Health insurance covers the expense of treatment when a patient is admitted to the hospital. However, the patient and his family are troubled by the drawn-out claim settlement process. The patient must wait at the hospital for several hours after the doctor grants permission to go home since it takes so long to settle health insurance claims. The patient is still waiting to go home, and the family keeps visiting the TPA desk, but these hours of waiting are about to end. The guidelines for settling health insurance claims changed by IRDAI.
IRDAI modified the health insurance regulations.
A body that regulates insurance The Indian insurance industry’s Development and Regulation Authority (IRDAI) has made some changes in the rules regarding health insurance. The new changes will provide relief to the policyholders. IRDAI has issued a master circular canceling 55 circulars on health insurance. According to the new master circular, the settlement of claims of health insurance policyholders will now be done within 3 hours.
Settlement of the claim will take three hours.
With the master circular, IRDAI has provided policyholders with a great deal of relief. Policyholders won’t have to wait much longer for the settlement of their claims. The IRDAI’s latest circular stipulates that the claim settlement must be completed within three hours of receiving the hospital’s discharge statement. A new circular was released by IRDAI on May 29, 2024. The insured will never have to wait to be released from the hospital, according to the new circular. The insurance regulator has directed the businesses to pay the additional sum if the policyholder’s claim settlement takes more than three hours and the hospital bills him more.
Completely cashless transaction
According to the insurance regulator, the insurance provider will respond to the request for claim payment right away if the insured passes away while receiving treatment. In addition, IRDAI has given insurance providers strict instructions to settle 100% of claims cashlessly within the allotted time. In an emergency, the cashless request must be decided upon in less than an hour. Insurance firms have also been urged to provide policyholders a digital pre-authorization process at the same time.
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