The Center is planning to make the cashless authority mandatory for health insurance companies to approve the requests within an hour, and according to two people of development, final claim settlement request within three hours.
Also, a professional agency can be hired to designing standardized insurance claim and application form that is easy to understand and fill. Such forms will also ensure that insurance companies deal with claims within a complete and specified period.
“This idea is for the standards of BIS-type in the insurance sector that streamlines the operation of the health insurance industry,” one of the authorities quoted on condition of anonymity. BIS or Bureau of Indian Standards is the national standard body of India.
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The official said that its objective is to bring more people under health insurance coverage so that “insured patients do not face financial crisis due to increasing medical bills”. It is in line with the objective of the Central Government to provide cheap health insurance coverage and insurance to all by 2047, which was announced by Idardi in November 2022.
To ensure this, India (IRDAI) -Had of the Insurance Sector Regulatory -Bima Regulatory and Development Authority released a master circular in 2024 with specific guidelines for the timely solution of claim settlement requests. However, health insurers facing an increase in claims have failed to follow the rules.
“There have been cases of rejecting or refusing 100% cashless claims to the insurers,” the official said, “the officer said earlier. “Strict enforcement of IRDAI rules and standardization of disposal process should help increase consumer confidence in health insurance products.”
The Querry and Irai, emailed to the Union Finance Ministry, remained unanswered until time.
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The move to accelerate the process of approval from insurance companies is in addition to the center’s efforts to strengthen the National Health Authority and the Exchange of National Health Class with Idardi. NHCX is a digital platform designed by insurance companies to streamline and standardize the processing of health insurance claims.
By July 2024, 34 insurers and third-party administrators (TPAs) lived at NHCX, and about 300 hospitals were starting to send their claims on stage. To ensure this, India have 26 general insurance companies, two special insurers and seven standalone health insurance companies, and the estimated 200,000 hospitals are highly counted.
Not so easy
Internal sources in the insurance industry appreciated the hurry in a hurry, but pointed to the on-ground challenges. A top executive of a private sector general insurer requested to remain anonymous, saying that this idea would definitely promote more participation of people in health insurance. “However, the government should also pay attention to aspects of the growing healthcare bills that often make quick claim settlement difficult,” said this executive. “Standardization of claims of claims will be a good step, but its enforcement must be ensured.”
According to General Insurance Aco’s India Health Insurance Index 2024, the average claim size in health insurance policies increased by 11.35% in 2023, showing the cost of health care and an increase in medical inflation. This increase in medical inflation leads to a high health insurance premium which has almost doubled in the last three to four years. In addition, the report indicates an annual 14% rate of increase in health care costs in India.
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IBAI (Insurance Brokers Association of India) General Secretary R. Balsundaram pointed to more challenges. “This is a thing to pass a regulation, but a completely different issue on implementation,” he said. “Inspectors/ TPAs/ Hospitals have their own practical issues that come in the way of fulfilling these deadlines. This is only a close coordinated attempt among these stakeholders that can crunch the deadline to finish a claim.”
Balsundaram said that a claimant is only concerned about how soon the TPA (third-party administrator) approves a claim and how soon he may come out of the hospital after confirming the settlement amount.
“The claimant cannot be harassed about the time taken to settle in the insurer’s hospital,” he said. “However, it is also most important for hospitals and insurers. It is working on progress. We are on the right path, although the progress is slow. It will be a short time before the progression of health insurance coverage.”
Former General Secretary of General Insurance Council CR Vijayan said, “Quick disposal of cashless claims is very important.” “The hospital is generally discharged in the evening. The bills are sent by hospitals to the insurance company/TPA. They get to answer either an hour. During this time the patient/biustander is worried about when the claim will be fixed and how much. The current system needs to be re -prepared and more transparent. It will help in standardization etc. as claims.”
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Sharad Mathur was in favor of the government’s step of the managing director and chief executive officer of Universal Sompo General Insurance. He said, “Rapid claim registration and disposal time, if implemented effectively, will strengthen the confidence in the insurance process, reduce the tension on patients and their families,” he said that the standardized surgery rates in hospitals and discharged documents can strengthen backnd operations and reduce the disputes, which can make the insurer rapidly and accumulate in the same form, which can make the insurer rapidly and accurately. Is.
“Such alignment between healthcare providers and insurers would undoubtedly have a smooth experience for policyholders. If necessary, bringing hospitals under regulatory inspection would support to achieve a large objective,” he said.
The central government is also working on being a separate regulator for health insurance business. Last year, the Union Finance Ministry wrote to the Union Ministry of Health to bring uniformity in health services and to finalize the shape of the new regulator for the health sector to facilitate cheap health insurance coverage for all citizens. However, the plan is still in work and has not moved forward.
Lower penetration
The latest development comes under the backdrop of increasing payment for insurance claims and the number of outstanding claims has not been fixed yet. According to IRDAI, FY25 (April to November) is written in the gross direct premium written by general insurers. 2,05,138 crore, an increase of 8.89% in the same period of last financial year ( 1,88,386 crore).
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As outstanding claims, IRDAI data suggests that by March 2024 there were 25 million outstanding claims. This was a significant growth compared to 17.5 million in March 2023, which in March 2022 doubled 8.5 million outstanding claims.
India’s health care expenses are less than the global average. According to the World Health Organization’s global health expenditure database, India’s healthcare costs are much lower than developed countries like the US and UK as a percentage of GDP, as well as developing countries such as Brazil, Naple, Vietnam, Singapore, Sri Lanka, Malaysia and Thailand.
Between 2013-14 and 2022-23, the total insurance entry increased from 3.9% to 4%, while the insurance density increased from $ 52 to $ 92.
Insurance entry and density are used to assess the level of development of insurance sector. Insurance entry is measured as a percentage of insurance premium for GDP, and insurance density is calculated as a ratio of the premium as a ratio of population (per capita premium).
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Shashwat Alok, Associate Professor of Finance at the Indian School of Business (ISB), said, “At least, at least, in the penetration of insurance coverage in India, the least remains in the least, as consumers are uncertain whether their claims will be honored at the time of need. Consumer and insurance industry can promote more confidence and consumer trust in the insurance industry.
“Over time, the insurers in detail in the consumer base can allow the insurers to pay more competitively due to an increase in risk diversification for a large number of customers, resulting in greater strength. However, the effectiveness of these changes will rest on the clear accountable structure to ensure the insurer and hospitals.
