Insurers can act against hospitals saying no to cashless coronavirus treatment: IRDAI

HYDERABAD: Swamped with complaints about Covid-19 patients being denied cashless facility at hospitals despite having health insurance, insurance regulator Insurance Regulatory and Development Authority of India (IRDAI) has stepped in and directed general and health insurance companies to take “appropriate action” against network hospitals asking policyholders to pay cash for treatment.

“Where any network provider denies cashless facility and deviates from agreed terms of the SLA (service level agreement), insurance company shall take an appropriate action against such network providers as provided in SLA,” IRDAI said in a circular on Tuesday. The regulator has also asked insurance companies to set up an exclusive grievance redressal system to solve the challenges faced by policyholders.

“Insurance companies are advised to put in place an exclusive grievance redressal mechanism to address the grievances of policyholders relating to the denial of cashless facility for Covid-19 and other grievances against such hospitals that are enlisted as network providers,” it said.


The regulator has also asked insurance companies to report to government agencies where policyholders’ interests are adversely affected because of conduct the network providers. “Action taken against such network providers may also be published on the website of the insurance company for the information of the insured public,” it said.

Additionally, IRDAI on Tuesday said insurance companies will provide a 5% discount in Corona Kavach policy premium to healthcare workers.