The Insurance Regulatory and Development Authority of India (IRDAI) has clarified that network hospitals have to facilitate cashless insurance claims of Covid-19 patients where insurers have a prior arrangement.

The IRDAI said, “Such network hospitals are obligated to provide cashless treatment for all treatments including treatment for COVID-19.”

The insurance body immediately issued a press release in this regard after Finance Minister Nirmala Sitharaman expressed concern about some hospitals denying cashless insurance to Covid-19 patients.

“Reports are being received of some hospitals denying cashless insurance. Spoken to Chairman, IRDAI Shri SC Khuntia to act immediately. In March’20 Covid-19 included as a part of comprehensive health insurance. Cashless available at networked or even temporary hospitals,” Sitharaman said in a tweet late on Thursday.

“As on 20/4/21, over 9 lakh Covid-related claims have been settled by insurance companies for 8642 Cr. Even teleconsultations can be covered. IRDAI shall direct companies to prioritise authorizations and settlements of Covid cases,” the finance minister added.

In its press release, IRDAI highlighted what Sitharaman mentioned. It said, “There are some reports that some hospitals are not granting cashless facility for treatment of Covid-19 despite policyholders being entitled for the cashless treatment under their Policy.”

“In this regard, it is clarified that where insurers have an arrangement with the hospitals for providing cashless facility, such network hospitals are obligated to provide cashless treatment for all treatments including treatment for COVID-19,” the insurance body added.

IRDAI went on to say that all network providers (hospitals) who have signed service level agreements (SLA) with general and health insurers have to mandatorily provide cashless facility for any treatment to policyholders including Covid-19 treatment “in accordance with agreed provisions of SLA and terms and conditions of policy contract”.

“Therefore all policyholders that are entitled to the cashless facility at all such network providers (hospital) with whom the Insurance company/TPA has entered into an agreement shall avail the benefit of cashless treatment,” it added.

WHAT TO DO WHEN DENIED?

In the event any network hospital denies cashless insurance claim facility to policyholders, IRDAI has advised them to send a complaint to the concerned insurance company at once.

The insurance body has also shared email IDs of grievance redressal officers of insurance companies via a link.

“Insurance companies have also been directed to ensure smooth availability of a cashless facility with all the network providers (hospitals) empanelled with them by actively interacting with the hospitals,” the IRDAI said.

The IRDAI's direction to network hospitals and insurers comes at a crucial time when Covid-19 cases are rapidly rising in the country. On Friday, India reported over three lakh new Covid-19 cases for a second straight day.