COVID-19 health insurance claim approvals to be communicated within 60 minutes: IRDAI

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Updated: April 29, 2021 9:53 PM

​The insurers have been told to process the claims promptly so that both authorisation for cashless treatment and discharge of the patient can be hastened to the maximum extent.

COVID-19 health insurance claim, cashless approvals, authorization, Third Party Administrators, irdai,It has been witnessed certain COVID related claims were taking time to get settled which was delaying the discharge process of the patient.

The settlement of COVID-19 health insurance claims is expected to be quicker than before. The IRDAI has issued norms to the insurance companies on settlement of COVID-19 health insurance claims. All the general and health insurance companies are asked to communicate their cashless approvals to the concerned hospitals and establishments within a maximum time period of 60 minutes. The High Court of New Delhi in its 28.4.2021 Order had directed IRDAI to advise Insurers to communicate their cashless approvals to the concerned hospitals and establishments within a maximum time period of 30 to 60 minutes so that there shall not be any delay in discharge of patients and hospital beds do not remain unoccupied.

“This move by 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, 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 operational perspective, however, it will be a boon for policyholders,” says Vinay Taluja, Chief Product Officer, Bajaj Capital.

The Insurance Regulatory and Development Authority of India (IRDAI) on 18.4.2020 had issued a note wherein a fixed turnaround time (TAT) of two hours for granting both cashless pre-authorization and for final discharge of the insured patient was specified.

In the wake of prevailing conditions of COVID-19 cases in the form of second wave and in line with aforesaid directions of the High Court, IRDAI has issued the following directions to all insurers:

a. Decision on authorization for cashless treatment for COVID-19 claims shall be communicated to the network provider (hospital) within a period of 60 minutes from the time of receipt of authorization request along with all necessary requirements from the hospital.

b. Decision on final discharge of patients covered in COVID-19 claims shall be communicated to the network provider within a period of one hour from the time of receipt of final bill along with all necessary requirements from the hospital.

The IRDAI has also asked insurers that notwithstanding the above outer limits of timelines specified, they are advised to process such requests promptly so that both authorisation for cashless treatment and discharge of the patient can be hastened to the maximum extent. The Insurers will have to issue appropriate directions to their respective Third Party Administrators for ensuring compliance with the timelines specified above.

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