Health insurance claim rule change: Insurance companies have to decide on treatment permission within 1 hour of the request and settle the claim within 3 hours. These three hours will start when the hospital informs them for the claim.
The Insurance Regulatory and Development Authority (IRDA) issued a basic circular on health insurance on Wednesday. In this, the insurance regulator clarified that the insurance company will have to decide on allowing cashless treatment within one hour of the request. IRDA said in a statement that 55 circulars already issued on health insurance products have been repealed. This is an important step towards strengthening the empowerment of policyholders and promoting inclusive health insurance.
Insurance companies will have to decide on treatment permission within 1 hour of the request and settle the claim within 3 hours. These three hours will start when the hospital informs them for the claim. Also, this circular states that the policyholder does not need to provide any documents to prove the claim. According to the circular, this work will have to be completed by the insurer and TPA in coordination with the hospital.
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The insurance regulator said, “The circular brings together the entitlements in health insurance policy available to policyholders/prospects at one place for their easy reference and also emphasises on measures to provide seamless, faster claim experience to policyholders purchasing health insurance and to ensure enhanced service standards in the health insurance sector.”
It states that insurance companies will provide a wide range of options to suit the affordability of the policyholders by offering a variety of insurance products for all ages, regions, medical conditions/all types of hospitals and health care providers by providing ‘products/add-ons/riders’. It also mentions the Customer Information Sheet (CIS), which is provided by the insurance company with every insurance document.
