What IRDAI's 2025 Master Circular Means for Policyholders

The IRDAI's master circular on health insurance — issued in 2024 and tightened in 2025 — has materially expanded policyholder rights. A quick summary.

Cashless approval timelines

Insurers now have to approve initial cashless authorisation within **one hour** of receiving the request and final discharge within **three hours**. Hospitals must hand over the discharge summary along with the claim form.

Standardised exclusions

Insurers can no longer add exclusions outside the IRDAI's master list. If your policy has a non-standard exclusion buried in the fine print, it is challengeable.

Moratorium period

After 60 months of continuous coverage, claims **cannot** be repudiated on grounds of non-disclosure or misrepresentation — except for proven fraud.

What it means for rejections

If your claim was rejected after the moratorium period for reasons other than fraud, you have a strong case for appeal. We've seen multiple such rejections reversed in 2025.

The full circular is on the IRDAI website. We recommend every senior policyholder skim through it once.