All you need to know about Irdai's new health insurance rules

The regulator has mandated health insurers to provide cashless authorisation within one hour, and final authorisation within three hours of intimation

- BENN KOCHUVEEDAN

THE Insurance Regulatory and Development Authority (Irdai) recently came up with a series of changes in the health insurance sector that will go a long way in improving service standards for policyholders.

The regulator has mandated health insurers to accept/reject a cashless claim immediately and latest by within one hour, and settle such a claim on discharge within three hours, else bear the additional cost if any. These game-changers have many benefits to policyholders as they significantly reduce the stress and anxiety associated with claim processing during hospitalisation.

This is also the harbinger for 100% cashless claim settlement in a time-bound manner and a major step in streamlining the real ordeal of both hospital admission and discharge. The master circular comes into effect immediately.

The new master circular repeals 55 previous circulars. Under the new norms, an insurer can't repudiate a claim sans the approval of its claims review panel. For claim settlement, the insurer and the third-party administrator must collect documents from hospitals and not from the insured. Also, policyholders with multiple health policies can select the policy under which they make the claim wherein the primary insurer will coordinate the settlement of the balance amount from other insurers. The new rules ask insurers to reward policyholders with no claims during the policy period by offering either an increased sum insured or discounted premium amounts.