IRDAI wants insurers to settle cashless health insurance claims for Covid-19 treatment

IRDAI wants insurers to settle cashless health insurance claims for Covid-19 treatment

The cost of hospitalization due to COVID-19 may run into a few lakhs as the hospital stay is usually around 14 days. The General Insurance Council (GI Council) has made a rate chart for the COVID-19 treatment, taking into account rates issued by various state governments and also after discussions with health claim experts. The rates are recommended by the GIC to be considered during treatments in hospitals. The IRDAI has sent a message to all life and health insurance companies regarding the settlement of health insurance claims against the General Insurance Council’s directions dated 20th June 2020 on ‘Reference Rates for COVID-19’.

The treatment for dealing with Coronavirus looks to be different from treatments done in other medical situations as it entails the use of PPE Kits and specific methods for medications. The hospitals across the country must follow a standardised rate chart and the insurance companies keep the case settlement process smooth and simple for the policyholders.

In the communication to the insurers, IRDAI has declared that in case of ‘Cashless Claims’ under a health insurance policy, the claims shall be settled as per the tariff decided by the people as per the provisions of Regulation 31 of IRDAI (Health Insurance) Regulations, 2016.

However, the insurers shall make efforts to have an agreement with health providers on prices for the treatment of Covid-19 similar to other diseases for which rate agreements are in court.

Also, while opening into such agreements, the reference rate of the General Insurance council can be kept in view for guidance forward with rates fixed by State Governments and Union Territory administration, if any and as applicable.

Further, all the insurers have been informed by IRDAI to ensure that the ‘Reimbursement claims’ under a health insurance policy shall be achieved as per the terms and conditions of the respective policy agreement.

The Reference Rates for COVID-19 of GI Council will apply to both cashless and payment Covid-19 claims where any Government Authority has not announced standard charges for Covid-19 treatment. Wherever Covid-19 treatment charges have been announced by any Government Authority, those statements shall apply to insurance claims with member companies