Health insurance: Making Claims Settlement Transparent

Health insurance by no means is a luxury in 2022. It has become one of the bare necessities when it comes to financial planning. While investing your money is important, it is also essential to invest in the right place to have a financial shield. With a health insurance policy, a secure financial buffer can be created to tackle medical requirements; not just for you but also your family members. 

Health insurance policies have several benefits and are not limited to treatment costs.

They also provide pre- and post-hospitalization coverage that enables policyholders to seek compensation for any medical procedures required before and after the actual treatment. 

There is a lot of information on health insurance available on the website Visitors can learn about different types of health insurance, coverage options, and ways to save money on premiums. The site also includes tips for choosing a health plan and understanding policy terms.

IRDAI’s efforts to make health insurance claims more transparent

A circular by the insurance regulator, the Insurance Regulatory and Development Authority of India (IRDAI), has asked the insurance companies to be more transparent in their claim settlement process. It also requires insurance companies to inform policyholders of any reason in case their claim is denied. Such an intimation helps the policyholder to have a clear and transparent communication at different stages of their insurance claim. * You can visit the official website of IRDAI for further details.  

It has also required the insurance companies to put effective systems in place to facilitate the tracking of the status of all claims, whether cashless or reimbursement, be it with the insurer, or a third-party administrator (TPA). Such tracking shall be required for all claims made online, whether through an app, or website, or portal, or other electronic means that the insurance company allows. Further, this status must cover details regarding the time of receipt of the claim request to the time of its disposal along with the decision thereon. 

In the event a TPA is handling an insurance claim on behalf of the insurance company, the policyholders must be informed of the process to track such claims. The regulator has also asked the insurance companies to not deny claims based on presumptions and conjecture. * Standard T&C Apply

Further, in case of denial of an insurance claim, the IRDAI (Health Insurance) Regulations of 2016 state that the insurer must specify the reason for any repudiation and also make a reference to the insurance policy’s terms. This requirement helps the policyholder to know which specific insurance clause denies them the claim. Policy details are also required to be furnished to the policyholder at a granular level detailing every disallowance and its reason thereof. * You can visit the official website of IRDAI for further details.  

Grievance redressal procedures are also required to be mentioned by the insurance company along with details of the insurance ombudsman for its redressal. *

To ensure the benefits of health insurance are rightly available to all policyholders, IRDAI has been making consistent efforts to improve the streamlining of insurance processes. This includes establishing timelines within which claims shall be settled. *

Selecting the right policy for you can be tricky considering there are plethora of alternatives to choose from. A health insurance calculator is a free tool made available by most insurance companies that enables you to compare health insurance plans, not only based on premium, but also its policy features. *

* Standard T&C Apply

Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms and conditions, please read sales brochure/policy wording carefully before concluding a sale.