The insurance regulator IRDA on Saturday asked the insurers to settle all health insurance claims pertaining to COVID 19 in two hours after receiving all necessary papers.
“The insurers will have to establish systems, procedures to enable efficient issuance of pre authorisations on a 24 hour basis and for prompt settlement of Covid 19 claims,said TR Alamelu, member(non-life), IRDAI
In light of prevailing conditions owing to COVID 19 as also taking into consideration the need for alleviating the pressure on the healthcare infrastructure all the insurers has to decide health insurance claims expeditiously, said IRDAI.
. In order to ensure all health insurance claims are responded to quickly, insurers are directed to comply with the following timelines:
– Decision on authorization for cashless treatment shall be communicated to the network provider (hospital) within two hours from the time of receipt of authorization request and last necessary requirement from the hospital either to the insurer or to the TPA whichever is earlier,
-Decision on final discharge shall be communicated to the network provider within two hours from the time of receipt of final bill and last necessary requirement from the hospital either to the insurer or to the TPA whichever is earlier,
– Insurers have to issue appropriate guidelines to their respective Third Party Administrators.