IRDAI issues norms on settlement of COVID-19 health insurance claims

The IRDAI has issued norms for settling COVID-19 health insurance claims vide Circular dated April 29, 2021. The norms have been issued in the wake of order dated 28.4.2021 passed by Delhi High Court in W.P. No. 5026/2021 wherein IRDAI was directed to advise Insurers to communicate their cashless approvals to the concerned hospitals/establishments within a maximum duration of 30 to 60 minutes so that there shall not be any delay in discharge of patients and hospital beds do not remain unoccupied. Following directions are issued to all the insurers:

  1. “Decision on authorization for cashless treatment for COVID-19 claims shall be communicated to the network provider (hospital) within a period of 60 minutes from the time of receipt of authorization request along with all necessary requirements from the hospital.
  2. Decision on final discharge of patients covered in COVID-19 claims shall be communicated to the network provider within a period of ONE hour from the time of receipt of final bill along with all necessary requirements from the hospital.”

The IRDAI has also asked the insurers to process such requests on time so that both authorizations for cashless treatment and discharge of patients could be done swiftly. The above instructions shall be in force with immediate effect.

 

*Tanvi Singh, Editorial Assistant has put this story together.

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