INSURANCE
IRDAI directs insurers to take decision on health insurance claims within 2 hours amid COVID-19 scare
Apr-20-2020

With an aim to ease pressure on the country's healthcare infrastructure currently facing the heat of the coronavirus outbreak, insurance regulator Insurance Regulatory and Development Authority of India (IRDAI) has directed insurers to take decision on health insurance claims within two hours. It said in light of prevailing conditions owing to COVID-19 as also taking into consideration the need for alleviating the pressure on the healthcare infrastructure, all the insurers shall decide health insurance claims expeditiously.

In order to ensure that all health insurance claims are responded to quickly, the IRDAI has directed insurers to comply with certain timelines. It said 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.

Further, decision on final discharge should 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 Third Party Administrator (TPA), whichever is earlier. It has also asked all general and health insurers (except ECGC and AIC) to issue appropriate guidelines to their respective TPA.

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