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+{{htmlmetatags>metatag-description=(IRDAI rule: your insurer must approve a cashless request within 1 hour and clear your final discharge within 3 hours, or pay the delay cost from its own funds.)&metatag-keywords=(IRDAI cashless 1 hour rule, 3 hour discharge authorisation, cashless health insurance timeline, IRDAI master circular 2024, Bima Bharosa complaint)&metatag-robots=(index,follow)&metatag-og:title=(IRDAI Cashless Rule: 1 Hour to Approve, 3 Hours to Discharge)&metatag-og:description=(IRDAI rule: your insurer must approve a cashless request within 1 hour and clear your final discharge within 3 hours, or pay the delay cost from its own funds.)&metatag-og:type=(article)}}
+====== IRDAI Cashless Rule: 1 Hour to Approve, 3 Hours to Discharge ======
+{{ :social:auto:irdai-cashless-claim-1-hour-3-hour-rule.png?direct&1200 |IRDAI Cashless Rule: 1 Hour to Approve, 3 Hours to Discharge — RTI Wiki}}
+<WRAP center round info 95%>
+**Quick Reply:** IRDAI rule: your insurer must approve a cashless request within 1 hour and clear your final discharge within 3 hours, or pay the delay cost from its own funds.
+</WRAP>
+Your insurer has 1 hour to approve a cashless request at admission and 3 hours to clear your discharge once the hospital sends the discharge authorisation request. This is a binding timeline set by IRDAI, not a courtesy. If the insurer misses the 3 hour discharge window, any extra amount the hospital charges for the delay must be paid by the insurer from its own shareholder funds, not by you.
+If you are short on time, jump to the decision flow below for what to do when the hospital will not let you leave because cashless is stuck.
+This page is about the time mandate, the clock the insurer must beat. It is not about a flat refusal. If your cashless request is refused outright, see [[https://righttoinformation.wiki/cashless-health-insurance-denied-hospital-india|what to do when cashless is denied at the hospital]].
+==== The clock is stuck: what to do right now ====
+Use this flow when you are at the hospital and the discharge or admission approval is delayed.
+  - Ask the hospital desk for the exact time they sent the cashless or discharge request to the insurer or TPA. Note it down. The clock starts from that timestamp.
+  - If 1 hour has passed since the admission request, or 3 hours since the discharge request, the insurer is in breach of the IRDAI Master Circular.
+  - Call your insurer and TPA. Say this is a breach of the IRDAI 1 hour and 3 hour cashless timeline, and ask for the authorisation reference.
+  - Tell the hospital billing desk the rule says you cannot be made to wait for discharge. Ask them to hold you under the cashless request, not convert you to a cash patient.
+  - Keep any bill that shows an extra charge caused by the delay. That amount is recoverable from the insurer.
+  - If it is still stuck, raise a written grievance with the insurer, then escalate to IRDAI Bima Bharosa. Steps are below.
+Do not pay the full bill in cash just to get out unless you have no choice. If you do pay, keep every receipt and file for reimbursement plus the delay amount.
+==== What the rule says, word for word ====
+The source is the IRDAI Master Circular on Health Insurance Business, reference IRDAI/HLT/CIR/PRO/84/5/2024, dated 29 May 2024. It is still the operative master circular as of June 2026.
+On the 1 hour approval, clause 15 says:
+"Insurer shall decide on the request for cashless authorization immediately but not more than one hour of receipt of request."
+On the 3 hour discharge, clause 16 says:
+"Insurer shall grant final authorization within three hours of the receipt of discharge authorization request from the hospital. In no case, the policyholder shall be made to wait to be discharged from the Hospital."
+On who pays for delay, clause 16 continues:
+"If there is any delay beyond three hours, the additional amount if any charged by the hospital shall be borne by the insurer from shareholder's fund."
+Clause 15 opens with the larger goal:
+"Every insurer shall strive to achieve 100% cashless claim settlement in a time bound manner."
+Note the deadline for systems. The circular required insurers to put the systems and procedures in place not later than 31 July 2024. That date has passed, so the clocks are live now.
+==== Two separate clocks, do not mix them up ====
+There are two distinct timelines. Knowing which one applies stops the insurer from buying time.
