Disclose health claims settlement data: IRDAI to insurers

In a guideline on public disclosures, the Insurance Regulatory and Development Authority of India (IRDAI) has asked general insurers, including health insurers to collate and publish data on processing and settlement of health insurance claims.

As per the guideline, the insurers transacting health insurance business should disclose the turnaround time (TAT) for cashless claims for individual/group policies (pre-authorisation and discharge from hospital) and settlement or repudiation of claims for individual/group/government policies.

The insurers should also disclose the number of policies/lives serviced by them individual/group /government.

The other data to be disclosed include number of claims at the beginning of the year, claims received/paid/repudiated during the year and outstanding claims at the end of the year.

The data should be disclosed claims processing agents or third party administrators (TPA) wise.

Similarly, the data on grievances against TPA should also be disclosed.

The IRDAI said the above data should be disclosed TPA wise within 90 days after the close of every financial year signed by the CEO or one of the Whole Time Directors.

All TPAs should provide the link of every insurance company where the said data is available.

According to IRDAI, policyholders wanting to know the details can access the same on visiting the insurers'' or TPAs website.

The sectoral regulator has stipulated that the data for the financial year ending 31.3.2020 should be published by Sept 30, 2020.