FM asks IRDAI to act against insurers for denying cashless claims

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New Delhi, Apr 22 (PTI) Finance Minister Nirmala Sitharaman on Thursday asked IRDAI chairman S C Kunthia to 'act immediately' to address the complaints of denial of cashless claims by insurance companies.

She also mentioned that more than 9 lakh COVID-related claims for Rs 8,642 crore have been settled by insurance companies.

'Reports are being received of some hospitals denying cashless insurance. Spoken to Chairman, IRDAI Shri SC Khuntia to act immediately. In March'20 #Covid included as a part of comprehensive health insurance. Cashless available at networked or even temporary hospitals,' the minister said in a series of tweets.

The Insurance Regulatory Development Authority of India (IRDAI), she added, has asked insurance companies to prioritise settlement of COVID claims.

She further said: 'As on 20/4/21, over 9 lakh #Covid related claims have been settled by insurance companies for Rs 8,642 Cr. Even tele-consultations can be covered. IRDAI shall direct companies to prioritise authorisations and settlements of #Covid cases.' India registered over 3.14 lakh new coronavirus cases in a day, the highest-ever single-day count recorded in any country, taking the the total tally of COVID-19 cases in the country to 1,59,30,965.

According to the Union Health Ministry data updated on Thursday, a total of 3,14,835 fresh infections were registered in a span of 24 hours, while the death toll increased to 1,84,657 with a record 2,104 new fatalities.

Registering a steady increase for the 43rd day in a row, the active cases have increased to 22,91,428 comprising 14.38 per cent of the total infections.

Taking cognisance of reports that some hospitals are not granting cashless facility for treatment of Covid-19 despite policyholders being entitled for the cashless treatment under their policy, the IRDAI said, 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.

'All the Network Providers (hospitals) who have signed Service Level Agreements (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 agreed provisions of SLA and terms and conditions of policy contract,' it said.

Therefore, all policyholders that are entitled to cashless facility at all such network providers (hospital) with whom the Insurance company/TPA has entered into an agreement shall avail the benefit of cashless treatment, it 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.

Insurance companies have also been directed to ensure smooth availability of cashless facility with all the network providers (hospitals) empanelled with them by actively interacting with the hospitals, it added. PTI DP CS MR