The Insurance Regulatory and Development Authority of India (IRDAI) said in a circular on Wednesday, “In emergency cases, the insurance company should decide on the request for cashless authorization within one hour of receiving the application. Companies should prepare for this by July 31.”
Insurance regulator IRDAI has taken a tough decision regarding health insurance. If the policyholder dies during treatment, the claim has to be settled immediately. The body has to be released from the hospital immediately. The regulator has asked insurance companies to achieve 100% cashless claim settlement in a timely manner.
The Insurance Regulatory and Development Authority of India (IRDAI) said in a circular on Wednesday, in emergency cases, the insurance company should decide on the request for cashless authorization within one hour of receiving the application. Companies should prepare for this by July 31. Insurers can set up desks in the hospital to deal with and assist cashless authorization. The regulator told insurance companies to start the pre-authorization process through digital means. This means that an initial amount has been approved by the insurance company.
Claim cannot be rejected without the approval of PMC
In case of health claims, the claim will not be rejected without the approval of the Product Management Committee i.e. PMC or its three-member sub-group. If the claim is rejected or partially rejected, the claimant will be informed with full details including the terms and conditions of the policy document.
Bonus will have to be given
If there is no claim during the policy period, the company can give the customers the option to choose no claim bonus by increasing the insurance amount or giving a discount in the premium amount. It has also been recommended to provide digital facilities to customers for efficient policy renewal, servicing and complaint redressal.
No need to submit any documents
The policyholder will not need to submit any documents. Insurance companies and third party administrators i.e. TPAs will have to collect documents from hospitals.
