In a big relief to policyholders, IRDAI has directed all the hospitals to provide cashless treatment if mentioned in the contract.
This clarification comes in the backdrop of reports that some hospitals have refrained from providing cashless facilities for treatment of coronavirus patients despite policyholders being entitled to it.
"Hospitals who have signed Service Level Agreement (SLA) with general and health insurers have to mandatorily provide cashless facility for any treatment to the policyholders including Covid-19 treatment in accordance with the agreed provision of SLA and terms and conditions of policy contract," the Insurance Regulatory and Development Authority (IRDAI) said.
In the event of denial of the cashless facility at any such hospital, the policyholder may send a complaint to the concerned insurance company. It also mentioned that the details and email IDs of grievances redressal officers of insurance firms can be accessed from the IRDAI's website (irdai.gov.in) by clicking on 'Grievances' and then on 'functions'.
It further directed all the insurance companies to ensure smooth availability of a cashless facility with all hospitals empaneled with them by actively interacting with the hospital.
Earlier, Finance Minister Nirmala Sitharaman held talks with the IRDAI Chairman SC Kunthia on the problems some have faced and the need to address them. She asked Kunthia to "act immediately" to address the complaints of denial of cashless claims by insurance firms. The FM underscored that more than 9 lakh COVID-related claims for Rs 8,642 crore have been settled by insurance companies as of April 20.
In a tweet, FM Sitharaman wrote, " As on 20/4/21, over 9 lakh #Covid related claims have been settled by insurance companies for Rs 8,642 Cr. Even teleconsultations can be covered. IRDAI shall direct companies to prioritise authorisations and settlements of #Covid cases".
India is witnessing a severe health crisis with active cases jumping to 22,91,428 cases, which is 14.2 per cent of the total cases. On the other hand, the Covid-19 related recoveries are going down with each passing day as hospitals get overwhelmed due to the surge in cases. The current recovery rate stands at 1,34,54,880 (84.46 per cent).
Also read: Fire breaks out at Virar hospital leaving 13 COVID-19 patients dead
Also read: 1,200 engineering units face closure threat due to industrial oxygen, raw material shortage