The Insurance Regulatory and Development Authority of India (IRDAI) has introduced major reforms on 29th May,2024 in the regulatory norms for health insurance policies. These changes, outlined in a Master Circular on Health Insurance Products, aim to streamline and enhance the health insurance process for policyholders. Here are the key updates:

Immediate Cashless Approval in Emergencies

• Emergency Cases: Insurers must decide on cashless approval requests immediately during emergencies within 1 hour of receipt of request.

• Quick Response: This ensures policyholders get prompt medical attention without financial stress.

Quick Final Approval for Discharge

• Three-Hour Rule: Insurers must grant final approval within 3 hours of receiving the discharge request from the hospital.

• No Waiting for Discharge: Policyholders should not be made to wait for discharge. If there's a delay beyond 3 hours, the insurer will cover any additional charges from the hospital.

Implementation Deadline

• July 31, 2024: Insurers must have necessary procedures in place by this date.

• Dedicated Help Desks: Insurers are encouraged to set up help desks at hospitals to handle cashless requests efficiently.

Other Significant Changes Announced by the IRDAI

• Wider Choices for Policyholders:

• Insurers must offer diverse products, add-ons, and riders.

• Coverage for all ages, regions, occupational categories, medical conditions, treatments, and healthcare providers.

• Flexibility for Multiple Policies:

• Policyholders with multiple health insurance policies can choose which policy to use for their claims.

• Customer Information Sheet (CIS):

• Insurers must provide a CIS with every policy document.

• This sheet will help policyholders understand their coverage and benefits clearly.

• No-Claim Rewards:

• If no claims are made during the policy period, insurers may offer rewards.

• Options include increasing the sum insured or discounting the premium amount.

• Premium Refunds:

• Policyholders can get a refund of the premium or a proportionate premium for the unexpired policy period if they cancel the policy during its term.

Addressing Delays in Claims Processing

• Survey Insights:

• A survey by Local Circles found that 43% of policyholders had difficulties processing health insurance claims.

• Patients often had to wait 10-12 hours for discharge because the insurance claim was still being processed.

• These new IRDAI regulations aim to reduce such delays, ensuring a more efficient and policyholder-friendly process.