Regulator Irdai has recently issued a new mandate requiring health insurers to make decisions on cashless authorisation requests within one hour, in a move aimed at providing policyholders with a faster and more convenient claims experience. The master circular on health insurance products released by Irdai consolidates information from 55 previous circulars, emphasizing the empowerment of policyholders and promoting inclusive health insurance. The circular highlights the importance of offering a wide range of insurance products to cater to various demographics, medical conditions, and healthcare providers, ensuring affordability for policyholders.
One of the key features outlined in the circular is the Customer Information Sheet provided by insurers along with every policy document, simplifying key insurance policy details for policyholders. Additionally, the circular advocates for 100% cashless claim settlement within defined timelines, with immediate decisions on cashless authorization requests and final authorization on discharge from the hospital within three hours of the request.
Furthermore, the circular underscores the importance of technology solutions for seamless onboarding, policy renewal, and grievance redressal for policyholders. It also streamlines the claim settlement process by removing the need for policyholders to submit documents directly, with insurers and third-party administrators collecting necessary documents from hospitals.
In cases of portability requests, the circular imposes stricter timelines on insurers to act promptly. Insurers failing to implement ombudsman awards within 30 days may face penalties, emphasizing the importance of timely claims resolution. Additionally, the circular addresses the release of mortal remains in the event of death during treatment, streamlining procedures and enhancing customer service in the health insurance sector.
Overall, the new mandate by Irdai represents a significant step towards empowering policyholders and ensuring high service standards in the health insurance sector. By focusing on streamlined processes, enhanced transparency, and prompt decision-making, the mandate aims to provide a smoother and more efficient claims experience for policyholders.
