The Insurance Regulatory and Development Authority of India (IRDAI) has introduced new rules to streamline the health insurance claim process, aiming to address delays and reduce costs for policyholders. The updated master circular mandates that insurers must approve cashless discharge requests within three hours. Furthermore, insurers will be responsible for covering any additional hospital charges incurred due to delays in claim approval.

Previously, delays in claim approvals often resulted in patients being stuck in hospitals longer than necessary, leading to increased costs and inconvenience. A survey conducted by Local Circles highlighted instances where patients waited 10-12 hours post-discharge readiness due to delayed insurance claim processing. Such delays forced patients to bear the cost of an additional night's stay, despite being medically fit for discharge.

Under the new guidelines, IRDAI has urged insurers to achieve 100% cashless claim settlement in a time-bound manner, ensuring that patients can be discharged promptly upon their medical fitness being confirmed by the treating doctor. This move aims to alleviate the burden on patients and their families, who often face financial and logistical challenges due to prolonged hospital stays.

The revised health insurance claim rules are expected to significantly benefit policyholders during critical moments of discharge from hospitals, ensuring a smoother and more efficient process.

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