Health insurance policyholders have reason to celebrate. With new rules set by the Insurance Regulatory and Development Authority (IRDAI), they will no longer have to wait hours for treatment approval. Moreover, claim settlements will be processed within just a few hours. These changes mark a significant step towards making health insurance more user-friendly and efficient.
Streamlining Health Insurance
In a bid to simplify health insurance, IRDAI has revoked 55 old circulars and issued a comprehensive master circular. This new directive aims to curb the arbitrary practices of insurance companies and ensure smoother processes for policyholders.
Immediate Relief from Financial Strain
One of the major highlights of the new rules is the implementation of a 1-hour and 3-hour rule for cashless insurance. According to IRDAI, insurance companies must now make a decision on cashless treatment within one hour. Previously, many families had to scramble to gather funds at the start of hospital treatments, causing significant stress. This new rule is designed to alleviate such issues.
Faster Claim Settlement Process
Under the new guidelines, insurance companies are required to settle claims within three hours of receiving a discharge request from the hospital. Until now, even with cashless health insurance, patients often faced difficulties in getting their claims settled promptly. This change ensures that patients can now expect quicker resolutions, reducing their stress and hassle.
Efficient Paperwork for Claims
In unfortunate cases where the policyholder passes away, insurance companies must expedite the paperwork to settle claims swiftly, ensuring that the family receives the body without delay. IRDAI has emphasized that insurance companies should strive for 100% cashless claim settlements. In emergency situations, decisions must be made within an hour. Importantly, policyholders will no longer need to submit any documents for claims; instead, insurance companies will collect necessary documents directly from the hospital. The deadline for insurance companies to comply with these new rules is set for July 31, 2024. Additionally, insurance companies are required to set up help desks within hospitals to assist policyholders.
Comprehensive Policy Information
IRDAI has mandated that all insurance companies must provide detailed information about health insurance products, ensuring transparency and preventing companies from withholding critical information. Customers must be given a Customer Information Sheet, which includes all essential details about the policy in simple language.
This includes whether the policy is cashless, the sum insured, coverage details, and any deductions applicable during claims. Customers will also have the freedom to choose from multiple policies, and those who do not make claims will receive offers. If a policy is terminated early, the company must refund the appropriate amount to the customer.
These new rules by IRDAI are set to revolutionize the health insurance sector. With these new rules, IRDAI aims to make health insurance more accessible and less stressful for policyholders, ensuring that they receive the treatment and benefits they deserve without unnecessary delays.
