Bhubaneswar: The Insurance Regulatory and Development Authority of India (IRDAI) has directed the general and health insurance companies having an arrangement with the hospitals for providing cashless facility to ensure it for all treatments including COVID-19.
The IRDAI in a letter to all general and health insurance companies has stated that it has been brought to its notice that some hospitals are denying cashless facility to policyholders for treatment of COVID-19 patients despite having cashless arrangement with the Insurers.
The insurance authority pointed at its circular issued on September 14, 2020 on provision of cashless facility to the policyholders. The circular specified that the insurers shall ensure that where the policyholder is notified about availability of cashless facility at the empanelled network provider, the facility will be made available to the policyholders as per the terms agreed in Service Level Agreement (SLA).
The general and health insurers shall ensure that all such network provider hospitals extend cashless facility for any treatment to the policyholder including COVID-19.
If any network provider denies cashless facility and deviates from agreed terms of the SLA, insurance company shall take appropriate action against them as provided in SLA, the letter stated.