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The Insurance Regulatory and Development Authority (IRDA) on Wednesday issued a master circular on health insurance and clarified that the insurance company will have to decide on allowing cashless treatment within one hour of the request. IRDA said in a statement that health insurance products But the Master Circular repeals 55 circulars issued earlier and is a significant step towards empowering policyholders and strengthening inclusive health insurance.
Big decision in the interest of the policyholder
The insurance regulator said, “This circular brings together the rights in a health insurance policy available to a policyholder/prospect at one place for their easy reference and also emphasises on measures to provide seamless, faster claim experience to the policyholder purchasing health insurance and to ensure enhanced service standards in the health insurance sector.”
It said that cashless authorisation requests should be decided promptly and within one hour and final settlement should be done upon discharge from the hospital within three hours of the request from the hospital.
Cashless payment within 3 hours
Earlier, one had to face a lot of effort for cashless payment in health insurance, but now it will be done within three hours of receiving the discharge request from the hospital. In a circular issued by the insurance regulator IRDAI on May 29, 2024, it has been said that in any case, the health insurance company will have to make cashless payment of the claim made by the policyholder within three hours of receiving the discharge request from the hospital.
In addition, in no case will the policyholder have to wait until the patient is discharged from the hospital. If there is a delay of more than three hours, then in such a situation any additional charge taken by the hospital will be paid to the subscriber by the insurance company.
If the insured dies during treatment…
IRDAI has clearly stated in its master circular that under the new guidelines, if a health insurance holder dies during treatment in the hospital, then in this situation the insurance company will have to immediately start the process of paying the claim. Not only this, along with this, the body of the deceased will also have to be removed from the hospital as soon as possible.
The insurance regulator has also changed the rules for emergency cases. The insurance company will have to take an immediate decision on cashless payment within one hour of receiving the request. Along with this, IRDAI has directed the insurance companies to complete this work by 31 July 2024 and for the convenience of the people, insurance companies should also set up a help desk in the hospital if possible so that the process of cashless payment can be made easier.
