The regulator wants insurers to achieve 100% cashless claim settlement in a time-bound manner, minimising the need for reimbursement claims to exceptional circumstances.
In terms of cashless claims, the regulator wants insurers to decide on authorisation requests within one hour of receipt. It has directed insurance companies to put in place necessary systems and procedures to meet the new guidelines by July 31, 2024.
Further, insurers are required to give final authorisation within three hours of receiving a discharge request from the hospital. If there is any delay beyond this timeframe, the insurer must cover any additional costs incurred by the hospital from their shareholders’ funds.
The circular allows policyholders to cancel their policies at any time during the term by giving a 7-day notice in writing, down from the previous 15-day grace period.IRDAI has also set a grace period for premium payments, which is 15 days for monthly premiums and 30 days for quarterly premiums.