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IRDAI has made major revisions to health insurance norms

Published on May 31, 2024
Current Context: The Insurance Regulatory and Development Authority (IRDAI) has recently made significant changes to the health insurance norms.
IRDAI has made major revisions to 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
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