Unannounced medical emergencies cause financial as well as emotional stress. Investing in the best health insurance plans is the key to combat such situations. However, many times customers may face claim rejection causing further distress.
How can we avoid such instances? The answer is to familiarise yourself with the IRDAI ground rules laid by the organization regarding claim settlements and rejections. The IRDAI stands between the customers and insurance providers maintaining trust between the buyer and seller.
This article talks more about all the new health insurance claim settlement rules formed by the IRDAI which will help you minimize health claim rejections.
The Insurance Regulatory and Development Authority of India or IRDAI is the regulatory body of the insurance sector in India. It was incorporated in April 2020. The objective was to increase customer choice and lower premiums by promoting healthy competition among insurance companies.
IRDAI turned the tide of the insurance sector in India by opening the market for foreign insurance companies. Foreign companies were allowed up to 26% ownership.
IRDAI has framed various insurance regulations since 2000. Right from registering insurance companies along with thinking in the best interest of the policyholders is all a part of IRDAI.
With daily regulations and evolving guidelines, the Indian insurance services credit about 7% of India’s GDP along with the banking sector.
Scroll below to discover new health insurance claim settlement rules by IRDAI for claim settlement and claim rejections:
Delayed claim settlements are unfortunately still a problem for many policyholders causing financial and emotional stress.
As per IRDAI, claims should be settled between 35 to 40 days from the day of submission of all documents. However, when the insurer delays settling claims on their end, they are liable to pay 2% interest on the claim amount.
The increased amount will be transferred to your bank account in case of a reimbursement claim or to the hospital directly in case of cashless claims.
If you renew your health plan consistently for 8 years, also known as the moratorium period you are about to gain some serious claim settlement perks!
As per the guidelines laid by IRDAI, an individual can not be rejected for a claim if he/she has completed the moratorium period. However, there are some conditions.
Claims can not be rejected by your insurance provider unless the claim is raised against a condition mentioned in the exclusions list of the policy or is fraudulent.
With COVID-19 putting a chokehold on the healthcare systems of the world, a need for the digital transformation of healthcare was long due.
Due to no physical contact, doctors were asked to consult patients via telephones, video calls, and other digital means which were earlier not covered by health insurance plans.
This was recognized by IRDAI bringing in the guideline of covering the cost of teleconsultations in almost every health insurance plan.
It is available for policyholders who have opted for OPD coverage in their base insurance plan.
There are certain guidelines set in place for a fair business transaction between the insurance provider and buyer which are highlighted below:
The various benefits of familiarising yourself with IRDAI guidelines are:
With the ever-changing landscape of the health insurance sector, it is essential to be familiar with IRDAI claim settlement guidelines.
Being aware of the new IRDAI health insurance claim settlement rules not only enhances your insurance purchase experience but also provides you with the confidence to resolve any claim-related concerns.
For further information regarding claim settlement or rejection, contact our insurance experts at PolicyX.