IRDA New Circular 2024 – Claim Process made easy

We have seen many instances where even after surgery sometimes the discharge gets delayed due to non completion of settlement from the insurance company.

Now everything within 3 hours

Final authorization for Discharge from the hospital in 3 hours:

Below are the revised rules
a. Insurer shall grant final authorization within three hours of the receipt of
discharge authorization request from the hospital. In no case, the policyholder shall be made to wait to be discharged from the Hospital.
b. If there is any delay beyond three hours, the additional amount if any charged by the hospital shall be borne by the insurer from shareholder’s fund.

Cashless Approval in Just one Hour

Every insurer shall strive to achieve 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.
b. Insurer shall decide on the request for cashless authorization immediately
but not more than one hour of receipt of request. Necessary systems and
procedures shall be put in place by the Insurer immediately and not later than 31st July, 2024.
c. Insurers may arrange for dedicated Help Desks in physical mode at the hospital to deal and assist with the cashless requests.
d. Insurers shall also provide pre-authorization to the policyholder through Digital mode.

In case of death of Policy Holder

In the event of the death of the policyholder during the treatment, the
insurer shall:
i. immediately process the request for claim settlement.
ii. get the mortal remains (dead body) released from the hospital
immediately

All these guidelines to be adhered immediately but strictly not later than 31st July 2024.

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