+^ Stage ^ Trigger ^ Deadline ^ What the rule binds ^
+| Admission | Hospital sends the cashless authorisation request | 1 hour to decide | Insurer must approve, query or decline inside the hour |
+| Discharge | Hospital sends the final discharge authorisation request | 3 hours to grant | Insurer must clear it, and you cannot be held back |
+The 1 hour clock is about getting cashless started. The 3 hour clock is about getting you out of the bed. Each starts from the hospital's request, not from your phone call.
+==== Who the rule binds, and who does not ====
+The mandate falls on the insurer. The TPA, the third party administrator that handles claims for many insurers, acts as the insurer's agent. So when the TPA sits on your file, the insurer is still on the clock. You can hold the insurer to the timeline even if a TPA is the one delaying.
+The hospital is the party that raises the request. IRDAI does not regulate hospitals, so the hospital is not bound by the 1 hour and 3 hour clocks the way the insurer is. The rule protects you from the hospital by stopping the insurer from making you wait. If a TPA is the one stalling, see [[https://righttoinformation.wiki/tpa-denied-cashless-health-insurance-claim|how to act when a TPA blocks your cashless claim]].
+Dr. Shrawan Kumar Pathak was ready for discharge by noon. The hospital sent the final bill to the TPA at 12:15 pm. By 4 pm there was no clearance. Under clause 16 the insurer was in breach from 3:15 pm, and any extra room charge for that afternoon was the insurer's liability, not his.
+==== How to escalate ====
+Escalation has a clear order. Do each step in writing and keep the reference numbers.
+  - First, raise a grievance with your insurer. Every insurer has a grievance officer and a complaint email. Give the policy number, the hospital request time and the breach.
+  - If the insurer does not respond in a reasonable time, or you are not satisfied with the reply, escalate to IRDAI.
+  - Register the complaint on the IRDAI Bima Bharosa portal at bimabharosa.irdai.gov.in. You can track the status there.
+  - You can also call the IRDAI grievance call centre toll free on 155255 or 1800 4254 732, or email [email protected].
+  - Upload your policy copy, the hospital bills with timestamps and your insurer complaint reference.
+Bima Bharosa never asks for any payment. Ignore any link or QR code that claims to send you money. For the wider picture of claim delay rights, see [[https://righttoinformation.wiki/health-insurance-claim-delay-rights-india|your rights when a health insurance claim is delayed]].
+For a step by step framework on drafting clean, evidence backed complaints, [[https://righttoinformation.wiki/book|The RTI Playbook]] is a useful companion.
+==== What to do in the next 30 minutes ====
+  * Get the exact timestamp of the hospital's request from the billing desk.
+  * Work out whether the 1 hour or 3 hour deadline has already passed.
+  * Call the insurer and TPA, quote the IRDAI timeline, and get an authorisation reference.
+  * Send a one line written grievance to the insurer by email or app, with the policy number and the breach time.
+  * Photograph every bill that shows an extra charge caused by the delay.
+==== Frequently asked questions ====
+==== What is the IRDAI 1 hour and 3 hour cashless rule? ====
+It is a binding timeline in the IRDAI Master Circular on Health Insurance Business dated 29 May 2024. The insurer must decide on a cashless request within 1 hour of the hospital sending it. The insurer must grant final discharge authorisation within 3 hours of the hospital sending the discharge request. The aim is to move the industry toward 100% cashless settlement.
+==== Who pays if the insurer is late at discharge? ====
+The insurer pays. Clause 16 of the circular says that if there is any delay beyond 3 hours, the additional amount charged by the hospital because of that delay shall be borne by the insurer from its shareholder funds. It cannot be charged to you or recovered from the policyholder pool. Keep the bill that shows the delay charge.
+==== Does the rule apply to the TPA too? ====
+The rule binds the insurer. A TPA is the insurer's agent, so when the TPA delays your file, the insurer is still in breach of the timeline. You hold the insurer responsible. The TPA being slow is not a valid reason for missing the 1 hour or 3 hour clock.
+==== Can the hospital still make me wait at discharge? ====
+The rule says in no case shall the policyholder be made to wait to be discharged from the hospital. The hospital can raise the request, but the insurer must clear it within 3 hours. If you are held back only because the insurer has not responded, the insurer is in breach and owes any extra delay charge.
