Good News: Cashless Facility for COVID-19 Treatment enabled by IRDAI

Good News: Cashless Facility for COVID-19 Treatment enabled by IRDAI

INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY OF INDIA

Ref: IRDAI / HLT/ MISC / CIR / 189 / 07 / 2020

14th July 2020

To, All General and Health Insurers (Except ECGC and AIC) Re: Provision of cashless facility to the policyholders. 1. It has been brought to the notice of authority that certain hospitals are denying cashless facility to policyholders for treatment of Covid-19. 2. Attention is drawn to the provisions of regulation 31(d) of IRDAI (Health insurance) Regulations, 2016 wherein every general and health insurance company shall endeavor to enter the agreements with an adequate number of both public and private sector network providers across the geographical spread. 3. Further, in terms of Regulation 31(a) of IRDAI (Health insurance) Regulations, 2016, general and health insurance companies may offer policies providing cashless services to the policyholders. For the purpose of providing cashless service insurers/ Third Party Administrators (TPAs) shall enlist networks providers (hospitals) to provide medical services and shall also enter into a service level agreement. 4. In this regard, insurance companies are advised to ensure that where the policyholder is notified about availability of cashless facility at the empanelled network provider, the cashless facility at such network provider shall be made available to the policyholder in accordance to the terms and conditions of the policy contract and as per the terms agreed in Service Level Agreement (SLA).