Cashless treatment will be allowed in just 1 hour, a major change in health insurance rules

Health Insurance: After covid common man has started to understand the importance of health insurance. The Insurance Regulatory and Development Authority (IRDA), which regulates the sector, is also constantly working to empower consumers, so that insurance companies are not at their mercy. As IRDAI has announced the master circular related to health insurance on Wednesday. In this, insurance companies are clearly told that, if hospitals generate a request for cashless treatment of a patient, they have to approve it in just one hour. Let's understand what other benefits you will get…

A decision has to be taken within an hour only

Suppose you have a health insurance policy and you have to be admitted to a hospital. In this case the hospital generates a request and sends it to the insurance companies whether your treatment will be cashless or not. Now after the change in IRDA rules, the insurance companies have to decide on such request within just one hour and approve or reject the request. There is no clear policy on this yet.

Insurance companies will settle the claim in 3 hours

Insurance regulator IRDAI has made yet another major change in the rules related to health insurance claims. Insurance companies now have to give their final approval within three hours of receiving a patient's discharge request from the hospital. It means that in one way the insurance companies have to settle the claim within 3 hours of the discharge request.

The common man will benefit in this way

Allowing insurance companies 1 hour for cashless treatment will enable the common man to start hospital treatment at the earliest. Not only this, the patient's family members will not be required to collect money at the request of the hospital at the beginning of the treatment.

Getting the final approval of claim settlement within 3 hours of receiving the discharge request will stop the headache with people at the time of discharge and the hospital will also be able to discharge the patient at the earliest and settle his bill.

Old circulars are no longer valid

By issuing this new master circular, IRDA has clarified that all the old 55 circulars related to health insurance are now cancelled. This comprehensive circular has been issued to include all of them. IRDA says the circular aims to empower health insurance consumers and provide them with better options.

Talk from no claim bonus to technical solutions

In this circular, IRDA has emphasized on providing maximum benefits to consumers. For example if a customer does not make any claim during the policy period, he is asked to either increase the sum assured or discount the premium. The real objective of this circular is to complete 100 percent cashless claim settlement in the health insurance sector within a time limit.

Insurance companies have to provide a customer information sheet to every insured customer. In this he has to give complete information in simple language about the type of policy, its sum assured, details of coverage, items outside the coverage, claims to be deducted.

Customers do not have to submit papers for settlement

The circular directs insurance companies to work towards providing end-2-end technology solutions from customer onboarding to policy renewal, policy related services and disputes etc. It says that the policy holder will not submit any documents for claim settlement, but the insurance companies will have to collect them from the hospital itself.

The circular talks about facilitating insurance portability. Further, in case of dispute, if the Insurance Ombudsman gives a decision against the insurance company and it is not implemented within 30 days, the insurance company will compensate the policy holder with Rs 5,000 per day.