IRDA instructs companies to expedite Covid19 claims ?

CoronaVirus1

Health insurers have been directed to decide/clear requests for cashless treatment and final discharge from hospitals within two hours of receipt of the request in view of the current coronavirus pandemic. The Insurance Regulatory and Development Authority of India (IRDAI) has issued norms for general and health insurers for quick settlement of claims filed by policyholders for coronavirus (COVID-19) disease/infection.

Perhaps for the first time, cashless health insurance claims related to Covid-19 treatment will get insurers’ nod within 120 minutes or flat two hours.To facilitate faster settlement of Covid-19 claims, the Insurance Regulatory and Development Authority of India (IRDAI) has given directions to health insurers to decide about clearing requests for cashless treatment and final discharge from hospitals within two hours of receipt.

On Saturday, the sector watchdog has issued norms for general and health insurers for quick settlement of claims filed by policyholders for coronavirus (Covid-19) infection under the Regulation 27(vi) of IRDAI (Health Insurance) Regulations of the Insurance Act, 1938.In the circular, the IRDAI also advised insurers to issue appropriate guidelines to their respective Third-Party Administrators (TPA).

“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 noted. It added that the decision on final discharge shall be communicated to the network provider within two hours from the time of receipt of the final bill and last necessary requirement from the hospital either to the insurer or to the TPA, whichever is earlier.

In an earlier circular in March 2020, the IRDAI had advised all insurers to expeditiously handle the health insurance claims pertaining to Covid-19. Earlier, the sector regulator also asked insurers to establish systems and procedures to enable efficient issuance of pre-authorisations on 24-hour basis and for prompt settlement of claims. It also urged insurers that the cost of medical expenses incurred during treatment, including the quarantine period, needed to be settled in accordance with the applicable terms and conditions within the policy contract and the regulatory framework.

As per estimates, as little as 2 per cent of Covid-19 patients have filed insurance claims. As on April 13, General Insurance Council (GIC) has reported about 200 Covid-19 claims as against 10,586 cases.
Meanwhile, following directions from the Central government, the IRDAI last Thursday extended time for making the renewal premium on health insurance policies.

Health insurance policies falling due for renewal between March 25 and May 3 are allowed to make such payments on or before May 15 to ensure continuity of the health insurance cover from the date of on which the policy falls due for renewal, so that any valid claim triggered during the grace period can be paid.

Speedy disposal
To facilitate faster settlement of Covid-19 claims, the Insurance Regulatory and Development Authority of India (IRDAI) has given directions to health insurers to decide about clearing requests for cashless treatment and final discharge from hospitals within two hours of receipt.

Ask any Question on Health Insurance .... We will reply for sure.