How long does cashless health insurance claim authorisation take in 2025? Latest IRDAI rules and data

Health insurance companies are required to authorise cashless claims in a time-bound manner since July 31, 2024. While pre-authorisation must be given within one hour of the claim request, the final authorisation should come within three hours, according to the Insurance Regulatory and Development Authority of India (IRDAI).

The IRDAI's 'Master Circular on Health Insurance Business 2024' lays down the following rules:

"Insurer shall decide on the request for cashless authorisation immediately but not more than one hour of receipt of request," the circular says. To implement this rule, the IRDAI had asked insurers to put necessary systems and procedures in place by July 31, 2024.

"Insurer shall grant final authorisation within three hours of the receipt of discharge authorisation request from the hospital. In no case, the policyholder shall be made to wait to be discharged from the Hospital," the master circular says.

Further, the IRDAI's circular also says that in case of any delay in final authorisation beyond three hours, the additional amount charged by the hospital shall be borne by the insurer.

Also, in case of the death of the policyholder during the treatment, the insurer shall:

• Immediately process the request for claim settlement.

• Get the mortal remains (dead body) released from the hospital immediately

At this point, you may be wondering how these rules are actually implemented. The Ministry of Finance has shared the latest data on cashless insurance authorisations (see below).

Latest cashless claim authorisation data 2025

According to the data shared by Finance Minister Nirmala Sitharaman in a written reply to a query in the Lok Sabha on December 1, 2025, nearly 86.88% cases were processed for pre-authorisation within one hour of claim request between August 1, 2024 and May 31, 2025.

Further, 96.69% of cashless requests were processed for final authorisation in this duration.

Handling insurance complaints

The IRDAI has integrated Bima Bharosa platform with the Complaint Management Systems (CMS) of the Insurers. So any complaints filed in Bima Bharosa are reflected in CMS of the insurers on real time basis and vice versa.

The IRDAI has mandated a time period of 14 days within which an insurer is required to resolve complaints. The Finance Minister shared the following data for resolution of health insurance complaints through the Bima Bharosa portal.

• During the financial year 2024-25, 2,57,790 complaints were received in Bima Bharosa portal, out of which, for 4,811 complaints, were not resolved within the stipulated time.

• During the current year 2025-26 (up to September 30, 2025), 1,36,554 complaints were received, out of which, for 532 complaints were not resolved within the stipulated time.

"IRDAI has further informed that Bima Bharosa system is not integrated with Insurance Ombudsman System and there is no provision in Bima Bharosa to escalate the complaints automatically to Insurance Ombudsman. However, a complainant not satisfied with the resolution provided by the insurers, has an option to file complaint with Insurance Ombudsman having competent jurisdiction. Such complaint can be filed either in physical mode or through electronic mode," the Finance Minister said.

"During financial year 2024-25, 53,102 complaints have been filed with Insurance Ombudsman offices against the insurers seeking relief," she added.