NEW DELHI: The insurance regulator on Thursday said that the health insurers should decide on the request for cashless authorisation within one hour of receipt of request, and that final authorization for discharge from hospital should not take more than three hours.
In a master circular on health insurance products issued on Wednesday, the Insurance Regulatory and Development Authority of India (IRDAI) said that if there is any delay beyond three hours, the additional amount charged by the hospital should be borne by the insurer.
The circular further says that in the event of the death of the policyholder during the treatment, the insurer should immediately process the request for claim settlement, and get the mortal remains released from the hospital immediately.
The master circular on health insurance would repeal 55 other circulars. The circular insists that health insurers should strive towards achieving facilitation of 100% cashless claim settlement in a time bound manner.
“The insurers shall endeavor to ensure that the instances of claims being settled through reimbursement are at bare minimum and only in exceptional circumstances,” says the circular.
It further says that no claim can be repudiated without the approval of the Claims Review Committee which is required to take decision on repudiation of every claim.
The circular further says that a policyholder with multiple health insurance policies gets to choose the policy under which he/she can get the admissible claim amount. The primary insurer with whom claim is first submitted should then coordinate and facilitate settlement of balance amount from the other insurers.