Master Circular on Health Insurance Products

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:

  1. 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.
  2. In the event of death during the treatment, mortal remains to be released from the Hospital immediately.
  3. No claim can be repudiated without the approval of the Claims Review Committee which is required to take decision on repudiation of every claim.
  4. For claim settlements, the policyholder shall not be required to submit any documents. Insurers and TPAs shall collect the required documents from the Hospitals.
  5. For portability requests on Insurance Information Bureau of India (IIB) portal, stricter timelines being imposed for the existing insurer and the acquiring insurers to act.
  6. Insurer is liable to pay Rs. 5000/- per day to the policyholder in case ombudsman awards are not implemented within 30 days.
  7. Underwriting policy to ensure Ayush treatment at par with the other treatments. Policyholders to be given an option to choose treatment of their choice.
  8. 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.
  9. 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option(s) to be given to policyholder to migrate to any other suitable product (existing or modified version of the withdrawn product) or one-time option to renew the products (if renewal falls within 90 days from the date of withdrawal).