The Insurance Regulatory and Development Authority of India has set new standards in the realm of health insurance. IRDAI sets a 3-hour time limit for insurers in approving cashless claims for Health Insurance. The IRDAI has mandated insurers to implement the required systems and procedures by July 31, 2024, to ensure full compliance.

What is the 3-Hour Claim Settlement Rule?

The 3-hour claim settlement rule mandates that insurance companies process and settle health insurance claims within three hours of receiving all necessary documents. This applies primarily to cashless claims in hospitals, ensuring patients receive timely medical treatment without financial hurdles.

Key Highlights of the New Rule

  • Faster Cashless Approvals

    Insurers must approve cashless authorization requests within one hour of receiving the necessary documents from hospitals.

  • Quick Discharge Authorizations

    Once a discharge request is submitted, insurers must finalize approvals within three hours, allowing patients to leave the hospital without unnecessary delays.

  • Push for 100% Cashless Claims

    The new guidelines encourage insurers to settle claims through cashless transactions, reducing the need for reimbursements, which are now limited to exceptional cases.

  • Dedicated Support at Hospitals

    Insurers must set up help desks in hospitals to assist with cashless claim processing, making it easier for policyholders to navigate the system.

  • Digital Pre-Authorization

    To speed up approvals, insurers must offer pre-authorization through digital platforms.

Bottom Line

The 3-hour claim settlement rule by IRDAI is a significant milestone in India's health insurance industry. It reflects the regulator’s commitment to policyholder welfare and improving the overall efficiency of the healthcare ecosystem. As insurance companies adapt to this change, policyholders can expect a more seamless, reliable, and customer-centric claim process.With this revolutionary step, the future of health insurance in India looks more promising, ensuring quicker access to quality healthcare for all.