New Rules By IRDAI To Settle Cashless Claims Faster
  • Understanding IRDAI New Rules
  • Who Is IRDAI?
  • Effectiveness of New Rules
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Quicker Cashless Claim Settlement: IRDAI New Rules

Isn’t it frustrating to wait for days, or even weeks without any response from your health insurer when you need the the most?

According to a recent survey, claim settlement is a challenging process for many insurance holders. A shocking 43% of insurance policyholders have faced difficulty during health insurance claims in the last 3 years on average.

Claim settlement is the most crucial step for any policyholder. The sole reason for purchasing a health insurance plan is to seek financial assistance during hospitalization or other medical treatments. If you have been discouraged before by your health insurer or are hesitant to invest in a comprehensive health cover, do not worry.

New rules by IRDAI to settle cashless claims have been announced recently. Let us shed some light on the issue.

First Things First: Who Is IRDAI?

IRDAI (Insurance Regulatory and Development Authority of India) looks after the licensing and regulation of insurance companies in India. The IRDAI falls under the Ministry of Finance and was founded in 1999 for the benefit of Indian insurance companies and consumers alike.

Quicker Claim Settlement: Circular Issued By IRDAI

The IRDAI has recently released a circular regarding cashless claim settlement asking insurers to approve cashless claims within 3 hours of receiving bills related to hospitals, and medical treatments.

“If there is any delay beyond three hours, the additional amount, if any, charged by the hospital shall be borne by the insurer from the shareholder’s fund”

Additionally, in case of the policyholder’s death, the IRDAI states that hospitals are required to allow the release of mortal remains from the hospital immediately. The governing body has provided time till 31st July for all insurers to align all their infrastructure required to fulfil these conditions.

How Delayed Claim Settlement Affects Policyholders?

Delayed claim settlement is a hassle as it causes multiple problems for policyholders such as:

  • Paying hospital bills from their pocket during discharge
  • Arranging immediate funds in case the hospital bills exceed lakhs
  • Emotional and psychological stress to the family of the patient
  • Gives room to hospitals to charge policyholders with repetitive and fraudulent expenses to increase the overall billing amount
  • Disrupts the common man’s trust in health insurance leading to a negative image of health insurance in India

How Will IRDAI Guidelines Provide Quicker Cashless Claims?

Insurers have to follow the guidelines to help common policyholders in quick cashless claims, which are:

  • The health insurance company must authorize a cashless claim request within 3 hours of receiving discharge authorization from the hospital. The policyholder should not be made to wait in any case making sure the process is smooth and hassle-free.
  • In case there is any additional waiting time, the increased amount charged by the hospital will be paid by the insurer from the shareholder’s fund making insurance holders answerable.
  • In case of the policyholder’s death while undergoing treatment, the insurer is supposed to immediately process the claim request ensuring efficiency and relieving the family and relatives of financial stress.

Concluding Note

Claim settlement is the last and most crucial step of the overall health insurance experience of the policyholders. Most insurance companies, thus take this step with utmost precision and consideration. Sometimes, due to negligence from the policyholder’s or insurance company’s side, a claim might get rejected. This can be terrifying for the insured and a loss of name for the insurer. To avoid these kinds of messy situations for both parties, the new rules declared by IRDAI will bring in a positive change.

So no more fear of unnecessary claim rejection. Stay healthy and insured with the best insurance plans from PolicyX. To know more, give us a call today!

New Rules By IRDAI To Settle Cashless Claims Faster: FAQ's

1. What is IRDAI?

IRDAI (Insurance Regulatory and Development Authority of India) is the regulatory body for all insurance providers in India. It manages and regulates the laws related to insurance and keeps transparency between insurers and insurance providers.

2. When IRDAI was formed in India?

IRDAI was formed in the year 1999 and falls under the Ministry of Finance.

3. What is the last date of implementation of the new rule by IRDAI?

IRDAI has announced that all insurance companies must apply the new rules for quick claim settlement by 31st July 2024.

4. How will the new IRDAI rule benefit you, the policyholder?

The IRDAI's new rules for quick claim settlement will provide you with transparent and hassle-free claim settlement leading to a trusted relationship between the insurer holder and insurance provider.

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Simran Kaur Vij

Written By: Simran Kaur Vij

Simran is an insurance expert with more than 3 years of experience in the industry. She may have all the answers to your insurance queries. With a background in Banking, she proactively helps her readers to stay on par with all the latest Insurance industry developments.