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Home / Insurance / Health insurers must decide on covid treatment requests within an hour: Irdai

Health insurers must decide on covid treatment requests within an hour: Irdai

The insurers will also have to issue appropriate directions to their respective third-party administrators (TPAs) for ensuring compliance with the timelines as specified. Photo: iStockphotoPremium
The insurers will also have to issue appropriate directions to their respective third-party administrators (TPAs) for ensuring compliance with the timelines as specified. Photo: iStockphoto

  • These norms on settlement of covid-19 health insurance claims will ensure that there’s an outer limit to settle the claims to keep policyholders ease as the topmost priority

In the wake of the surge in covid-19 cases, health insurers have been directed by regulator Irdai to decide/clear requests for cashless treatment and final discharge from hospital within one hour of receipt of the request.

These norms on settlement of covid-19 health insurance claims will ensure that there’s an outer limit to settle the claims to keep policyholders ease as the topmost priority.

Currently, the turnaround time for insurers for granting both cashless pre-authorization and for final discharge of the insured patient after getting the receipt of the final bill along with all requirements from the hospital is 2 hours. The same has been further reduced by one hour by the Insurance Regulatory and Development Authority of India (Irdai).

Vinay Taluja, Chief Product Officer, Bajaj Capital said, “This move from the regulator comes as a great help to the policyholders when the number of Covid-19 cases are growing rapidly. It has been witnessed certain COVID-related claims were taking time to get settled which was delaying the discharge process of the patient. However, with this new move of settling claims within one hour, that is, by setting an outer limit the customers will give much relief and can deal with the Covid-19 expenses easily."

"Though this move will surely put pressure on health insurers from an operational perspective, however, will be boon for policyholders," said Taluja.

Further, the regulator said that notwithstanding the one-hour outer limits of timelines specified, the insurers are advised to process such requests promptly so that both authorisations for cashless treatment and discharge of the patient can be hastened to the maximum extent.

The insurers will also have to issue appropriate directions to their respective third-party administrators (TPAs) for ensuring compliance with the timelines as specified.

Naval Goel, Founder & CEO, PolicyX.com said that the general time taken for authorisation of a cashless treatment is done within a minimum of 30 minutes or a maximum of 2 hours, but this timeline is restricted to the normal scenarios. But considering the current chaotic situation where the number of cases is in the thousands every day in each city and union territory along with a sense of panic amongst people, the implementation might be a little challenging, but it can be transformed into reality if the hospitals and insurance companies work in tandem. "Besides, now the insurers will also have to thoroughly assess the claims filed for Covid 19 within the timelines as specified before repudiating any claims if any," Goel added.

The regulator had been advising all insurers to expeditiously handle the health insurance claims about covid-19 since last year.

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