Cashless treatment for Coronavirus: The Insurance Regulatory and Development Authority of India (IRDAI) has taken note of instances of hospitals denying cashless facility to policyholders for treatment of COVID-19. In a circular dated 14th July 2020, the regulator advised insurance companies to ensure that policyholders get cashless treatment facility at hospitals where it is applicable.
“…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),” IRDAI said.
The insurance regulator has also advised the insurance companies to put in place an exclusive grievance redressal mechanism to address the grievances of policyholders relating to the denial of the cashless facility for Covid-19 and other grievances against such hospitals that are enlisted as network providers.
“Insurance companies shall also put in place continuous communication channel with all the network providers for prompt resolution of the grievances of policyholders,” IRDAI said.
As per IRDAI, the policyholders are entitled to the cashless facility at all such network providers (hospital) with whom the Insurance company/TPA has entered into an agreement in accordance to the norms of SLA.
Therefore, it is clarified that the policyholders are entitled to the cashless facility at all such network providers (hospital) with whom the Insurance company/TPA has entered into an agreement in accordance to the norms of SLA.
What policyholders can do if denied cashless treatment
According to the IRDAI circular, policyholders should immediately report the denial of cashless treatment to the “appropriate Government agencies” of the concerned state/area. The insurance company may publish action taken against such network providers on its website.
The IRDAI also said, “In the event of denial of cashless facility at any such enlisted network providers (hospitals) the aggrieved policyholders may send a complaint to the concerned insurance company.”
Details and email ids of Grievance redressal officers of insurance companies
The details and email ids of Grievance redressal officers of insurance companies can be accessed from the website of the insurers or at the following link:
In a separate statement, IRDAI said, “Insurance companies have been directed to ensure smooth availability of cashless facility with all the network providers (hospitals) empaneled with them by actively interacting with the hospitals.”
