IRDAI sets out norms for settlement of health insurance claims

Apr 20, 2020 | by Avantis RegTech Legal Research Team


Industry Specific Compliance

The Insurance Regulatory and Development Authority of India (IRDAI) on April 18, 2020, sets out norms for settlement of health insurance claims to expeditiously handle the health insurance claims pertaining to COVID 19 pandemic. As per the provisions of IRDAI (Health Insurance) Regulations, 2016, insurers shall establish systems, procedures to enable efficient issuance of pre authorisations on a 24 hours basis and for prompt settlement of claims.

IRDAI has issued the following norms in order to ensure all health insurance claims and insurers are required to respond quickly:-

a) It is decided that cashless treatment shall be communicated to the network provider (hospital) within two hours from the time of receipt of authorization request and last necessary requirement from the hospital either to the insurer or to the TPA whichever is earlier.

b) The decision on final discharge shall be communicated to the network provider within two hours from the time of receipt of final bill and last necessary requirement from the hospital either to the insurer or to the TPA whichever is earlier.

Insurers are advised to issue appropriate guidelines to their respective third-party administrators.

[IRDAI Circular No. IRDAI/HLT/MISC/CIR/95/04/2020]


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