Insuconsultants For Guidance On Filling Of Claims Under Mediclaim Policy

04/12/2025

IRDAI flags lapses in health insurance claims, issues show-cause notices, s

The IRDAI has initiated the process to issue show-cause notices to eight insurance companies due to irregularities detected in their health insurance portfolios.



The IRDAI has initiated the process to issue show-cause notices to eight insurance companies. Image: Twitter

The Insurance Regulatory and Development Authority of India (IRDAI) has initiated the process to issue show-cause notices to eight insurance companies due to irregularities detected in their health insurance portfolios, a CNBC TV18 report stated citing sources.



These insurers included Niva Bupa, Star Health, Care Health, ManipalCigna, New India Assurance, Tata AIG, ICICI Lombard, and HDFC Ergo.

Earlier on June 26, another report by CNBC TV18 had stated that IRDAI had initiated inspections at health insurance companies and flagged concerns with some insurers on implementation of certain regulatory norms in the new health insurance master circular. The regulator had found significant lapses in health claim practices at these insurance companies.

Reacting to this, ICICI Lombard told CNBC TV18 that over the past year, IRDAI had introduced several regulatory guidelines, including master circulars. The company further maintained that the regulator carried out inspections in stages to assess the insurers’ compliance with these directives.



“ICICI Lombard has gone through the inspection and as an industry leader, we follow high standards of regulatory compliance and corporate governance in all our operations,” it said.



Further, New India Assurance also said that IRDAI has the right to inspect all insurers. The company called the inspections “not adversarial” but aimed at promoting better operations and compliance. New India Assurance stated it has fully adopted the Master Circular.



During the inspection, per the report, IRDAI identified some procedural concerns. These included an excessively detailed Customer

04/12/2025

IRDAI penalizes Policybazaar Rs 5 crore for various violations including ..

IRDAI penalizes Policybazaar Rs 5 crore for various violations including biased and misleading product promotions

Synopsis

IRDAI has fined Policybazaar Rs 5 crore for various regulatory breaches. As per the IRDAI order, Policybazaar promoted specific insurance products unfairly. They ranked products as `top` without proper justification. The company also delayed remitting premiums to insurers, violating the Insurance Act. Policybazaar also failed to properly map policies to Authorised Verifiers.

Insurance watchdog IRDAI has penalised Policybazaar with a total of Rs 5 crore on accounting of violating 11 charges under various provisions of the Insurance Act and IRDAI (Insurance Web Aggregators) Regulations, 2017.



Apart from regulatory breaches like KMPs (key managerial personnel) holding directorships in other companies without prior IRDAI approval, Policybazaar was found guilty of promoting products in a biased manner, and ranking various insurance products are top or best without “making available any material to the prospects to make an informed choice”, as per the IRDAI order.

In addition to this, Policybazaar, or Policybazaar Insurance Web Aggregator Pvt. Ltd, referred to as IWA in the order, was fined Rs 1 crore for delaying the remittance of premiums paid by policyholders to the concerned insurers. During the period of IRDAI inspection, Policybazaar was an IWA or an insurance web aggregator. It went on to obtain its composite broker license in February 2024. Read on to know more.



Unfair product promotion

According to the order, on the IWA website, at the time of inspection (1st to 5th June 2020), the top 5 ULIP plans displayed on the site were Bajaj Allianz Goal Assure, Edelweiss Tokyo Wealth Gain+, HDFC Click2 Wealth, SBI Life e-wealth Insurance and ICICI Signature.



“The IWA website displayed only details of ULIP products of 5 insurance companies, while the IWA had ag

04/12/2025

15K hospitals to suspend cashless services for Bajaj Allianz policyholders

Citing low reimbursement rates and arbitrary payment deductions, the Association of Healthcare Providers-India (AHPI) on Friday said that it has advised member hospitals in north India to stop providing cashless treatment facilities for policyholders of Bajaj Allianz General Insurance Company with effect from September 1, 2025.



There are over 15,000 member hospitals, including Max Healthcare and Medanta, which would now stop cashless treatment by the insurer.



