New Delhi: Insurance watchdog Irdai on Wednesday directed health insurers to decided on cashless treatment within an hour of receiving a request from the insured party. The insurance industry regulator issued a master circular to this effect, in which 55 55 circulars previous circulars were cancelled, batting on the side of policyholders. “To decide on cashless authorization requests immediately and within one hour and final authorization on discharge from hospital within three hours of request from the hospital,” it said.
The master circular also lays emphasis on seamless, fast and hassle-free claims, said IRDAI. Tyhe master circular is aimed at improving the service standards for the wider health insurance industry.
What are the main features of IRDAI master circular
The IRDAI master circular states:
Health insurers will provide a wider choice to the insured
This choice pertains to products, add-ons and riders
These products must cater to all age groups
The insurers must cater to a wider range of regions and medical conditions
Insurers must cover all types of hospitals as well as healthcare providers
Health insurers must offer more affordability to policyholders
Insurers must share a Customer Information Sheet (CIS) with every policy
Insurers must explain salient policy features in easy language
Policyholders must be informed properly about the sum insured
They must be aware of coverage details
Exclusion and sub-limits must also be clearly mentioned
Insurers must specify deductibles as well as waiting period in the simplest language
The IRDAI has also directed health insurers to offer no claims bonus to the insured during the policy period. This bonus may be offered in the form of a higher sum insured or a discount on the policy premium, it said. “The circular has brought in one place the entitlements in a health insurance policy available to a Policyholder/prospects for their easy reference,” said IRDAI.
Grievance redressal and policy portability
IRDAI directed insurers to ensure end-to-end technology use for hassle-free policy onboarding. Similar systems should be in place for policy renewal, servicing and redressal of any grievances submitted by the policyholder, said IRDAI. Insurers and third-party administrators must collect the documents from hospitals instead of requiring the customer to submit the same, said IRDAI.
The insurance watchdog also directed insurers to respect timelines for porting policies submitted to the Insurance Information Bureau of India (IIB) portal. A Rs 5,000 per day penalty will be charged from the insurer or TPA, to be shared with the policyholder for failing to respect the 30-day timeline for an ombudsman award, said IRDAI. Insurers must allow the mortal remains of the patient to be released immediately in the event of death during treatment, it added.
In a big boost to the rights of health insurance policyholders, industry watchdog IRDAI has directed health insurance providers and TPAs to decide on insurance claims in 1 hour and collect relevant documents directly from the hospital to streamline the consumer experience, according to its latest master direction. Personal Finance Business News – Personal Finance News, Share Market News, BSE/NSE News, Stock Exchange News Today
