IRDAI Mandates 1-Hour Approval for Cashless Claims
New Delhi. 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.
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.
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.
Benefits for Policyholders
Reduced Stress: Faster approvals mean less financial worry and paperwork hassle for patients during hospitalization.
Improved Efficiency: The streamlined process allows for quicker discharges and reduced administrative burdens on hospitals.
Greater Transparency: Clear timelines for claim approvals enhance transparency in the health insurance system.
Implementation Timeline
IRDAI has set a deadline of July 31st, 2024 for health insurers to implement the necessary systems and procedures to comply with the new regulation. This ensures a smooth transition for both insurers and healthcare providers.
A Step Towards Easier Healthcare
IRDAI's mandate for faster cashless claim approvals is a welcome step for policyholders in India. It signifies a commitment to improving the efficiency and accessibility of healthcare services for those who rely on health insurance plans.