IRDAI improves health cover experience
- The insurance landscape in India has seen a major transformation over the last few years, thanks to the consistent efforts of the Insurance Regulatory and Development Authority of India (IRDAI).
Key highlights
- The latest reform is that “no claim can be rejected due to the lack of documents”.
- To simplify the claim process, IRDAI mandated the necessary documents be sought by the insurer at the time of underwriting.
Hassle-free claims
- The IRDAI had earlier directed that while cashless claims must be cleared within a three-hour limit, the decision on cashless authorisation by the insurer has to be made within one hour of the claim request.
- The IRDAI circular also mandated all insurers should strive to achieve 100% cashless claim settlement in a time-bound manner and ensure claim settlement through reimbursement mode is done only in exceptional circumstances.
- This directive is in line with IRDAI’s recent ‘Cashless Anywhere’ directive which asked insurers to settle claims in cashless mode even in those hospitals not in their list of network hospitals.
- Moreover, they should provide digital pre-authorisation to policyholders to facilitate the claims.
- To address this, the IRDAI said in case the claim is not settled in three hours, any additional costs charged by the hospital would be borne by the insurer.
Impact on sector
- The only way this directive can be implemented is through better coordination between insurers and hospitals.
- Not only operational processes would have to be improved, sharing of medical records between different stakeholders would have to be more streamlined to help insurers to take a decision on the claim.
- Medical record digitisation is already happening via the National Health Claims Exchange, which is facilitating a more transparent and smooth exchange of information.
- The good news is insurers have been showing positive intent to support the regulator in all its efforts to improve the insurance experience for customers.
- Timely settlement will eliminate most glitches and go a long way to better healthcare experience for patients and caregivers.
- The IRDAI added if a policyholder dies during treatment, the insurer must immediately process the request for claim settlement and get the mortal remains released from the hospital immediately.
- This will surely offer the grieving family some semblance as they deal with a tragic loss
- The norms are consumer-centric and prioritise policyholders’ welfare above everything else.
- This commendable move is poised to revolutionise the health insurance landscape, ensuring timely and hassle-free claim settlements, enhancing customer satisfaction, and providing inclusive and affordable health insurance solutions for all