By Admin 
- Despite expensive premiums, eight percent of health claims were rejected.
- IRDAI made it mandatory to give concrete reasons for rejecting the claim.
- Policyholders will now be able to know the exact reasons for rejection.
- Insurance companies will have to settle cashless requests within an hour.
Health Insurance: In view of the increasing diseases nowadays, it has become very important to take health insurance. After the Corona epidemic, the number of people taking health insurance has increased rapidly. To avoid expensive treatment, people are taking health insurance by paying expensive premiums. At the same time, companies are also making the premium expensive year after year. Despite this, many people are not getting claims. According to a report, almost one in every 12 health insurance claims was rejected in FY25.
What does the data tell?
According to a data, in 2024-25, insurance companies filed 3.26 crore health insurance claims and paid Rs 94,248 crore during the year. However, about 8% of claims were rejected, which means almost one in every 12 policyholders who made a claim did not get paid.
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What has IRDAI said?
Now, the Insurance Regulatory and Development Authority of India (IRDAI) has taken strict action. Under the new reforms of the regulator, IRDAI clearly said that the companies will have to give strong reasons for rejecting the claim and mention the specific policy conditions on the basis of which the decision to reject the claim has been taken. This step has been taken at a time when claims related complaints are increasing despite improvement in claim processing time.
What will be the benefit?
After strictness in this, it will become easier for the policyholders to find out whether the claim rejection is justified or not, and if necessary, they can pursue the matter through complaint handling channels or Insurance Ombudsman. This reform is based on several claims related ideas initiated by the regulator. It is now mandatory for insurance companies to process cashless pre-authorization requests within one hour and communicate the discharge decision within three hours of receiving the final request from hospitals.
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