The Insurance Regulatory and Development Authority (IRDAI) has urged hospitals to provide a cashless facility for the treatment of coronavirus and has called for strict actions against medical centres that do not provide the facility despite such arrangements with the insurers. Besides initiating action, as provided under the Service Level Agreement (SLA), the general and health insurers concerned should immediately report the conduct of the network providers (hospitals) to the appropriate government agencies of the concerned State or area. The action taken may also be published on the insurer’s website, the IRDAI said on Tuesday.
"As per the provisions of regulation 31 (d) of IRDAI (Health insurance) Regulations, 2016, general and health insurance companies are expected to enter into agreements with public and private sector healthcare providers across the geographical spread," the IRDAI said in a release.
The list of the network providers (hospitals) with whom the insurance company has entered into a service level agreement shall be published in the websites of the insurers and TPAs (Third Party Administrators)," it stated.
"Where such service level agreements (SLA) are entered with the Network Providers (hospitals), it is essential for all such hospitals to provide a cashless facility for any treatment to the policyholders including Covid-19 treatment in accordance with agreed provisions of SLA and terms and conditions of policy contract," the IRDAI said.
Policyholders are entitled to a cashless facility at all such network providers (hospital) with whom the Insurance company/TPA has entered into an agreement in accordance with the norms of SLA, the IRDAI has said.
Clarifying the steps that can be taken in case hospitals do not provide cashless facilities, the IRDAI has said the aggrieved policyholders may send a complaint to the concerned insurance company.
Insurance companies have also been directed to ensure the smooth availability of a cashless facility with all the network providers (hospitals) empaneled with them by actively interacting with the hospitals.