Mediclaim Update: If you have a health insurance policy then no more waiting for claim settlement..
Sumit's father had to be admitted to a hospital. When Sumit showed his Mediclaim Card, he came to know that he could avail cashless treatment. Sumit opted for cashless treatment and was relieved. On the day of discharge, the hospital informed them that his father would have to stay in the hospital till the claim settlement was done with the insurance company. It took another 24 hours for the claim settlement to be done. During this time, the patient had to stay in the hospital for one more day and the expenses also increased. Given such cases, the Insurance Regulatory and Development Authority of India (IRDAI) has made some changes in the rules of health insurance policies.
What has IRDAI said?
IRDAI has cancelled 55 circulars on health insurance and issued a master circular. According to this circular, the policyholder will get the facility of claim settlement within 3 hours of requesting. IRDAI has said that the insurance company will have to settle the matter within three hours of receiving the discharge request from the hospital.
No waiting for hospital discharge
The insurance regulator has said that the patient should not be made to wait for discharge from the hospital under any circumstances. If the policyholder's patient is discharged from the hospital for more than three hours, then the additional amount (if any) charged by the hospital will be borne from the funds of the shareholders of the insurance company.
IRDAI made these rules
Now a rule has been made that if the policyholder dies during treatment, the insurance company will immediately act on the request for claim settlement. Not only this, the body will be removed from the hospital immediately. The regulator has said that the insurance company should do 100% cashless claim settlement promptly within a fixed time frame. If there is an emergency, then the decision should be made within one hour of the request.
When will these rules be implemented?
IRDAI has asked the insurance companies to implement these rules by July 31. Hospitals can arrange a help desk for cashless request cases.
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