Health Insurance: Cashless Authorization To Be Done In An Hour, No Claim Bonus May Be Awarded, Says IRDAI

Health Insurance: Cashless Authorization To Be Done In An Hour, No Claim Bonus May Be Awarded, Says IRDAI

This, as in many cases, hampered processing can delay the eventual discharge and could increase the cumulative fee on account of an extended stay.

Juviraj AnchilUpdated: Thursday, May 30, 2024, 10:43 AM IST
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In what is seen as a major and much-needed change, the insurance regulatory body of India, IRDAI, in a new master circular released on May 29, has brought about some crucial changes to the paradigm of cashless claim settlement. One of the points mentioned was regarding the cashless settlement of claims.

Cashless Claim in an Hour

The circular said, "To decide on cashless authorization requests immediately and within one hour and final authorization on discharge from hospital within three hours of request from the hospital."

This, as the ordeal of completing the process, has often beleaguered patients and their families alike. IRDAI also laid emphasis on the usage of technology and the need to settle 100 per cent cashless claims in a time bound manner. There have been many instances of patients and their families vying to pay the bills, in the dearth of approval of insurers or third parties, that have come to the fore.

This, as in many cases, stuck up can delay the eventual discharge and could increase the cumulative fee on account of an extended stay.

In addition, the new rule also talked about other instances, including the case of the demise of a patient under treatment. The circular read, "In the event of death during the treatment, mortal remains to be released from the Hospital immediately."

IRDAI also said, that no claim can be rejected without the approval of the claims review committee, which is mandatory for every single claim.

"In case of no claims during the policy period, the insurers may reward the policyholders by providing an option to choose such 'No Claim Bonus' either by increasing the sum insured or discounting the premium amount." |

The IRDAI said, that it has repealed 55 circulars and brought in some other changes, including expanding the choices available to customers, allowing to select from a diverse set of insurance products, and providing greater flexibility to the customers.

No Claim Bonus

In addition, the regulatory body also touched upon the issue of no claim of insurance in a given period, and said, "In case of no claims during the policy period, the insurers may reward the policyholders by providing an option to choose such 'No Claim Bonus' either by increasing the sum insured or discounting the premium amount."

Customer can also use the 'Free Look Period', wherein duringthe span of 30 days, customer will have review and therefore scrutinse the terms and conditions of the policy.

Customer can also use the 'Free Look Period', wherein duringthe span of 30 days, customer will have review and therefore scrutinse the terms and conditions of the policy. |

The circular also referred to the element of the Customer Information Sheet or CIS, and said that, the form should consist of details including type of insurance, sum Insured, coverage provided, summary of exclusions which policy does not cover, sub-limits, deductibles and waiting period.

Customer can also use the 'Free Look Period', wherein duringthe span of 30 days, customer will have review and therefore scrutinse the terms and conditions of the policy. In this, if the policy holder is not content with the policy, they reserve the right to rescind the policy, if the term is for a year or more.

These new policies will be effective immediately and the required change will have be to implemented before May 30.

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