IRDAI launches shared hospital network and faster cashless claims to make health insurance more accessible, affordable

In a move to make health insurance more accessible and affordable for Indian citizens, the Insurance Regulatory and Development Authority of India (IRDAI) has initiated a shared hospital network and streamlined cashless claim process.

This measure is set to enhance transparency in treatment costs and expedite insurance services for policyholders.

In collaboration with the General Insurance Council, general insurance companies began integrating hospitals into a unified network under this scheme.

Currently, over 600 eye hospitals and 150 general hospitals have been approached for this facility with a target to expand the network up to 5,000 hospitals in the upcoming months.

The treatment rates within this shared network will be based on the pricing models of government health schemes such as Ayushman Bharat (PMJAY), ensuring uniform and transparent charges for medical procedures. This development is expected to significantly reduce out-of-pocket expenses for policyholders.

In a parallel effort, the government is formulating a policy that will mandate insurance companies to approve cashless treatment requests within one hour, and settle final claims within three hours of treatment completion.

To support this fast-tracked process, the claims forms will be simplified and standardised with assistance from a professional agency.

Furthermore, there are plans to implement Bureau of Indian Standards (BIS)-like norms across the insurance ecosystem, with the objective of improving service delivery and accountability among stakeholders.

The push for faster and more efficient claim settlements comes in response to a sharp rise in pending claims over the years:

• In 2022: 8.5 million pending claims
• In 2023: 17.5 million pending claims
• In 2024: 25 million pending claims

The insurance regulator has also highlighted a long-term vision to provide accessible and affordable insurance coverage to every citizen by the year 2047.

Policyholders benefits

Here are several benefits for policyholders:

• Wider access to cashless treatment across a larger network of hospitals
• Pre-defined treatment costs, promoting transparency and cost control
• Simplified and quicker claim settlements
• Greater accountability from insurers and healthcare providers
• Increased consumer trust and broader insurance coverage across the country