IRDAI directs insurers to ensure fast resolution of COVID-19 claims

Irdai

Insurance Regulatory and Development Authority of India (IRDAI) has directed the insurers to ensure quick settlement claims of COVID-19. The regulator stated that insurers must ensure fast settlement of claims on a cashless basis amidst the reports of certain hospitals turning down the cashless payments from policyholders for the treatment of Covid-19. The regulator has also asked hospitals not to show any discrimination differentiate in terms of admission or treatment.

IRDAI stated that several media reports show that hospitals are charging high rates and insisting on cash payments from policyholders to offer COVID-19 treatment despite having a cashless arrangement with insurers. “In compliance with the provisions…the insurers, in case of ‘cashless claim’ under a health insurance policy, are advised to ensure expeditious settlement of such claims on cashless basis in accordance to the Service Level Agreements (SLAs) entered with hospitals,” said IRDAI in a circular.

The regulator also directed the insurers in a bid to ensure that policyholders are charged according to the rates approved for the network providers wherever applicable. “Insurers are also advised to ensure that hospitals do not levy any additional charges for the same treatment other than those rates that are agreed with the insurers,” the circular said.

In a separate communique IRDAI stated that charging different rates to the policyholders, demanding advance deposits and denying cashless treatment to policyholders of health insurance policies is violative of the service agreement between provider hospitals and insurance companies as well as detrimental to interests of policyholders.

IRDAI directed the network provider hospitals to ‘rise to the occasion’ and offer cashless treatment to policyholders as India struggles with the second wave of coronavirus.

“All hospitals are also requested not to differentiate the patients in terms of admission or treatment whether they are insured or not insured or whether they pay cash or avail of cashless facility. A gesture of this nature on the part of hospitals in these difficult times will reinforce the confidence of the public in the healthcare system including health insurance and build trust,” said the statement.

Besides, all insurers have been asked by the regulator to ensure that the “reimbursement claims” under a health insurance policy should be settled expeditiously.

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