The decision came in the wake of AHPI member hospitals raising repeated complaints of unilateral deductions by the company, delay in payments and unduly high time taken for issuing pre-auth and pre-discharge approvals.

“In addition, member hospitals complained that Bajaj Allianz has refused to revise hospital reimbursement rates in line with the rising medical costs, pressuring hospitals to further reduce tariffs that were agreed upon years ago under now expired contracts,” the body said in a public statement.



The not-for-profit organisation currently boasts around 15,200 members and affiliate hospitals, of which it claimed a majority, including big-ticket players such as Max Healthcare, Medanta and PSRI, have decided to suspend cashless services for Bajaj Allianz policyholders.

The hospital body added that while providers have been advised to temporarily suspend cashless services for customers of Bajaj Allianz until fair and sustainable tariff agreements are reached, member hospitals shall continue to provide treatment to their policyholders at self-pay rates, who shall seek reimbursement from their insurer on post-basis.

The AHPI added that a similar notice has been served to Care Health Insurance on Friday, seeking response by August 31.



“Failing this, our member hospitals will be constrained to discontinue cashless services to the Care Health Insurance beneficiaries as well,” the hospital body added.



Comment

05/12/2024

The Insurance Regulatory and Development Authority of India (IRDAI) released a new master circular on health insurance. According to this circular, insurers must decide on cashless authorisation within one hour of receiving a request.



This master circular replaces 55 earlier circulars and is aimed at empowering policyholders and strengthening inclusive health insurance, stated Irdai in a circular dated May 29



The circular consolidates information on policyholder entitlements in a health insurance policy for easy reference. It also highlights measures to provide policyholders with a smoother, faster, and hassle-free claims experience and ensure improved service standards across the health insurance sector.

“We are committed to aligning our health insurance offerings with the IRDAI`s Master Circular on Health Insurance Business. Our goal is to provide policyholders with a wide range of products covering most medical conditions, including pre-existing diseases. We ensure equal treatment options across all lines of medicine, including Allopathy and AYUSH, and we strive to make 100% cashless services available.

"The new Master Circular requires insurers to process discharge authorizations within three hours, enhancing customer service and addressing a common grievance among policyholders, Insurers are urged to strive for 100% cashless claims."

"The updated norms also encourage diversity in product offerings, catering to various demographics and medical needs. They allow policyholders with multiple policies to choose the policy under which to claim. Enhanced transparency is ensured by providing a Customer Information Sheet with each policy. Policyholders stand to benefit from No Claim Bonuses and have the flexibility to cancel policies at any time for a refund of the unexpired premium.

29/11/2024

Ayushman Yojana: Now free treatment up to Rs 10 lakh? | New eligibility, co



The Centre is likely to hike the insurance coverage amount under the Ayushman Bharat health scheme to Rs 10 lakh from the existing Rs 5 lakh, according to a report.

It is expected that the Centre in this month’s union budget may make this mega announcement about the doubling of insurance coverage, PTI reported quoting sources. The report also said that the government may double the beneficiary base under the Ayushman Bharat health insurance scheme. Now, the scheme will cover all those aged above 70 years of age, as per the report.



Once the proposal is implemented, the scheme is expected to cost the exchequer additional Rs 12,076 crore annually as per estimates prepared by the National Health Authority, the report said.



What is Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY)?

Ayushman Bharat PM-JAY is the largest health assurance scheme in the world which aims at providing a health cover of Rs 5 lakhs per family per year for secondary and tertiary care hospitalization to over 12 crore poor and vulnerable families (approximately 55 crore beneficiaries) that form the bottom 40% of the Indian population.

PM-JAY was earlier known as the National Health Protection Scheme (NHPS) before being rechristened. It subsumed the then existing Rashtriya Swasthya Bima Yojana (RSBY) which had been launched in 2008. The coverage mentioned under PM-JAY, therefore, also includes families that were covered in RSBY but are not present in the SECC 2011 database. PM-JAY is fully funded by the government and cost of implementation is shared between the central and state governments.



