The growth of the insurance sector is expected to reach 7.1% from 2024 to 2028, and the aim is to increase the number of policyholders. Recent announcements by IRDAI (Indian Regulatory and Development Authority of India) focus on reducing the burden on policyholders and increasing the responsibility of insurance providers.
The new rules stipulate that insurers, such as ACKO General Insurance, must approve cashless claims within an hour and approve hospital discharges within three hours. Since then, insurance providers are responsible for responding to claim requirements in a timely manner. If they delay in authorizing the discharge, the insurer must cover any additional costs charged by the hospital. It must be paid into the shareholders’ fund.
Prompt Payment of Non-cash Claims
During a health crisis, navigating a health insurance policy is difficult for the patient and family. If you must focus on your health immediately, the terms of the policy instruct you to find an in-network hospital for cashless claims. Otherwise, you have to pay the hospital expenses out of your own pocket and ask for reimbursement if the policy allows you to do so. The new IRDAI practice has removed this restriction, allowing policyholders to make cashless claims at any hospital, including out-of-network hospitals.
Even if you have cashless claims, you must provide insurance cards to the hospital, and they will contact your provider for approval. Usually, it takes a few hours, causing stress and anxiety for the policyholder. IRDAI’s mandate to respond to cashless claims within an hour makes insurance consumer-friendly.
More importantly, insurers must pay cashless claims on discharge within three hours of receiving a claim from the hospital. Patients do not have to stay in the hospital and pay additional costs; they just have to wait for the insurance providers to complete their claims. As a result, you can leave the hospital without delay. Many hospitals charge extra for extra waiting time, increasing medical bills. It can be completely avoided when cashless requests are completed within three hours.
Those who have opted for cashless applications can now avoid delays and get treatment at the right time anywhere. There will also be no need to pay out of pocket unnecessarily for extensive coverage. This is especially beneficial for senior health insurance because elderly patients can be discharged quickly without worrying about additional costs.
Impact on Insurers
With increasing responsibilities for prompt payment of claims, insurers are moving towards digitalization. Manual verification of hospital documents cannot be done within the specified three-hour window. Therefore, all insurance providers should implement a digital claim submission and verification system. Also, they should respond to a cashless application within one hour, reducing the pressure on policyholders. Insurers are given time until July 31, 2024, to update their infrastructure to meet new living conditions.
The National Health Claims Exchange (NHCX) platform helps streamline the processing of health claims. It improves administrative efficiency, thereby improving customer service. The National Health Authority (NHA) and the Union Ministry of Health and Family Welfare have worked together to create the NHCX platform which will act as a digital gateway for exchanging information related to claims.
All stakeholders, including insurers, health institutions, beneficiaries, and other stakeholders, can access the application process using the same portal. Allowing faster exchange of information will speed up the claims resolution process. Using this platform, insurers can respond to non-cash claims and resolve them quickly without delay.
Take away
The actual health insurance benefit is available only at the time of payment of the claim. Complex and time-consuming healthcare applications must now be completed quickly and accurately. There is no need to worry about unnecessary application rejection. It greatly reduces the burden on policyholders and holds insurance companies accountable for negligence. The new rules from IRDAI will bring a positive change in healthcare payments for cashless applications facilitated by the NHCX platform.
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(This article is part of a sponsored feature by IndiaDotCom Pvt Lt, a paid publishing program. IDPL claims no editorial involvement and assumes no responsibility or liability for any errors or omissions in the content of the article.)
