Covid-19: IRDAI asks insurers to settle policyholders' claims on cashless basis

Insurance Regulatory Development Authority of India (IRDAI) asked the hospitals not to charge patients unreasonably and insist on cash payments from the policyholders for providing them treatment for COVID-19 despite having 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.

"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.

Charging differential rates and demanding advance deposits from the policyholders are violative of the service level agreement between the service provider hospitals and the insurance companies besides being detrimental to the interests of the policyholders.

"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 re-inforce the confidence of the public in the healthcare system including health insurance and build trust," the statement said.

IRDAI also asked the insurers to put in place an effective communication channel for speedy resolution of the grievances of the policyholders.

Further, it also directed the insurers to settle the reimbursement claims under a health insurance policy expeditiously.

On Thursday, Finance Minister Nirmala Sitharaman had asked the regulator to act immediately to resolve the complaints of denial of cashless facility by several insurance companies.