IRDAI issues clarification on cashless claims in Covid-19 cases

Insurance Regulatory and Development Authority of India (IRDAI) has clarified that wherever insurers have an arrangement with the hospitals for providing cashless facility, such network hospitals are obligated to provide cashless service for all treatments including treatment for Covid-19.

This clarification comes in the backdrop of some reports that some hospitals are not granting cashless facility for treatment of Covid-19 despite policyholders being entitled for the cashless treatment under their policy.

Finance Minister Nirmala Sitharaman had earlier held talks with the IRDAI Chairman SC Kunthia on the problems some have faced and the need to address it. The FM had earlier tweeted, "Reports are being received of some hospitals denying cashless insurance. Spoken to Chairman, IRDAI Shri SC Khuntia to act immediately. In March’20 #Covid included as a part of comprehensive health insurance. Cashless available at networked or even temporary hospitals."

All the Network Providers (hospitals) who have signed Service Level Agreements (SLA) with general and health insurers have to mandatorily provide cashless facility for any treatment to the policyholders including Covid-19 treatment in accordance with agreed provisions of SLA and terms and conditions of policy contract.

Therefore, all policyholders that are entitled to cashless facility at all such network providers (hospital) with whom the insurance company/TPA has entered into an agreement shall avail the benefit of cashless treatment.

In the event of denial of cashless facility at any such hospitals the aggrieved policyholders may send a complaint to the concerned insurance company. The details and email ids of grievance redressal officers of insurance companies can be accessed from the website of the insurers.

Insurance companies have also been directed to ensure smooth availability of cashless facility with all the network providers (hospitals) empaneled with them by actively interacting with the hospitals.

Source: The Hindu Business Line