the health insurance sector in India. By enforcing quicker settlement times and ensuring cashless claim processes, the regulator aims to enhance the accessibility and reliability of health insurance services. This move is expected to build greater trust between insurers and policyholders, as well as to promote a more customer-centric approach in the industry.

The new circular also highlights the importance of technology in modernizing health insurance services. By leveraging advanced systems for real-time claim processing and authorisation, insurers can significantly reduce the time and effort required to settle claims. This not only benefits policyholders by providing quicker access to funds but also helps insurance companies streamline their operations and reduce administrative costs.

Moreover, the circular’s emphasis on covering additional costs incurred due to delays showcases IRDAI’s commitment to holding insurers accountable. This provision ensures that policyholders are not financially burdened due to procedural inefficiencies, thereby reinforcing the regulator’s focus on protecting consumer interests.

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Overall, the new health insurance guidelines issued by IRDAI represent a significant step towards creating a more efficient, transparent, and customer-friendly insurance sector in India. By prioritising cashless claims, reducing settlement times, and offering greater flexibility in premium payments and policy cancellations, the regulator aims to foster a more supportive and responsive health insurance environment. This initiative is expected to enhance the overall experience for policyholders, providing them with the assurance that their health insurance needs will be met promptly and effectively.

Resource: Economic Times İndiatimes, May 30, 2024

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