New Delhi: Patients with health insurance will no longer have to wait long for treatment or hospital discharge. The insurance regulator, Insurance Regulatory and Development Authority of India (IRDAI), has introduced new rules.
According to the Finance Ministry, these rules aim to support policyholders by setting fixed timelines for processing cashless health insurance claims.
IRDAI has decided that:
Cashless pre-authorization must be approved within 1 hour
Final authorization must be completed within 3 hours
The goal is to reduce delays and ensure patients receive timely treatment
‘Golden Hour’ Rule for Cashless Claims
To prevent delays during hospitalization, IRDAI has introduced strict timelines under the ‘Golden Hour’ rule:
Insurance companies must approve cashless pre-authorization within 1 hour
Final approval must be completed within 3 hours at the time of hospital discharge
This rule is expected to make the process faster and smoother for patients.
Rapid Growth in Health Insurance Sector
The health insurance sector in India is growing quickly. In the financial year 2024–25, it is expected to grow by around 9%, with total premiums crossing ₹1.2 trillion.
The government says this growth is due to:
Increasing health awareness among people
Better access to healthcare financing
Rising need for protection against medical expenses
Improvement in Claim Settlement Ratio
The claim settlement ratio has improved over the past few years:
FY 2024–25: 87.5%
FY 2023–24: 82.46%
FY 2022–23: 85.66%
This shows that more claims are being successfully settled.
Why Insurance Premiums Are Increasing
There are several reasons behind the rise in health insurance premiums:
Age factor: Premiums increase as the policyholder gets older due to higher risk
Higher coverage: People are choosing larger insurance coverage for serious diseases
Advanced features: New policies include benefits like outpatient care and wellness services, which increase costs
Quick Resolution of Complaints
According to 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% of complaints were resolved within the same financial year, showing improved efficiency in handling issues.
Claims Are Still Being Rejected
Despite improvements, some insurance claims are still rejected. The main reasons include:
Co-payment clauses
Sub-limits on coverage
Room rent limits
Non-medical expenses not covered
If you are buying health insurance, make sure to carefully read and understand all terms and conditions. If anything is unclear, contact the insurance company to avoid problems later.
