Cashless claims must now be approved by insurance firms (insurers) within a three-hour interval.
The Insurance Regulatory and Development Authority of India (IRDAI) has implemented significant modifications to the regulatory standards governing health insurance plans.
Cashless Claims To Be Approved By Insurance Firms Within Three Hours
The insurance will deduct from the shareholder’s fund any additional money that the hospital bills for delays that last more than three hours.
Patients and their families have expressed worry about insurers’ or third-party administrators’ (TPAs’) delays in resolving health insurance claims.
This is particularly valid when leaving the hospital.
Should the policyholder pass away while receiving treatment, the insurer will handle the claim settlement request right away.
The insurance will arrange for the quick discharge of the corpse (mortal remains) from the hospital.
Insurance companies should strive for a 100% cashless claim settlement within a given time frame.
In an emergency, the insurer has one hour from the time the request is received to make a decision about cashless claims.
Insurance companies must implement the appropriate processes by July 31, 2024.
Insurance Companies Can Set Up Physical Help Desks at Hospitals
Insurance companies might set up physical help desks at hospitals to handle and support requests for cashless claims.
Insurance companies are expected to give policyholders more options by offering riders, add-ons, and products. All age groups, geographical locations, professional classifications, medical conditions or therapies, and hospital and healthcare provider types should be targeted by insurance policies.
When a policyholder has many health insurance plans, they can select the one that allows them to get the maximum amount of allowable claims.
Insurers are required to include a Customer Information Sheet (CIS) with each policy document.
Insurers may compensate policyholders if there are no claims filed during the duration of the policy.
The benefit can be given by reducing the premium amount or by raising the insured amount in order to offer a No Claim Bonus (NCB).
If policyholders decide to cancel their policy at any point during the policy term, they will be eligible for a refund of the premium or a prorated premium for the portion of the policy that has not yet expired.
