New Delhi, Regulator Irdai on Wednesday issued a master circular on health insurance specifying that insurers have to take a decision on cashless authorization within an hour of the request.
The master circular on health insurance products supersedes 55 circulars issued earlier and is an important step towards strengthening the empowerment of policyholders and promoting inclusive health insurance, Irdai said in a statement.
"The circular has brought together the rights in the health insurance policy available to the policyholder/prospects at one place for their easy reference and also to provide seamless, fast and hassle-free claim experience to the policyholder purchasing a health insurance policy and ensure better The emphasis is on improving service standards in the health insurance sector.
Sharing the key features of the master circular, it said, wider choices will be made available by insurers by offering diverse insurance products for all ages, regions, medical conditions, all types of hospitals and health care providers.As per the affordability of the policyholders.
It also specifies the Customer Information Sheet (CIS) which is provided by the insurer with each policy document.
It explains the basic features of insurance policies in simple terms such as type of insurance, sum insured, coverage details, exclusions, sub-limit deductions and waiting period.
In case there are no claims during the policy period, insurers can reward policyholders by providing them the option to opt for such no claim bonus, either increasing the sum insured or giving a discount in the premium amount.
Emphasis has been laid in the Master Circular to make efforts towards achieving 10 percent cashless claim settlement facility in a time bound manner.It says, "To take decisions immediately and within one hour on cashless authorization requests and within three hours of the last authorization request on discharge from the hospital."
It also talks about providing end-to-end technology solutions for effective, efficient and seamless onboarding of policyholders, policy renewal, police service and grievance redressal.
For claim settlement, it said, the policyholder will not be required to submit any documents, rather insurers and TPAs should collect the necessary documents from the hospitals.
With regard to portability requests on the Insurance Information Bureau of India (IIB) portal, it said, strict timelines are being enforced for existing insurers and acquiring insurers to undertake the task.
If the Lokpal awards are not implemented within 30 days the insurer is liable to pay Rs 5,000 per day to the policyholder.It said that in case of death during treatment, the body will be immediately discharged from the hospital.
This Master Circular represents a historic effort to empower policyholders to ensure that they receive the highest standards of care and service; This includes promoting an environment of trust and transparency in the health insurance sector
The master circular on health insurance products supersedes 55 circulars issued earlier and is an important step towards strengthening the empowerment of policyholders and promoting inclusive health insurance, Irdai said in a statement.
"The circular has brought together the rights in the health insurance policy available to the policyholder/prospects at one place for their easy reference and also to provide seamless, fast and hassle-free claim experience to the policyholder purchasing a health insurance policy and ensure better The emphasis is on improving service standards in the health insurance sector.
Sharing the key features of the master circular, it said, wider choices will be made available by insurers by offering diverse insurance products for all ages, regions, medical conditions, all types of hospitals and health care providers.As per the affordability of the policyholders.
It also specifies the Customer Information Sheet (CIS) which is provided by the insurer with each policy document.
It explains the basic features of insurance policies in simple terms such as type of insurance, sum insured, coverage details, exclusions, sub-limit deductions and waiting period.
In case there are no claims during the policy period, insurers can reward policyholders by providing them the option to opt for such no claim bonus, either increasing the sum insured or giving a discount in the premium amount.
Emphasis has been laid in the Master Circular to make efforts towards achieving 10 percent cashless claim settlement facility in a time bound manner.It says, "To take decisions immediately and within one hour on cashless authorization requests and within three hours of the last authorization request on discharge from the hospital."
It also talks about providing end-to-end technology solutions for effective, efficient and seamless onboarding of policyholders, policy renewal, police service and grievance redressal.
For claim settlement, it said, the policyholder will not be required to submit any documents, rather insurers and TPAs should collect the necessary documents from the hospitals.
With regard to portability requests on the Insurance Information Bureau of India (IIB) portal, it said, strict timelines are being enforced for existing insurers and acquiring insurers to undertake the task.
If the Lokpal awards are not implemented within 30 days the insurer is liable to pay Rs 5,000 per day to the policyholder.It said that in case of death during treatment, the body will be immediately discharged from the hospital.
This Master Circular represents a historic effort to empower policyholders to ensure that they receive the highest standards of care and service; This includes promoting an environment of trust and transparency in the health insurance sector
