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New IRDAI rules for settlement of medical claims effective immediately.

NEW MASTER CIRCULAR issued by IRDAI repeals 55 previous circulars.

Major reforms FOR health insurance policies – especially beneficial for Sr Citizens.

  1. Insurers / TPA should approve cashless claims within 1 hour.
  2. Final authorization for hospital discharge within 3 hours of intimation by the hospital.
  3. One-month grace period for annual renewal of medical policies. (Policy will be protected up to 1 month from expiry of policy
  4. In case of multiple policies, policyholders can select the policy under which they wish to claim
  5. IMPORTANT – for settlement of claims, the insurer / TPA must collect documents/queries from hospitals directly.
  6. They should NOT call for documents from the insured (policyholder)
  7. Policyholders with NO CLAIMS, are to be rewarded with an increased sum assured OR discounted premium (at the time of renewal)
  8. All medical insurance policies are renewable and renewal CANNOT be denied because of previous claims (except in case of fraud, or misrepresentation). No fresh underwriting is required for renewal (without enhancement)

Insurers have been advised to move to 100 % cashless claim settlements – and empanel all categories of hospitals considering affordability for all population segments.

Stricter time limits for portability.

CIS – Customer Information Sheet to be provided with every policy document giving complete details of the medical insurance policy.

These are MAJOR LANDMARK reforms in the health insurance sector that come into effect immediately.

1 thought on “New IRDAI rules for settlement of medical claims effective immediately.”

  1. Arun Merchant

    I highly appreciate the major change of asking hospitals directly for any queries/documents instead of asking policy holder.Generally policy holder is not aware of proper medical terminology and that used to create lot of misinformation

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