Ayushman Bharat health cover allocation hiked in interim budget

In the interim Budget 2024, the Modi government raised the allocation for the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana to Rs 7,200 crore. The Centre also allocated Rs 646 crore for the Ayushman Bharat Health Infrastructure Mission (PM-ABH

27/11/2024

Why you shouldn’t rely only on claim settlement ratio while buying term ins

When it comes to selecting the right term insurance policy, the ultimate goal is clear: to secure

peace of mind for your family. After all the research and decision-making, the last thing you want is for your loved ones to struggle when it’s time to claim the benefits. So, how do you choose the right insurance company that will make the process as smooth as possible?







One term that always comes up in discussions when you seek advice on which company’s policy you should buy is the ‘claim settlement ratio’.



What is a claim settlement ratio?

In simple terms, the claim settlement ratio is the number of claims an insurer has settled compared to the number of claims they received in a financial year. For example, if an insurer has a claim settlement ratio of 98%, it means they settled 98 out of every 100 claims they received during that year.



Sounds promising, right? But as Aayush Dubey, Co-Founder & Head of Research at Beshak.org, points out, “This ratio alone doesn’t tell the whole story.” He explains that it doesn’t guarantee that your family will have an easy time when it’s time to file a claim. “Just because an insurer has a high claim settlement ratio doesn’t mean your claim will be approved without a hassle,” he adds. The ratio reflects past settlements and doesn’t promise future outcomes.



Let’s dive deeper into why relying solely on the claim settlement ratio might not be the best approach.

The limitations of claim settlement ratio:

According to Dubey, there are several reasons why the claim settlement ratio might not be the most reliable metric to base your decision on:

It doesn’t account for claim amounts

An insurance company could have a high claim settlement ratio by settling numerous small claims while rejecting larger ones. “While that percentage looks impressive, the actual money paid out might be quite low,” Dubey notes.

It doesn’t show processing time

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22/09/2024

The Insurance Regulatory and Development Authority of India (IRDAI) released a new master circular on health insurance. According to this circular, insurers must decide on cashless authorisation within one hour of receiving a request.



This master circular replaces 55 earlier circulars and is aimed at empowering policyholders and strengthening inclusive health insurance, stated Irdai in a circular dated May 29



The circular consolidates information on policyholder entitlements in a health insurance policy for easy reference. It also highlights measures to provide policyholders with a smoother, faster, and hassle-free claims experience and ensure improved service standards across the health insurance sector.

“We are committed to aligning our health insurance offerings with the IRDAI`s Master Circular on Health Insurance Business. Our goal is to provide policyholders with a wide range of products covering most medical conditions, including pre-existing diseases. We ensure equal treatment options across all lines of medicine, including Allopathy and AYUSH, and we strive to make 100% cashless services available.



"The new Master Circular requires insurers to process discharge authorizations within three hours, enhancing customer service and addressing a common grievance among policyholders,"Insurers are urged to strive for 100% cashless claims."

"The updated norms also encourage diversity in product offerings, catering to various demographics and medical needs. They allow policyholders with multiple policies to choose the policy under which to claim. Enhanced transparency is ensured by providing a Customer Information Sheet with each policy. Policyholders stand to benefit from No Claim Bonuses and have the flexibility to cancel policies at any time for a refund of the unexpired premium.

17/09/2024

Group health insurance is a type of health insurance provided by employers to their employees. This is a popular form of employee benefit, and can help attract and retain quality employees.

There are two main types of group health insurance:

1. Fully employer-funded health insurance: In this type of plan, the employer pays the entire premium for the employee's coverage. This is the most cost-effective option for the employee, but also gives the employer the most control over the plan.

2. Employer-subsidized health insurance: In this type of plan, the employer and employee share the cost of the premium. This can be a more affordable option for employers, but also means employees will have fewer choices when it comes to their coverage.

