IRDAI directs Health Insurers to settle claims within 2 hours

Insurance

Insurances Regulator IRDAI directed the Insurers to decide on health insurance claims to the earliest that is within 2hours. It aims at alleviating the pressure of the country in dealing with the outbreak of COVID-19.

In a circular, the IRDAI Stated that “In order to ensure that all health insurance claims are responded to quickly, the Insurance Regulatory and Development Authority of India (IRDAI) has directed insurers to “comply” with certain timelines.

“Decision on authorisation for cashless treatment shall be communicated to the network provider

(hospital) within two hours from the time of receipt of authorisation request and last necessary requirement from the hospital either to the insurer or to the TPA whichever is earlier,”

It further added that decision on final discharge needs to be communicated to the network provider within two hours from the time of receipt of the final bill and last necessary requirement from the hospital either to the insurer or to the Third Party Administrator (TPA), whichever is earlier.

It further asked the general and health insurers (except ECGC and AIC) to issue appropriate guidelines to their respective TPA.

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