IRDAI has asked policyholders to complain to the concerned insurance company if a hospital denies cashless facility to them.

A medic conducts screening of an elderly patient in the wake for novel coronavirusPTI file image
Atom Insurance Wednesday, July 15, 2020 - 09:56

Taking cognisance of the issue of some hospitals denying cashless facility for treatment of COVID-19, the Insurance Regulatory Authority of India (IRDAI) has reiterated that policyholders are entitled to cashless facility at all network hospital with whom an insurance company has entered into an agreement for the same.

“The Authority is aware of reports that some hospitals are not granting cashless facility for treatment of Covid-19 despite such arrangements with the insurers. It is also brought to the notice of the Authority that some of these hospitals are also demanding cash deposits from the policyholders,” IRDAI said in a media statement on Tuesday.

IRDAI has said that as per 31 (d) of IRDAI (Health insurance) Regulations, 2016, general and health insurance companies are expected to enter into agreements with enough number of public and private sector healthcare providers across the geographical spread.

Wherever such agreements are entered into, it has said that it is essential for all such hospitals to provide cashless facility for any treatment to the policyholders including Covid-19 treatment in accordance with terms of agreement and the terms and conditions of policy contract.

IRDAI has asked policyholders to complain to the concerned insurance company if a hospital denies cashless facility to any person. When a complaint is received from a policyholder on denial of the cashless facility, IRDAI has asked the insurance company to take an appropriate action against such hospitals.

It has also directed insurance companies to ensure that the cashless facility is available at all the hospitals they have partnered with as part of their insurance offerings.

“Also, where policyholders' interests are adversely affected because of the conduct of the network providers, such instances may be immediately reported to the appropriate Government agencies of the concerned State/area. Action taken against such network providers may also be published on the website of the insurance company for the information of the insured public,” it further added.

IRDAI has also asked insurance companies to ensure that the policyholder knows about the availability of cashless facility at the hospitals in the insurer’s network.

It has also advised insurance companies to put in place an exclusive grievance redressal mechanism to address the grievances of policyholders relating to the denial of cashless facility for COVID-19 and other grievances against such hospitals that are enlisted as network providers.

“Insurance companies shall also put in place continuous communication channel with all the network providers for prompt resolution of the grievances of policyholders,” IRDAI said in a circular to all insurance companies.

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