17/09/2024

Environmental insurance is an insurance policy that protects the policyholder from financial liability arising from environmental damage.
This damage can be caused by various events, such as hazardous material spills, air pollution, or improper waste disposal.
Environmental insurance can help cover the costs of cleanup, remediation and other preventive measures.
This can also help protect policyholders from lawsuits filed by third parties.
There are different types of environmental insurance available, and policy coverage can vary. It is important to choose a policy that suits the specific needs of the business or individual.
Environmental insurance can be an important tool in managing environmental risks. This can help companies protect themselves from major financial liabilities and provide peace of mind.
If you are a business concerned with protecting yourself from the risk of environmental damage, then environmental insurance is something you should consider.

17/09/2024

Electronic equipment insurance is an insurance policy that protects your electronic equipment from damage or loss. This can include items such as TVs, computers, smartphones and appliances.
Electronic equipment insurance is an insurance policy that protects your electronic equipment from damage or loss. This can include things like TVs, laptops, smartphones and kitchen appliances.
Electronic equipment insurance can help you replace your electronic equipment if it is damaged or lost. It can also help you pay for repairs if your electronic equipment breaks down.
By following these tips, you can help extend the life of your electronic equipment and reduce the likelihood that you will need to file an insurance claim. If you are considering purchasing electronic equipment insurance, it is important to compare different policies to find the best one for you. You should consider the cost of the policy, the benefits offered, and the reputation of the insurance company.

05/09/2024

The Insurance Regulatory and Development Authority of India (IRDAI) released a new master circular on health insurance. According to this circular, insurers must decide on cashless authorisation within one hour of receiving a request.



This master circular replaces 55 earlier circulars and is aimed at empowering policyholders and strengthening inclusive health insurance, stated Irdai in a circular dated May 29



The circular consolidates information on policyholder entitlements in a health insurance policy for easy reference. It also highlights measures to provide policyholders with a smoother, faster, and hassle-free claims experience and ensure improved service standards across the health insurance sector.

“We are committed to aligning our health insurance offerings with the IRDAI`s Master Circular on Health Insurance Business. Our goal is to provide policyholders with a wide range of products covering most medical conditions, including pre-existing diseases. We ensure equal treatment options across all lines of medicine, including Allopathy and AYUSH, and we strive to make 100% cashless services available.
"The new Master Circular requires insurers to process discharge authorizations within three hours, enhancing customer service and addressing a common grievance among policyholders.

"The updated norms also encourage diversity in product offerings, catering to various demographics and medical needs. They allow policyholders with multiple policies to choose the policy under which to claim. Enhanced transparency is ensured by providing a Customer Information Sheet with each policy. Policyholders stand to benefit from No Claim Bonuses and have the flexibility to cancel policies at any time for a refund of the unexpired premium.

19/08/2024

The Insurance Regulatory and Development Authority of India (IRDAI) released a new master circular on health insurance. According to this circular, insurers must decide on cashless authorisation within one hour of receiving a request.



This master circular replaces 55 earlier circulars and is aimed at empowering policyholders and strengthening inclusive health insurance, stated Irdai in a circular dated May 29



The circular consolidates information on policyholder entitlements in a health insurance policy for easy reference. It also highlights measures to provide policyholders with a smoother, faster, and hassle-free claims experience and ensure improved service standards across the health insurance sector.

“We are committed to aligning our health insurance offerings with the IRDAI`s Master Circular on Health Insurance Business. Our goal is to provide policyholders with a wide range of products covering most medical conditions, including pre-existing diseases. We ensure equal treatment options across all lines of medicine, including Allopathy and AYUSH, and we strive to make 100% cashless services available.



"The new Master Circular requires insurers to process discharge authorizations within three hours, enhancing customer service and addressing a common grievance among policyholders.

"The updated norms also encourage diversity in product offerings, catering to various demographics and medical needs. They allow policyholders with multiple policies to choose the policy under which to claim. Enhanced transparency is ensured by providing a Customer Information Sheet with each policy. Policyholders stand to benefit from No Claim Bonuses and have the flexibility to cancel policies at any time for a refund of the unexpired premium.