IRDAI Said Hospitals Cannot Reject Cashless Claims for COVID-19 Treatment

    The IRDAI clarified that policyholders have the right to cash-less care at any network hospital with which an insurance provider has an arrangement. Realizing that some hospitals have denied COVID-19 cashless treatment facilities.

    “The Authority is aware that some hospitals, following these agreements with the insurers, do not offer cashless treatment facilities to Covid-19. The Authority is also aware of the fact that some such hospitals also demand the policyholders to deposit cash, “IRDAI said on Tuesday in a press release.

    In compliance with 31 (d) of the IRDAI (Health Insurance) Regulations, the IRDAI has said that in 2016 general and health insurance companies are required to enter into agreements with a large number of geographically wide public and private health providers.

    When these agreements are reached, it was said that in accordance with the terms and conditions of the policy contract, it is necessary that all such hospitals provide cashless facilities for any care to policyholders, including Covid-19 care.

    IRDAI asked policyholders to complain to the concerned insurance company if a hospital refuses any person cashless facility. IRDAI has requested the insurance undertaking to take appropriate action against such hospitals when it is received by the customer for the refusal of the cashless facility.

    It also has directed insurance companies to ensure that the cashless facility is available in all hospitals with which they are partnered.

    “Any such instance shall be immediately reported to the relevant government agencies of the State or area concerned, also when policyholders’ interests are adversely affected by the actions of the network providers. Actions taken against these network providers can also be made accessible to the information of the insured public on the insurance company’s website, “it continued.

    IRDAI has also asked insurance companies to make sure the policyholder is aware of the availability of cashless facilities in the insurer’s network hospitals.

    The Commission also advised insurance companies to establish an exclusive grievance relief mechanism to deal with policyholders’ grievances regarding the denial of COVID-19 cashless facilities and any other grievances against hospitals enrolled as network service providers.

    In a circular with all insurance companies, IRDAI stated that “Insurance companies shall also establish a continuous communication channel with all network operators for the prompt settlement of the complaints by policyholders.”

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