Insurance Regulator

Insurance companies are taking over six hours to process the majority of health cover claims and facilitate hospital discharges post-settlement.

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Insurance Companies Continue Delays in Hospital Bill Settlements Despite IRDAI Directive

This practice persists despite IRDAI's clear directive that insurers must process cashless authorisation requests within one hour of receipt. According to IRDAI's Master Circular on health insurance, final authorisations for discharge requests should be granted within three hours to ensure timely hospital releases. The directive also stresses that under no circumstances should policyholders be made to wait unnecessarily for their discharge.

Further, IRDAI mandates that any delay beyond three hours requires the insurer to cover any additional charges levied by the hospital from the insurer's shareholder funds. In unfortunate events of policyholder deaths during treatment, insurers are instructed to immediately settle claims and ensure the release of the mortal remains.

However, a recent survey conducted by LocalCircles revealed that 60% of health insurance policyholders who filed claims in the last three years experienced delays ranging from 6 to 48 hours for approvals and discharges. Among the 30,366 respondents, 21% reported settlement processes taking 24-48 hours, 12% experienced 12-24 hours, 14% reported 9-12 hours, and another 12% faced 6-9 hours of delays. Only 8% indicated their claims were processed instantly.

Business Correspondents Advocate for Inclusion in Insurance Sales

The Business Correspondent Resource Council (BCRC) has approached the Insurance Regulatory and Development Authority of India (IRDAI) seeking permission for field agents to sell insurance products. At present, the BC network-introduced in 2007-is limited to last-mile banking services.