Patients with health insurance will no longer need to wait long for treatment or hospital discharge. The insurance regulator, Insurance Regulatory and Development Authority of India, has introduced new rules.
According to the Ministry of Finance, these rules set fixed timelines for processing cashless health insurance claims to better support policyholders.
IRDAI has directed insurers to approve cashless pre-authorization within one hour and give final approval within three hours. The goal is to reduce delays and ensure patients receive timely treatment.
Boom in Health Insurance Sector
The health insurance sector in India is growing rapidly. In the financial year 2024–25, the sector is expected to grow by around 9%, with total premiums likely to cross ₹1.2 trillion.
The government says this growth is driven by:
Increased health awareness
Better access to healthcare financing
Rising need for protection against medical expenses
‘Golden Hour’ Rule for Faster Claims
To prevent delays during hospitalization, IRDAI has introduced strict timelines:
Cashless pre-authorization must be approved within 1 hour
Final approval at discharge must be completed within 3 hours
This rule ensures faster treatment and smoother discharge for patients.
Improvement in Claim Settlement Ratio
There has been a steady improvement in claim settlement:
FY 2024–25: 87.5%
FY 2023–24: 82.46%
FY 2022–23: 85.66%
This shows that more claims are being successfully settled over time.
Reasons Behind Rising Insurance Premiums
Health insurance premiums have increased due to several factors:
Age of policyholder: Higher age increases risk, leading to higher premiums
Higher coverage: More people are opting for larger sum insured for serious illnesses
Advanced features: New policies now include benefits like outpatient care and wellness services
Quick Resolution of Complaints
As per IRDAI’s Bima Bharosa portal, a total of 137,361 complaints related to general and health insurance were filed in FY 2025. Out of these, 93% were resolved within the same financial year, showing faster grievance handling.
Claims Still Getting Rejected
Despite improvements, some claims are still rejected. Common reasons include:
Co-payment clauses
Sub-limits on treatments
Room rent limits
Non-medical expenses not covered
Before buying a health insurance policy, it is important to carefully read and understand all terms and conditions. If anything is unclear, contact the insurance company to avoid problems later.
