29th April, 2021
and Health Insurers (Except ECGC & AIC)
Norms on settlement of COVID-19 health insurance claims
1. Reference is
invited to Order dated 28.4.2021 passed by Hon’ble High Court of New Delhi in
WP(C) No.5026 /2021 wherein IRDAI was directed to advise Insurers to communicate
their cashless approvals to the concerned hospitals/establishments within a
maximum time period of 30 to 60 minutes so that there shall not be any delay in
discharge of patients and hospital beds do not remain unoccupied.
2. In this
regard, attention is invited to circular ref.no. IRDAI/HLT/MISC/CIR/95/04/2020
dated 18.4.2020 wherein a fixed turnaround time (TAT) of two
hours for granting both cashless pre-authorization and for final discharge of
the insured patient was specified.
3. In the wake of
prevailing conditions of COVID-19 cases in the form of second wave and
in line with aforesaid directions of the Hon’ble High Court, the following
directions are issued to all insurers:
a. Decision on
authorization for cashless treatment for COVID-19 claims shall be communicated
to the network provider (hospital) within a period of 60 minutes from the time
of receipt of authorization request along with all necessary requirements from
b. Decision on
final discharge of patients covered in COVID-19 claims shall be communicated to
the network provider within a period of ONE hour from the time of receipt of
final bill along with all necessary requirements from the hospital.
the above outer limits of timelines specified, the insurers are advised to
process such requests promptly so that both authorisation for cashless
treatment and discharge of the patient can be hastened to the maximum extent.
5. The Insurers shall
issue appropriate directions to their respective Third Party Administrators for
ensuring compliance with the timelines specified above.
guidelines are issued under the powers vested with Regulation 27 (vi) of IRDAI
(Health Insurance) Regulations, 2016 read with Section 34 (1) of Insurance Act,
7. The above instructions shall be
in force with immediate effect.
(D V S Ramesh)