Cashless health Claim - As IRDAI mandates a 3-hour deadline for cashless health claim approvals, here's what leaders in the insurance industry have to say:
In a groundbreaking move, the regulatory body Irdai recently issued a master circular on health insurance, stipulating that insurers must make cashless health claim authorization decisions within one hour of request, with a 3-hour limit for claim clearance. This circular replaces 55 previous directives.
( Cashless Health Claim ) Among the key provisions highlighted by Irdai is the necessity for insurers to offer a broader range of products, add-ons, and riders, tailored to diverse demographics, medical needs, and healthcare facilities, ensuring affordability for policyholders.
Additionally, the circular introduces the Customer Information Sheet (CIS) accompanying every policy document, simplifying insurance details such as coverage, exclusions, and deductibles for policyholders' clarity.
In a significant move towards customer-centricity, insurers are encouraged to reward policyholders with No Claim Bonuses, either by increasing sum insured or discounting premiums in the absence of claims.
To streamline claim settlements, Irdai mandates that insurers and TPAs collect necessary documents directly from hospitals, sparing policyholders the hassle.
Furthermore, the circular imposes strict timelines for portability requests on the Insurance Information Bureau of India (IIB) portal, ensuring prompt action from both existing and acquiring insurers.
In case of delays in implementing ombudsman awards, insurers are liable to pay Rs 5,000 per day to policyholders, enhancing accountability.
In response to the circular, industry leaders have expressed optimism:
Shashi Kant Dahuja, Chief Underwriting Officer at Shriram General Insurance, applauds the move, emphasizing its potential to increase insurance penetration in India while prioritizing customer needs. He highlights the alleviation of financial pressure on policyholders due to timely claim approvals.
Siddharth Singhal, Business Head of Health Insurance at Policybazaar.com, commends the three-hour limit for cashless claims, foreseeing improved efficiency and customer satisfaction through better coordination and digitization of medical records.
Sachin Joshi, President of Claims at Liberty General Insurance, hails the directive as a game-changer, emphasizing its role in ensuring swift access to medical treatment for policyholders, driving insurers to enhance operational efficiencies.
This regulatory initiative, supported by industry stakeholders, aims to create a more efficient and inclusive health insurance ecosystem, benefitting consumers across demographics.
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Source - Internet
