Health insurers will make the decision about cashless authorization: A master circular on health insurance was posted by regulator Irdai on Wednesday, stating that an insurer must determine whether to approve cashless authorization within an hour of receiving a request.
Irdai stated in a statement that the master circular on health insurance products, which repeals 55 previous circulars, is a major step toward promoting inclusive health insurance and policyholder empowerment.
“The circular has consolidated the benefits that policyholders and prospective policyholders can access in one location for convenient reference. It also highlights steps to ensure that policyholders obtaining health insurance policies have a smooth, expedient, and hassle-free claims process, as well as higher service standards throughout the health insurance industry,” the statement reads.
Highlighting key points from the master circular, it stated that insurers should give policyholders more options by offering a variety of products, add-ons, and riders that cater to a wide range of age groups, locations, medical conditions, and hospital and healthcare provider types, all at the policyholders’ affordability.
It also mentions the Customer Information Sheet (CIS), which every insurance document is issued with by the insurer.
Simple terms such as kind of insurance, sum insured, coverage specifics, exclusions, sub-limits, deductibles, and waiting periods are used to describe the fundamental elements of insurance plans.
The insurers may offer policyholders a No Claim Bonus if they file no claims during the policy period. This bonus may take the form of a premium discount or an increase in the sum insured. In a timely way, the master circular advocates for working toward the ease of 100% cashless claim settlement.
“To determine cashless authorization requests promptly and within one hour, and final authorization upon hospital discharge within three hours of the hospital requesting it,” the statement stated.
It also discusses offering end-to-end technological solutions for grievance redressal, policy servicing, insurance renewal, and the successful, efficient, and smooth onboarding of policyholders.
It stated that in order to settle a claim, the policyholder would not need to provide any documentation; instead, insurers and third-party administrators (TPAs) would gather the necessary records from the hospitals.
Stricter deadlines are being enforced for the existing insurer and the acquiring insurers to take action regarding portability requests on the Insurance Information Bureau of India (IIB) portal, it added.
If ombudsman awards are not implemented within 30 days, an insurance may be required to pay the policyholder Rs 5,000 every day. It said that if a patient passes away while receiving treatment, their mortal remains would be promptly released from the hospital.
It further stated that this master circular fosters an atmosphere of trust and transparency in the health insurance industry by empowering consumers and guaranteeing they receive the best treatment and services possible.
