The Insurance Regulatory and Development Authority of India (IRDAI) has issued a comprehensive Master Circular on Health Insurance Products repealing 55 circulars. Following are the major compliances mandated for insurers:
- To decide on cashless authorization requests immediately and within one hour and final authorization on discharge from hospital within three hours of request from the hospital.
- In the event of death during the treatment, mortal remains to be released from the Hospital immediately.
- No claim can be repudiated without the approval of the Claims Review Committee which is required to take decision on repudiation of every claim.
- For claim settlements, the policyholder shall not be required to submit any documents. Insurers and TPAs shall collect the required documents from the Hospitals.
- For portability requests on Insurance Information Bureau of India (IIB) https://iib.gov.in/ portal, stricter timelines being imposed for the existing insurer and the acquiring insurers to act.
- Insurer is liable to pay Rs. 5000/- per day to the policyholder in case ombudsman awards are not implemented within 30 days.
- Underwriting policy to ensure Ayush treatment at par with the other treatments. Policyholders to be given an option to choose treatment of their choice.
- Performance of TPAs to be monitored. Payments to be made to the TPAs only upon full discharge of satisfactory service. Claw back of remuneration/charges paid to TPA basis customer feedback, which shall be passed on to the policyholders.
- In case of withdrawal of products suitable option(s) to be given to policyholder to migrate to any other suitable product (existing or modified version of the withdrawn product) or one-time option to renew the products (if renewal falls within 90 days from the date of withdrawal).
