INSURANCE
IRDAI asks insurers to ensure expeditious settlement of claims for treatment of Covid-19
Apr-26-2021

Insurance Regulatory and Development Authority of India (IRDAI) has asked insurers to ensure expeditious settlement of claims on cashless basis amidst reports of certain hospitals insisting on cash payments from policyholders for the treatment of Covid-19. IRDAI has also requested all the hospitals not to differentiate the patients in terms of admission or treatment. The regulator noted that there are reports of certain network providers (hospitals) charging high rates and insisting on cash payments from the policyholders for providing treatment to COVID-19 infected patients despite having cashless arrangement with insurers.

It said ‘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’. Insurers have also been asked to ensure that the policyholders are charged as per the rates agreed to by network providers wherever applicable. It added ‘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’.

Meanwhile, in a separate statement, IRDAI also said charging differential rates to policyholders, demanding advance deposits and denying cashless treatment to policyholders of health insurance policies is not only detrimental to the interest of policyholders but may also violative of the service level agreement between the service provider hospitals and the insurance companies. In this difficult time of a second wave of COVID-19 pandemic, IRDAI said network provider hospitals are requested to 'rise to the occasion' and to provide cashless treatment to policyholders for all treatments covered by the insurance policy including COVID-19.

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