IRDAI has made major revisions to health insurance norms

Current Context: The Insurance Regulatory and Development Authority (IRDAI) has recently made significant changes to the health insurance norms.

• Here are the key points:
• Cashless Claim Processing: Health insurers are now required to accept or reject a cashless claim within one hour, and settle such a claim on discharge within three hours. If there is a delay beyond the mandated three hours, the additional amount, if any, charged by the hospital to the customer should be borne by the insurer.
• Claim Review Panel: An insurer can’t repudiate a claim without the approval of its claims review panel.
• Document Collection: For claim settlement, the insurer and the third-party administrator must collect documents from hospitals and not from the insured.
• Multiple Health Policies: Policyholders with multiple health policies can select the policy under which they make the claim.
• No Claim Bonus: The new rules ask insurers to reward policyholders with no claims during the policy period by offering either an increased sum insured or discounted premium amount.
• Policy Cancellation: Policyholders can receive a premium refund for the unexpired policy period if one cancels the policy mid-way.
• Policy Renewal: All individual health policies are renewable and cannot be denied on the basis of previous claims, except in cases of fraud, non-disclosures, or misrepresentation.
• Portability Requests: Stricter timelines are imposed on portability requests via the Insurance Information Bureau of India portal.
• Customer Information Sheet: Insurers are asked to include a customer information sheet as part of the policy document explaining all customer-facing details.

Question:

1. What is the time limit for health insurers to accept or reject a cashless claim?

• A) 30 minutes
• B) 1 hour
• C) 2 hours
• D) 3 hours

Answer: B) Health insurers are now required to accept or reject a cashless claim within one hour, and settle such a claim on discharge within three hours.