Authorise cashless health insurance claim in one hour: IRDAI

The health insurer needs to decide on the authorisation of the cashless claims within an hour, as per the master circular released by the Insurance Regulatory and Development Authority of India (IRDAI) on May 29.

“Insurer shall decide on the request for cashless authorisation immediately but not more than one hour of the receipt of request,” stated the circular.

The circular also directed the insurers to put in place the necessary systems and procedures for the same by July 31, 2024.

The insurance companies must arrange physical help desks at hospitals for cashless requests, and pre-authorisation should be available digitally.

The list of hospitals that have tied up for cashless claims, the process for claim settlement, and turnaround times should be displayed on the insurance companies’ websites, according to the IRDAI master circular.

Health insurance for all

Apart from that, the general information for the consumers includes directions for insurers.

It states that the insurance companies must cater to all ages, all types of existing medical conditions, pre-existing diseases, and chronic conditions.

Moreover, all treatments and medicines – allopathy, AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy), and any other systems of medicine.

The circular also stated that health insurance must be provided to all regions, occupations, persons with disabilities, and other categories.

However, IRDAI clarified that these instructions do not mean that an insurance company should have one product to cater for all of the above.

Free Look Period

30 days from the receipt of the policy document, a Free Look Period must be available for the policyholders where they can review the terms and conditions of the policy. After that, if a consumer wants to opt-out, they are free to cancel their policy.

This option is available for policies with a term of one year or more.

Grace period

For monthly premium payments, a grace period of 15 days should be provided. For quarterly, half-yearly, and annual payments, the grace period for the payment is 30 days.

Renewal of health insurance

Except for the cases where the policyholder commits fraud or misrepresents information, the health policies will be renewable and the renewal cannot be denied on the ground that the policyholder had made claims in the preceding policy years.

Unless the sum insured is increased, a fresh underwriting is not required for renewal.

No claim bonus

For not claiming the policy, the consumers must be offered a No Claim Bonus (NCB) in the form of an addition to the sum covered or a discount on renewal.

Document language

The proposal forms for the health insurance policy should be in simple language. Both proposal form and policy document should be provided in 22 scheduled languages.