The Insurance Regulatory and Development Authority of India’s (IRDAI) new guidelines and timelines for all general and standalone health insurance companies will alleviate the pressure on the healthcare infrastructure.
“In order to ensure all health insurance claims are responded to quickly, insurers are directed to comply with the following timelines,” a circular issued by the IRDAI said.
The IRDAI instructs that decisions on authorisation for cashless treatment shall be communicated to the network provider (hospital) within two hours from the time of receipt of authorisation request and last necessary requirement from the hospital either to the insurer or to the third party administrator (TPA) - whichever is earlier, it adds.
IRDAI member (non-life) TL Alamelu added that insurers should issue appropriate guidelines to their respective TPAs.
The National Health Authority of India notes that the majority of Covid-19 treatments (regarding positive cases) in India is being handled by government hospitals. As such, healthcare providers in the private sector are only handling around 10 per cent of positive Covid-19 cases – as a result, there are only a small number of insurance claims at this point.