In providing compensation to health insurers, the Insurance Regulatory and Development Authority (IRDA) has asked insurance companies to explain the reason for the cancellation. Experts say that following this IRDA directive, the insurer will be able to obtain insurance. Insurance companies will not be able to cancel an insurance claim based on estimates made so far. This brings transparency into the claim process.
The rights disposition process should be transparent
The IRDA issued a circular asking insurance companies to be more transparent in the health insurance claims settlement process. In addition, the regulator has asked insurance companies to give a clear reason for the policyholder to deny the claim. The IRDA says it is mandatory for all insurance companies to establish procedures through which policyholders can obtain information about the various stages of the claim process in a transparent manner.
IRDA’s advice to insurance companies is to be transparent in the disposition of health insurance claims
The regulator said that all insurance companies would have to implement arrangements with the policyholder to obtain information about the claims status of the cashless treatment / insurance company / TPA with the website / portal / app or otherwise.
The insurer must have complete knowledge
The IRDA says it must have complete information from the time of application to the time of the disposition of the rights. Health insurance claims settlement circular for life insurance, general insurance and single health insurance companies (Third Party Administrator-TPA). Irda said that if the claims were settled by the TPA on behalf of the insurance company, all information would need to be made available to policyholders. The IRDA has asked insurance companies to ensure that the claim cannot be dismissed on the basis of pre-umption hae or suspicion.
