Due to the second wave of COVID-19, IRDAI issued the circular after the Delhi High Court order
Amid the raging second wave of the pandemic in the country, the insurance regulatory body – Insurance Regulatory and Development Authority or IRDAI has directed health insurers to settle and approve cashless COVID-19 treatment claims within a period of 60 minutes. According to a recent circular issued by the regulatory body, titled ‘norms on settlement of COVID-19 health insurance claims’, IRDAI has directed all general and health insurers to communicate their decision on the authorisation for cashless treatment for coronavirus within one hour from the time of receipt of the request, along with all necessary requirements from the hospital.
The circular comes in the wake of the need to make hospital beds available quickly for the other waiting patients. The insurance regulator issued the direction after the Delhi High Court asked in an order to tell insurers to communicate the cashless approvals within a maximum time period of 30-60 minutes, in order to accommodate maximum patients and also, so that there no delay in discharging treated patients.
In its circular, IRDAI also stated that the decision on the final discharge of patients covered in COVID-19 claims will be communicated to the network provider within a period of one hour from the time of receipt of the final bill along with all necessary requirements from the particular hospital. The regulatory body added that if the insurers do not withstand the outer limits of the timelines specified, then the requests must be processed promptly so that both, the authorisation for cashless treatment of COVID-19, as well as the discharge of the patient can be streamlined.
IRDAI also directed the insurers to issue the appropriate directions to their respective third-party administrators or TPAs for ensuring compliance with the timelines specified, according to the order. All instructions as part of the circular, will come into force with immediate effect, said IRDAI.