Page 35 - Insurance Times April 2020

norms specified in the above referred guidelines or may 2. Reference is also invited to the provisions of Regulation
be offered as a temporary relief for a period of twelve 27 of IRDAI (Health Insurance) Regulations, 2016 that
months (one policy year) in respect of all the health specified norms on settlement / rejection of claim by
insurance policies that are due for renewal up to 31st insurers. In terms of Regulation 26 of these Regulations,
March, 2021. Towards this, the provision of clause 3.9 inter alia, insurers shall establish systems, procedures
of the above referred guidelines that mandate a gap to enable efficient issuance of pre authorisations on a
of at least 12 months for effecting minor modifications 24 hour basis and for prompt settlement of claims.
stands relaxed.
3. In light of prevailing conditions owing to COVID 19 as
5. The matter of availability of facility of payment of also taking into consideration the need for alleviating
premiums in instalments and the conditions thereon the pressure on the healthcare infrastructure all the
shall be suitably published in the website of every insurers shall decide health insurance claims
insurance company. expeditiously. In order to ensure all health insurance
claims are responded to quickly, insurers are directed
6. Where the facility of payment of premiums in to comply with the following timelines:
instalments is offered in respect of any product /
products the same shall be offered to all policyholders a. Decision on authorization for cashless treatment shall
without any discrimination and policyholders shall be also be communicated to the network provider (hospital)
notified of the applicable conditions. within two hours from the time of receipt of
authorization request and last necessary requirement
7. Specific consent of having agreed to the conditions shall from the hospital either to the insurer or to the TPA
be obtained from the policyholders. whichever is earlier.

8. The names of the products that are offered the facility b. Decision on final discharge shall be communicated to
of payment of premiums in instalments shall be the network provider within two hours from the time
published in the websites of insurers for the information of receipt of final bill and last necessary requirement
of policyholders. from the hospital either to the insurer or to the TPA
whichever is earlier.
9. The details of products in respect of which the
Instalments facility is made available shall be filed with 4. Insurers are advised to issue appropriate guidelines to
the Authority as per Annexure – 1 specified in the their respective Third Party Administrators.
within referred guidelines and within seven days from
the date of offering the facility. There will no change 5. These guidelines are issued under the powers vested
to the UIN allotted to the product. with Regulation 27 (vi) of IRDAI (Health Insurance)
Regulations, 2016 read with Section 34 (1) of Insurance
10. These Guidelines are issued under the powers vested Act, 1938.
in Section 34 (1) of Insurance Act, 1938 read with T L Alamelu, Member (NL)
Regulation 2(i)(g) read with Regulation 2 (i)(o) of IRDAI
(Health Insurance) Regulations, 2016. Premium payment for renewal of Motor
D V S Ramesh, General Manager (Health)
Third Party Insurance policies falling due

Norms on settlement of health during the lockdown period
insurance claims Further to Circular Ref: IRDAI/NL/CIR/MOT/079/04/2020

1. Reference is invited to the Circular Ref. No. IRDAI/HLT/ dated 2nd April, 2020, it is hereby informed that the
Department of Financial Services, Government of India
REG/CIR/054/03/2020dated 04th March, 2020 wherein has issued Notification dated 15th April, 2020 wherein
all insurers were advised to expeditiously handle the it has amended the Order issued vide S.O.1237(E) dated
health insurance claims pertaining to COVID 19.
1st April, 2020 on the subject.
The Insurance Times, April 2020 35