Insurance Regulatory and Development Authority of India (IRDAI) has issued norms for general and health insurers. It has a coronavirus (COVID-19) disease/infection. There is a reference to the speedy settlement of claims filed by policyholders for the treatment of infection.
2 Hours Deadline:
Significantly, the Insurance Regulatory and Development Authority of India (IRDAI) has reported coronavirus (COVID-19) disease/infection. Norms have been issued to general and health insurance companies for speedy settlement of claims filed by policyholders for treatment claims of infection. It directs health insurers to do that; because of the current coronavirus pandemic, they should clarify the situation within 2 hours on the claims received for cashless treatment and final discharge in the hospital.
Pressure must be reduced:
IRDAI's circular on norms for settlement of health insurance claims mentions the rules applicable. The circular says that there is a need to reduce the additional pressure on health-care infrastructure due to circumstances arising out of pandemic COVID 19. All insurers would be speeding up decisions on health insurance claims. All health insurance claims should be answered at the earliest to ensure. At the same time, insurers have been directed to comply with the stipulated time frame.
The hospital will be informed to the network provider on behalf of the insurer or TPA (whichever is earlier) request and the authorized decision for cashless treatment within 2 hours from the food supply of the last necessary qualification. The hospital will be informed to the network provider on behalf of the insurer or TPA (whichever is earlier) request and the decision authorized for final discharge within 2 hours from the food supply of the final required qualification.
Advice to Insurers:
The circular advised insurers that; They should issue appropriate guidelines to their respective third party administrators. Significantly, in a circular issued earlier in March 2020, IRDAI had advised all insurance companies to expeditiously execute health insurance claims relating to COVID 19. In the latest circular, the insurance regulator has asked insurance companies to set up a 24-hour based system for settlement of claims. The objective is to speed up the treatment and settlement of claims of life insurance policyholders affected by novel coronavirus disease infection.
Review Claims:
Earlier, regulator IRDAI had asked insurance companies to dispose of treatment cost costs, including quarantine periods, under policy contracts and terms and conditions applicable under the regulatory framework. However, the regulator gave insurers COVID-19 disease/infection. The filing for infection treatment was asked to thoroughly assess the claims which were required to be reviewed by the Review Committee before (the claims) were repealed. According to reports, the cases under treatment health insurance are only a few. Only 2% of the people suffering from epidemic COVID-19 have registered insurance claims. According to the report given by the General Insurance Council (GIC) to the Ministry of Finance till Monday (April 13, 2020), out of 10,586 cases, only 200 cases are COVID-19 claims.
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