AllGeneral and Health Insurance Companies
Re: Facilitation by the Insurers for Cashlessservices at network hospitals
1. It has been brought to thenotice of the Authority that some hospitals are denying cashless facility topolicyholders for treatment of COVID-19 treatment despite having cashless arrangementwith the Insurers.
2. Your attention is drawn to theAuthority’s circular Ref.No: IRDAI/HLT/MISC/CIR/189/07/2020dated 14.7.2020 on Provisionof cashless facility to the policyholders where in it was specified that theInsurers shall ensure that where the policyholder is notified aboutavailability of cashless facility at the empanelled network provider, thecashless facility at such network provider shall be made available to thepolicyholders in accordance to the terms and conditions of the policy contractand as per the terms agreed in Service Level Agreement (SLA).
3. Therefore, general and healthInsurers shall ensure that all such network provider hospitals extend cashlessfacility for any treatment to the policyholder including COVID-19 treatment inaccordance with agreed provisions of SLA and terms and conditions of the policycontract.
4. Where any network providerdenies cashless facility and deviates from agreed terms of the SLA, insurancecompany shall take an appropriate action against such network providers asprovided in SLA in addition to taking up appropriate action as specified in theaforesaid circular.
5. The Insurers have also been directedto ensure smooth availability of cashless facility with all network providersempanelled with them by putting in place continuous communication channel withall the network providers for prompt cashless services and for resolution ofgrievances of policyholders if any.
6. This has the approval of thecompetent authority.
DV S Ramesh