Insurance regulator IRDAI asks health insurers to settle claims within two hours

New Delhi: Insurance regulator IRDAI has directed insurers to take decision on health insurance claims within two hours, a move aimed at alleviating pressure on the country's healthcare infrastructure currently facing the heat of the coronavirus outbreak.

In light of prevailing conditions owing to COVID-19 as also taking into consideration the need for alleviating the pressure on the healthcare infrastructure, all the insurers shall decide health insurance claims expeditiously, it said in a circular.

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," the circular said.

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

IRDAI  has also asked all general and health insurers (except ECGC and AIC) to issue appropriate guidelines to their respective TPA.

Regulation 27 of the IRDAI (Health Insurance) Regulations, 2016, specifies norms on settlement/ rejection of claim by insurers.