Faster Claim Settlements: Health insurance gets consumer-friendly with new rules

The growth of the insurance sector is expected to hit 7.1% from 2024 to 2028, and the goal is to increase the number of policyholders. Recent IRDAI (Indian Regulatory and Development Authority of India) announcements are focused on reducing the burden on policyholders and increasing the responsibility of insurance providers.

The new norms dictate that insurers, like ACKO General Insurance, must approve cashless claims within an hour and authorise discharge from the hospital within three hours. Effective immediately, insurers are responsible for responding to claim requirements at expedited time. If they delay in approving the discharge, the insurer must bear any additional cost charged by the hospital. It must be paid from the shareholder's fund.

Faster Settlement of Cashless Claims

During a health crisis, navigating the health insurance policy landscape is difficult for the patient and the family. When you must immediately focus on your health, the policy terms instruct you to find a network hospital for cashless claims. Otherwise, you must pay hospital expenses out of your pocket and then claim reimbursement if the policy allows you to do so. The new IRDAI norm has removed this limitation, allowing policyholders to request cashless claims in any hospital, including out-of-network hospitals.

Even with cashless claims, you must provide insurance cards to the hospital, and they will contact your provider to get approval. Typically, it takes a few hours, creating stress and anxiety for the policyholder. The IRDAI's mandate of replying to cashless claims within an hour makes insurance consumer-friendly.

More importantly, insurance providers must settle cashless claims on discharge within three hours of receiving the request from the hospital. Patients need not stay in the hospital and pay additional charges; they just have to wait for insurers to settle their claims. As a result, you can get discharged from the hospital without any delay. Many hospitals charge more for additional waiting time, inflating the medical bills. It can be avoided entirely when cashless claims are settled within three hours.

Those who have opted for cashless claims can now avoid delays and get treatment at the right time anywhere. There will also be no need to pay out of pocket unnecessarily with comprehensive coverage. This is especially beneficial for senior citizens' health insurance because elderly patients can be discharged quickly without worrying about additional costs.

Impact on Insurers

With the added responsibilities of faster claim settlements, insurers are pushed towards digitisation. Manual verification of hospital documents cannot be done within the stipulated three-hour window. So, all insurance providers must adopt a digital claim submission and verification system. Also, they must respond to the cashless claim request within one hour, reducing the stress for policyholders. The insurance providers are given time until July 31, 2024, to update their infrastructure to fulfill the new settlement conditions.

The National Health Claims Exchange (NHCX) platform helps streamline health claims processing. It improves administrative efficiency, thereby enhancing customer service. The National Health Authority (NHA) and the Union Ministry of Health and Family Welfare worked together to create the NHCX platform to serve as a digital gateway for claims-related information exchange.

All the stakeholders, including insurers, health institutions, beneficiaries, and other parties, can access the claims process using the same portal. Allowing faster information exchange will expedite the claims settlement process. Leveraging this platform, insurers can respond to cashless claims and settle them quickly without any delay.

Takeaway

The true benefit of health insurance is realised only during claim settlement. The complicated and time-consuming healthcare claims must now be completed quickly and accurately. There is no need to worry about unnecessary claim rejection. It dramatically reduces the burden on policyholders and holds insurance companies liable for negligence. The new rules from IRDAI will bring a positive change in the cashless claim health settlements aided by the NHCX platform.

Looking for customisable health plans? Explore ACKO health insurance policies for cost-effective and comprehensive health coverage for all ages.

(This article is part of IndiaDotCom Pvt Lt’s sponsored feature, a paid publication programme. IDPL claims no editorial involvement and assumes no responsibility or liability for any errors or omissions in the content of the article.)