Faster treatment ahead: IRDAI sets 1-hour approval, 3-hour insurance claim settlement timeline

In a significant move aimed at improving patient care, the Insurance Regulatory and Development Authority of India (IRDAI) has introduced new rules mandating strict timelines for processing cashless health insurance claims. Under the revised guidelines, hospitals must receive pre-authorization approval within one hour, while final claim settlement at discharge must be completed within three hours. The decision is intended to eliminate delays in treatment and ensure timely medical support for policyholders.

The new framework, often referred to as the “golden hour” rule, is designed to reduce waiting time during hospital admission and discharge. The Finance Ministry stated that these timelines will help patients avoid prolonged uncertainty, especially during emergencies. Additionally, the introduction of IRDAI’s PIR system ensures that even if policy documents are misplaced, all insurance details can still be accessed digitally, further easing the process for patients.

At the same time, the health insurance sector is witnessing strong growth. In the financial year 2024–25, the total premium collection crossed ₹1.2 lakh crore, registering a growth rate of around 9%. This rise has been attributed to increasing health awareness, better access to healthcare financing, and the growing need for financial protection against rising medical expenses. Improved claim settlement ratios, which reached 87.5% in FY 2024–25, also reflect better efficiency in the system.

However, despite these improvements, certain challenges remain. Claims are still rejected in some cases due to policy conditions such as co-payment clauses, sub-limits, room rent caps, and non-medical expenses. Authorities have advised policyholders to carefully read and understand all terms and conditions before purchasing insurance to avoid complications during claims. Overall, the new rules aim to create a more responsive and patient-friendly health insurance ecosystem.