We hope this message finds you well. We are writing to inform you of significant regulatory changes introduced by the Insurance Regulatory and Development Authority of India (IRDAI) concerning health insurance policies. These updates aim to enhance your claims experience and ensure higher service standards across the health insurance sector.
Please find below the key highlights from the
IRDAI’s Master Circular dated May 29, 2024:
- Expedited Claims Processing:
✅ Insurers are now mandated to grant final authorization within three hours of receiving the discharge request from the hospital.
✅ Policyholders must not experience any delays in hospital discharge. Should there be a delay beyond three hours, any additional costs incurred will be borne by the insurer from their shareholder’s fund.
- Provisions in the Event of Policyholder’s Death:
✅ Insurers are required to immediately process claim settlement requests upon the death of a policyholder during treatment.
✅ The insurer must ensure the immediate release of the mortal remains (dead body) from the hospital.
- Goal of 100% Cashless Claims:
✅ Insurers are encouraged to achieve 100% cashless claim settlements.
✅ For emergency cases, insurers should decide on the request for cashless authorization within one hour of receipt.
✅ Insurers are to implement the necessary procedures by July 31, 2024, and may set up dedicated help desks in hospitals to assist with cashless requests.
- No Claim Bonus (NCB):
✅ Policyholders may be rewarded for not making any claims during the policy period. The reward options include increasing the sum insured or discounting the premium amount.
- Premium Refunds:
✅ Policyholders are entitled to a refund of the premium or a proportionate premium for the unexpired policy period if they choose to cancel their policy at any time during the policy term.
- Other Changes/Updates:
✅ Enhanced Policyholder Choices: Insurers should offer a wider range of products, add-ons, and riders to cater to various ages, regions, occupational categories, medical conditions, treatments, and types of hospitals and healthcare providers.
✅ Multiple Health Insurance Policies: Policyholders holding multiple health insurance policies have the flexibility to choose under which policy they would like to claim the admissible amount.
✅Customer Information Sheet (CIS): Insurers are required to provide a Customer Information Sheet (CIS) along with every policy document to ensure transparency and clarity for policyholders.
These changes are designed to provide a more seamless, efficient, and hassle-free experience for all policyholders.
For more detailed information,
Please refer to the complete IRDAI Master Circular here
Please refer to the news article here
