Covid: IRDAI directive to hospitals on cashless treatment

IRDAI asked the respective insurers to ensure that their empanelled hospitals that have agreed to offer cashless claims honour that including for treatment of Covid cases

Hyderabad: The Insurance Regulatory And Development Authority Insurance (IRDAI) has flagged the issue of hospitals not honouring the cashless claims even as the number of Covid cases has been hitting new highs.

In a circular issued on April 22, it asked the respective insurers to ensure that their empanelled hospitals that have agreed to offer cashless claims honour that including for treatment of Covid cases.

Irdai said instances of hospitals not accepting cashless treatment for valid policy holders should be brought to the notice of the respective insurance company. It further directed the insurance companies to take appropriate action against the network providers as provided in the service level agreement.

Amit Chhabra, Head- Health Insurance, Policybazaar.com, said, “There may be cases of some hospitals not accepting cashless treatment at this point of time. However, many hospitals continue to offer cashless treatments. That is beneficial to all the parties involved – the hospital, the insurer and the policyholders. Insurers continue to push for cashless treatments as the prices are discounted.”

“The recent guidelines from IRDAI will help the patients as well as the insurance companies. The hospitals, on the other hand, too are experiencing stress due to the rise in number of patients,” he said.

Chhabra said that many policyholders are looking to port to a different insurance company. Higher cover, lower premium, presence of chosen hospitals in the network hospitals and fewer exclusions are the main reasons why people are porting, he said adding that porting ensures that the old benefits and inclusions are carried forward to the new policy. This contrasts with the situation of mandatory waiting periods for the new policies. Also, there will be a need to undergo certain medical tests again mandatorily in case of fresh policies, he said.

Many insurers have now introduced telemedicals – to assess the health condition of the policy buyers on phone or through a video call. On claims, he said the rising number of Covid cases reflected in the rising number of hospitalisations. The number increased in February and March, he said.

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