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 it 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 by your health insurer before 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 these new regulations.
First Things First: Who Is IRDAI?
IRDAI (Insurance Regulatory and Development Authority of India) oversees the licensing and regulation of insurance companies in India. Falling under the Ministry of Finance, IRDAI was founded in 1999 to benefit both Indian insurance companies and consumers.
Quicker Claim Settlement: Circular Issued By IRDAI
IRDAI recently released a circular regarding cashless claim settlement, instructing insurers to approve cashless claims within 3 hours of receiving bills related to hospital 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 a policyholder's death, IRDAI states that hospitals are required to allow the immediate release of mortal remains. The governing body has given all insurers until July 31st to align their infrastructure to fulfill these conditions.
How Delayed Claim Settlement Affects Policyholders
Delayed claim settlement is a hassle, causing multiple problems for policyholders such as:
- Paying hospital bills from their pocket during discharge.
- Arranging immediate funds if hospital bills exceed lakhs.
- Emotional and psychological stress for the patient's family.
- Allows hospitals to charge policyholders with repetitive and fraudulent expenses, increasing the overall billing amount.
- Disrupts the common person's trust in health insurance, leading to a negative image of health insurance in India.
How Will IRDAI Guidelines Provide Quicker Cashless Claims?
Insurers must follow these guidelines to facilitate quicker cashless claims for policyholders:
- The health insurance company must authorize a cashless claim request within 3 hours of receiving discharge authorization from the hospital. This ensures a smooth and hassle-free process, preventing policyholders from unnecessary waiting.
- If there is any additional waiting time, the increased amount charged by the hospital will be paid by the insurer from the shareholder's fund, holding insurers accountable.
- In case of a policyholder's death while undergoing treatment, the insurer must immediately process the claim request, ensuring efficiency and relieving the family and relatives of financial stress.
Concluding Note
Claim settlement is the final and most crucial step in a policyholder's overall health insurance experience. Most insurance companies approach this step with utmost precision and consideration. Sometimes, due to negligence from either the policyholder's or the insurance company's side, a claim might get rejected. This can be distressing for the insured and damaging for the insurer's reputation. To avoid such situations for both parties, the new rules declared by IRDAI are expected to bring about a positive change.
With these changes, policyholders can have less fear of unnecessary claim rejection. Stay healthy and insured with the best insurance plans from PolicyX. To know more, give us a call today!
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