How new IRDAI order speeds up cashless claim facility at hospitals amid COVID pandemic

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Published: July 26, 2020 3:39 PM

The Insurance Regulatory and Development Authority of India (IRDAI) recently asked insurers to ensure cashless treatment facility for coronavirus to policyholders.

cashless facility in health insuranceWhat IRDAI says on cashless facility in health insurance

The Insurance Regulatory and Development Authority of India (IRDAI) recently asked insurers to ensure cashless treatment facility for coronavirus to policyholders. The IRDAI said in its official circular that the cashless facility should be provided to the policyholder at the empanelled network providers as per the terms and conditions of the policy contract.

The IRDAI also asked insurers to set up an exclusive grievance redressal mechanism to look into complaints of policyholders denied cashless facility at the empanelled hospitals. Experts say that the new IRDAI advice to insurers would speed up the entire cashless treatment facility and help in settling the claims faster.

Explaining the implications of the IRDAI circular, Dhirendra Mahyavanshi, Co-Founder, Turtlemint (an InsurTech Company), today told FE Online: “The cashless claim facility for indemnity health insurance plans would be extended by the insurer even for Covid-19 claims along with other claims in the network hospitals. Thus, the network hospitals and the Third Party Administrators (TPAs) are expected to refresh their Service Level Agreement (SLA) with the insurer in order to include cashless claims for Covid-19 as well.”

“This would expedite the entire claim process and help the policyholders settle it faster, rather than reimbursement when they are getting admitted in the network hospitals,” he added.

What to do if empanelled hospital denied the cashless facility

Dhirendra Mahyavanshi said, “Each and every insurer is expected to publish the list of hospitals and TPA with whom they have a Service Level Agreement (SLA) for availing the cashless facility on their website. However, if the cashless facility is still denied to any policyholder despite the SLA of the insurers with the hospitals, then the policyholder can approach the Grievance Cell of the IRDAI and necessary action would be taken by IRDAI.”

All relevant details of the Grievance Cell are mentioned below: https://www.irdai.gov.in/ADMINCMS/cms/NormalData_Layout.aspx?page=PageNo225&mid=14.2

“IRDAI wants to ensure that policyholders do not face any concern and they do get cashless facility even for a COVID-19 claim if their policy permits,” he added.

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