Policyholders can navigate claim processes more confidently by knowing the timeline and protections that IRDAI mandates for health insurance claims.
Five IRDAI rules that help ensure smoother claim settlements
- Prompt notification and complete documentation: Inform the insurer and the chosen hospital without delay and submit all required forms and records to prevent unnecessary hold-ups.
- Cashless claims via network hospitals: If you plan to use cashless facilities, choose a network hospital and obtain any pre-authorization required by the insurer, so the process stays streamlined.
- Timely claim decision after submission: Once the insurer has all necessary documents, a decision on the claim should be communicated within the period defined by regulations, with clear reasons if a claim is denied.
- Clear communication on outcomes and recourse: Insurers must provide the grounds for rejection and inform policyholders about the next steps, including options to appeal or request a review.
- Accessible grievance channels: For delays or unresolved issues, policyholders can contact the insurer’s grievance redressal unit and, if needed, approach the Insurance Ombudsman or the IRDAI consumer grievance mechanism.
