Post by Acko

Read this before your next hospital admission. . . . . . . . . . For the first time, an Indian health insurance claim has a deadline. And the deadline isn't yours. IRDAI's March 25 master circular gives insurers 15 calendar days from your final discharge summary to settle a claim. Miss it — the claim is automatically approved, with 2% compound interest added on top. From July 1, the insurer also pays IRDAI ₹2 lakh per violation. 15% of all claims will be audited every quarter. ₹30,000 crore in claims were denied in FY25. 73,729 complaints landed on Bima Bharosa by February this year. The rule arrives years too late. But it arrives. Five things worth knowing before you need to use it. One. The 15-day clock starts when the insurer receives your final discharge summary. The receipt date is now the single most important date in your file. Two. The insurer can ask for missing documents only twice. SMS and email. Only up to the 10th working day. After that, the document window closes — a delay can't be pinned on paperwork you were never asked for. Three. If the 15-day deadline passes in silence, the claim is approved by default. The 2% interest accrues from day 16. You don't have to complain to trigger it. Four. If payment still doesn't land, escalation is free. Bima Bharosa (bimabharosa*dot*irdai*dot*gov*dot*in) is IRDAI's official portal — no agent, no fee, no lawyer needed. The Insurance Ombudsman is the next step. Five. The 15% quarterly audit means the regulator is now sampling claims actively, not reactively. The behaviour at the desk handling your file changes whether or not you ever call. The most expensive line item in any Indian hospital bill has always been the waiting. From July, that line item sits on someone else's balance sheet. Worth knowing before you need to use it.