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BusinessRegulator issues cashless claim guidelines for quicker hospitalization benefits under health plans

Regulator issues cashless claim guidelines for quicker hospitalization benefits under health plans


Patients with insurance policies will soon experience smoother hospitalization experiences with cashless claims becoming the norm from August 1st. In a recent directive, the Insurance Regulatory and Development Authority of (IRDAI) has asked all insurers to put in place necessary systems and procedures for cashless claim settlement by July 31st.

According to the circular issued, dedicated help desks should be set up at hospitals to facilitate cashless requests from policyholders. Digital pre-authorization of claims is also to be enabled. Insurers have been told to strive for 100% cashless settlements within prescribed timelines, minimizing instances where claims have to be reimbursed.

Key timelines laid out include insurers deciding on cashless requests within an hour of receiving them. Final authorization for discharge should also take place within 3 hours, ensuring patients are not detained in hospitals. Any delays beyond this will mean the additional costs are borne by the insurer. Speedy processing of claims has also been stressed in case of an unfortunate demise during treatment.

Surveys in the past have shown policyholders facing numerous hurdles like lengthy processing times and partial approvals when filing health insurance claims. The new directives aim to simplify the process for customers through streamlined cashless facilities. Insurers will now have to seamlessly transfer policy and claims details of customers porting to a new company. Complete information has to be shared within 72 hours of request.

By ensuring patients can avail seamless cashless hospitalization under health plans, the regulator hopes to enhance the overall experience for customers. Compliance by insurers within the timelines will give policyholders quicker access to their rightful benefits during medical emergencies or planned procedures.

The Northlines is an independent source on the Web for news, facts and figures relating to Jammu, Kashmir and Ladakh and its neighbourhood.

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