+==== Is this rule different from a cashless denial? ====
+Yes. This page is about the timeline, where cashless is approved in principle but the clock is being missed. A denial is a flat refusal of cashless at the desk. If your request is refused outright, read the dedicated guide on [[https://righttoinformation.wiki/cashless-health-insurance-denied-hospital-india|cashless denied at the hospital]] instead, since the remedy there starts with reimbursement and complaint, not the clock.
+==== Where do I complain if the insurer ignores the timeline? ====
+First raise a written grievance with your insurer. If there is no response in a reasonable time, or you are unhappy with the reply, register a complaint on the IRDAI Bima Bharosa portal at bimabharosa.irdai.gov.in. You can also call the toll free grievance number 155255 or 1800 4254 732, or email [email protected]. Attach your policy, the timestamped hospital bills and the insurer complaint reference.
+==== Has the 29 May 2024 circular been replaced? ====
+No. As of June 2026 the Master Circular on Health Insurance Business dated 29 May 2024, reference IRDAI/HLT/CIR/PRO/84/5/2024, remains the operative master circular. The circular itself says it is reviewed every year unless review or repeal is warranted earlier. No later master circular has changed the 1 hour and 3 hour cashless timelines.
+==== Sources ====
+  * IRDAI Master Circular on Health Insurance Business, IRDAI/HLT/CIR/PRO/84/5/2024, dated 29 May 2024, clauses 15 and 16, irdai.gov.in.
+  * IRDAI Bima Bharosa grievance portal, bimabharosa.irdai.gov.in.
+Last reviewed: 15 June 2026.
+===== IRDAI cashless claim 1-hour/3-hour rule: How to enforce it? =====
+IRDAI has mandated timelines for cashless health insurance claim approvals. Here is the complete guide:
+  - **Step 1: The 1-hour/3-hour rule.** IRDAI's 2024 guidelines mandate: (a) cashless claim authorization must be given within 3 hours of receiving the request at the hospital, (b) final discharge authorization must be given within 1 hour of receiving the discharge summary and bills. If the insurer does not respond within these timelines, the claim is deemed approved.
+  - **Step 2: How cashless claims work.** (a) The hospital sends a pre-authorization request to the insurer/TPA, (b) the insurer/TPA reviews the request and approves/rejects within 3 hours, (c) at discharge, the hospital sends the final bills, (d) the insurer approves the final amount within 1 hour.
+  - **Step 3: Common violations.** (a) insurer/TPA takes more than 3 hours to approve pre-auth, (b) insurer delays final approval beyond 1 hour, (c) insurer rejects the claim without valid reason, (d) insurer approves only a partial amount, leaving the patient to pay the balance.
+  - **Step 4: What to do if the rule is violated.** (a) Note the time of submission and the time of response, (b) insist that the claim is deemed approved as per IRDAI guidelines, (c) ask the hospital to raise a dispute with the insurer/TPA, (d) file a complaint with the insurer's Grievance Redressal Officer.
+  - **Step 5: Escalation.** (a) File a complaint with IRDAI at [[https://igms.irda.gov.in|igms.irda.gov.in]], (b) file a complaint with the Insurance Ombudsman, (c) file a consumer complaint for deficiency in service and delay in claim settlement.
+  - **Step 6: Documentation.** Keep: (a) pre-auth request timestamp, (b) insurer/TPA response timestamp, (c) discharge summary, (d) final bills, (e) all correspondence with the insurer.
+  - **Step 7: File RTI.** File RTI with IRDAI asking for: (a) the cashless claim timeline guidelines, (b) the complaints received about delay, (c) the penalty imposed on insurers, (d) the compliance rate.
+See [[https://righttoinformation.wiki/health-insurance-free-look-period-30-days-refund-india|Free-Look Period Guide]] and [[https://righttoinformation.wiki/insurance-exclusion-ambiguity-coverage-dispute-consumer-forum-india|Insurance Exclusion Guide]].
+{{tag>irdai cashless claim 1 hour 3 hour rule health insurance deemed approved ombudsman 2026}}