IRDAI instructs health insurers to approve cashless claims within 1 hour

In an emergency, the decision should be made within an hour of the request. IRDAI has asked insurance companies to implement these rules by July 31.

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In emergency cases, the insurance company should decide on the request for cashless authorization within one hour of receiving the application, according to a circular issued by the Insurance Regulatory and Development Authority of India (IRDAI) on Wednesday. Companies should prepare for this by July 31. Insurers can create desks in hospitals to handle and assist with cashless authorizations. The regulator has asked insurance companies to start the pre-authorization process through digital means, meaning an initial amount has been sanctioned by the insurance company.

IRDAI issues circular

IRDAI has issued a master circular, canceling 55 previous circulars on health insurance. According to this circular, the policyholder will benefit from claim settlement within three hours of the request. IRDAI has stipulated that the insurance company must settle the case within three hours of receiving the discharge request from the hospital.

Three hour delay not acceptable

The insurance regulator has emphasized that under no circumstances should the patient be made to wait for discharge from the hospital. If there is a delay of more than three hours in the discharge of the policyholder’s patient from the hospital, any additional amount charged by the hospital (if any) will be borne from the funds of the shareholders of the insurance company.

100 percent cashless settlement 

A new rule has been established that in case of the policyholder’s death during treatment, the insurance company must immediately act on the claim settlement request. Moreover, the body will be immediately removed from the hospital. The regulator has mandated that the insurance company should ensure 100% cashless claim settlement in a timely manner and within a stipulated timeframe. In an emergency, the decision should be made within an hour of the request. IRDAI has asked insurance companies to implement these rules by July 31. Hospitals can arrange a help desk for handling cashless requests.