Insurance regulator IRDAI has asked health insurance companies to ensure that policyholders entitled to cashless treatment are extended the facility by all the hospitals that have agreed to provide the same.
“It is clarified where insurers have an arrangement with hospitals for providing cashless facility, such network hospitals are obligated to provide cashless treatment for all treatments, including treatment for COVID-19,” the regulator said on Thursday.
The IRDAI statement followed reports of some hospitals not granting cashless facility for COVID-19 treatment.
Union Finance Minister Nirmala Sitharaman had tweeted: “Reports are being received of some hospitals denying cashless insurance. Spoken to Chairman, IRDAI Shri S.C. 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 with general and health insurers have to mandatorily provide cashless facility for any treatment to the policyholders in line with the agreed provisions of the SLA and as per terms and conditions of policy contract, the IRDAI statement said.
Advising insurers to ensure “smooth availability of cashless facility at all the network hospitals empaneled with them,” IRDAI said the aggrieved policyholders can lodge complaint with the concerned insurance company. Details and email ids of the grievance redressal officers of insurers can be accessed on: https://www.irdai.gov.in/ADMINCMS/cms/NormalData_Layout.aspx?page=PageNo225&mid=14.2.
In a circular to the insurers, the regulator said, “where any network provider denies cashless facility and deviates from agreed terms of the SLA, insurance company shall take an appropriate action...”
While Union Finance Ministry tweeted the IRDAI communication, Ms. Sitharaman shared the same saying “IRDAI acts on reports.”
