Health Insurance Cashless Claim: The Insurance Regulatory and Development Authority of India (IRDAI) said that insurers can also arrange a help desk in physical mode at the hospital to deal with cashless requests.
Health Insurance Cashless Claim: The Insurance Regulatory and Development Authority of India (IRDAI) has made major changes in the regulatory norms for health insurance policies and has issued an impressive master circular on health insurance products.
IRDAI said that the insurer will have to provide final authorization within three hours of receiving the information given by the hospital about discharge. That is, the claim made within three hours will have to be cleared.
The regulator said, “Under no circumstances should the policyholder wait to be discharged from the hospital. If there is a delay of more than three hours, the excess amount charged by the hospital (if any) will be borne by the insurer from the shareholder’s fund.”
IRDAI said that in emergency cases, the insurer should promptly decide on the request for cashless authorisation. To do so, the regulator ordered insurers to immediately put in place the necessary plan by July 31, 2024.
The regulator said insurers may also arrange a help desk in physical mode at the hospital to deal with cashless requests.
Relief for Patients and Their Families (IRDAI Changes)
- IRDAI said that insurers should provide policyholders with a wide range of products/add-ons/riders. To achieve this objective, insurers should offer a variety of insurance products for all ages, regions, occupational categories, medical conditions/treatments, all types of hospitals and healthcare providers.
- Policyholders having more than one health insurance policies will get the option to choose the policy under which they can receive the admissible claim amount.
- Insurance companies will also have to provide Customer Information Sheet (CIS) with each policy document.
- In case there is no claim during the policy term, insurers can help policyholders by providing options like increasing the sum assured or discounting the premium amount.
- If the policyholder chooses to cancel the policy at any time during the policy term, they will get refund of premium/proportionate premium for the remaining policy term.
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