Cashless Health Insurance Settlement: IRDAI has issued directions to insurance companies that the insurer should decide on the request for cashless authorization immediately, but not more than one hour from the date of receipt of the request.
Cashless Health Insurance Settlement: Insurance companies will have to settle health insurance claims cashlessly from August 1 this year, which will make the settlement of hospital bills of policyholders easier and faster. The Insurance Regulatory and Development Authority of India (IRDAI) has said that insurers should implement the necessary systems and processes immediately and before July 31, 2024.
The regulator said insurers should arrange for dedicated help desks in physical mode at the hospital to deal with and assist in cashless requests. “Insurers should also provide pre-authorisation to the policyholder through digital mode,” it said.
IRDA said that every insurer should strive to achieve 100 per cent cashless claim settlement in a timely manner. It said that insurers should try to ensure that settlement of claims through reimbursement is minimal and done only in exceptional circumstances.
The Master Circular on Health Insurance Business states that the insurer should decide on the request for cashless authorisation promptly, but not later than one hour from the date of receipt of the request. “IRDAI has said that the insurer should provide the final authorisation within three hours of receiving the discharge authorisation request from the hospital.
In any case, the policyholder should not wait for discharge from the hospital. If there is a delay of more than three hours, the excess amount charged by the hospital should be paid by the insurer from the shareholder’s fund. IRDA has said that in case of death of the policyholder during treatment, the insurer should immediately process the request for claim settlement and immediately remove the body from the hospital.
