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Action to be taken against hospitals for not allowing cashless Covid- 19 treatment to eligible policyholders: IRDAI

"Where insurers have an arrangement with the hospitals for providing cashless facility, such network hospitals are obligated to provide cashless treatment for all treatments including treatment for COVID-19," said the Finance Ministry in a Tweet.

On Thursday (April 22), the Insurance Regulatory and Development Authority of India (IRDAI) made it clear that policyholders are eligible for cashless treatment for Coronavirus at network hospitals. The development comes amidst multiple complaints to the nodal insurance authority about non-compliance by some hospitals.

In a press release by the IRDAI, it said, “There are some reports that some hospitals are not granting cashless facility for treatment of Covid-19 despite policyholders being entitled to the cashless treatment under their Policy.” The nodal insurance authority emphasised, “In this regard, it is clarified that where insurers have an arrangement with the hospitals for providing cashless facility, such network hospitals are obligated to provide cashless treatment for all treatments including treatment for COVID-19.”

“Where any network provider denies cashless facility and deviates from agreed terms of the Service Level Agreement (SLA), the insurance company shall take any appropriate action against such network providers as provided in SLA,” IRDAI stated. It also added, “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. The details and email ids of grievance redressal officers of insurance companies can be accessed from the website of the insurers”

It further added that the insurers must put a continuous communication channel with all network hospitals for grievance redressal of policyholders and ensure cashless services. IRDAI said that all policyholders who are entitled to cashless benefits at network hospitals, associated with an insurance company, are eligible to get cashless treatment for Covid-19.

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