Cashless treatment to be approved in just 1 hour, a major change to health insurance rules

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Post Covid, the common man started understanding the importance of health insurance. At the same time, the Insurance Regulatory and Development Authority (IRDA), which regulates this sector, is also continuously working to empower customers so that insurance companies cannot act arbitrarily. Like IRDAI, it issued a general circular related to health insurance on Wednesday. In this regard, insurance companies have been told bluntly that if hospitals generate a request for cashless treatment of a patient, they will have to approve it in just one hour. Let us understand what other benefits you will get…

Let’s say you have a health insurance policy and you have to be admitted to the hospital. In this situation, the hospital generates an application and sends it to the insurance companies to check whether your treatment will be cashless or not. Now, after the change in IRDA norms, insurance companies will have to take a decision on such requests in just one hour and give approval or disapproval to this request. There was still no clear policy in this regard.

Insurance companies will resolve claims within 3 hours

Insurance regulator IRDAI has made another major change in rules related to health insurance claims. Now, as soon as the insurance companies receive the patient’s discharge request from the hospital, the insurance companies will have to give their final approval within three hours. That means, in a way, that insurance companies will have to resolve the claim within 3 hours of the registration request.

Common man will get benefits like this

By giving 1-hour approval to insurance companies for cashless treatment, the common man will be able to start treatment in the hospital at the earliest. Not only this, the patient's family members will not need to raise money at the request of the hospital at the beginning of treatment.

Upon receiving the discharge request, getting final approval for settlement of the claim within 3 hours will end the torture of people in the hospital at the time of discharge and the hospital will also be able to pay its bill by discharging the patient as soon as possible.

All old circulars are no longer valid.

By issuing this new master circular, IRDA has made it clear that all the 55 old circulars related to health insurance have been repealed. This comprehensive circular has been issued including all of them. IRDA says the purpose of this circular is to empower health insurance customers and provide them with better options.

Talk about no claims bonus for technical solutions

In this circular, IRDAI has laid emphasis on providing maximum benefit to the customers. For example, if a customer does not file any claim during the policy period, he has been asked to increase the sum assured or give a discount on the premium. The real objective of this circular is to complete claim settlement in the 100 per cent cashless health insurance sector within the deadline.

Insurance companies must provide a customer information sheet to each insurance customer. In this, you will have to give complete information in plain language about the type of policy, its sum insured, details of coverage, things outside the coverage, information about deductible claims and illness waiting period.

Clients will not have to submit documents for settlement.

The circular directs insurance companies to work towards providing end-to-end technical solutions, from customer onboarding to policy renewal, policy-related services and disputes, etc. It says that the insured will not present any documents for the settlement of the claim, but rather that the insurance companies will have to collect them from the hospital itself.

The circular talks about facilitating the portability of insurance. Also, in the event of litigation, if the Insurance Ombudsman issues a ruling against the insurance company and it is not executed within 30 days. Then the insurance company will give compensation of Rs 5,000 per day to the policyholder.

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