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IRDAI asks insurers to ensure swift settlement of COVID-19 claims

"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," said IRDAI

twitter-logoBusinessToday.In | April 24, 2021 | Updated 08:40 IST
IRDAI asks insurers to ensure swift settlement of COVID-19 claims
IRDAI asks insurers to expedite COVID-19 settlement claims

Insurance Regulatory and Development Authority of India (IRDAI) on Friday asked insurers to ensure that settlement claims of COVID-19 treatment are expedited. The regulator said that insurers must ensure expeditious settlement of claims on a cashless basis amidst reports of certain hospitals insisting on cash payments from policyholders for the treatment of Covid-19. It also asked hospitals not to differentiate patients in terms of admission or treatment.

IRDAI said that there are reports on media of hospitals charging high rates and insisting on cash payments from policyholders to provide 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," it said in a circular.

The regulator also asked insurers to ensure that policyholders are charged as per the rates agreed to by 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 statement IRDAI said that charging differential rates to 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 asked network provider hospitals to 'rise to the occasion' and provide 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," the statement said.

Further, all insurers have been directed to ensure that the "reimbursement claims" under a health insurance policy should be settled expeditiously.

Also read: IRDAI asks hospitals to provide cashless treatment for COVID-19 to policyholders

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