Insurance sector regulator Irdai has asked all insurers to be more transparent in their health insurance claim settlement process and apprise the policyholders of reasons in case of denial of claims filed.
It it essential that all insurers establish procedures to let policyholders get clear and transparent communication at various stages of claim process, Irdai said in a circular. “All the insurers shall ensure putting in place systems to enable policyholders track the status of cashless requests/claims filed with the insurer/TPA through the website/portal/app or any other authorised electronic means on an ongoing basis,” said the regulator.
The circular on ‘Health Insurance Claims Settlement’ is addressed to life, general and standalone health insurance companies including the third party administrators (TPAs).
It has said insurers should ensure that policyholders are provided granular details of the payments, amounts disallowed and the reasons for the amount disallowed, as per the regulatory norms.