The Insurance Regulatory and Development Authority of India (IRDAI) has directed insurers to take a decision on health insurance claims within two hours, with an aim to alleviate pressure on the country's healthcare infrastructure that is currently facing the heat due to the COVID-19 outbreak.
In a circular, the regulator said that all insurers were to decide on health insurance claims expeditiously in light of prevailing conditions owing to COVID-19
In order to ensure that all health insurance claims are responded to quickly, the IRDAI has directed insurers to "comply" with certain timelines.
"Decision on authorisation for cashless treatment shall be communicated to the network provider (hospital) within two hours from the time of receipt of authorisation request and last necessary requirement from the hospital either to the insurer or to the TPA whichever is earlier," the circular said.
Further, a decision on final discharge should be communicated to the network provider within two hours from the time of receipt of the final bill and last necessary requirement from the hospital either to the insurer or to the Third Party Administrator (TPA), whichever is earlier.
IRDAI has also asked all general and health insurers (except ECGC and AIC) to issue appropriate guidelines to their respective TPA. Regulation 27 of the IRDAI (Health Insurance) Regulations, 2016, specify norms on settlement/ rejection of the claim by insurers.