The Insurance Regulatory Development Authority of India (IRDAI) has notified all General and Health Insurers (Except ECGC and AIC) to allow the cashless facility for COVID-19 treatment.
It has been brought to the notice of IRDAI authority that certain hospitals are denying cashless facility to policyholders for treatment of COVID-19. In this regard, insurance companies are advised to ensure that where the policyholder is notified about the availability of cashless facility at the impaneled network provider.
The cashless facility at such a network provider shall be made available to the policyholder in accordance with the terms and conditions of the policy contract and as per the terms agreed in Service Level Agreement (SLA).
The Insurance companies are advised by IRDAI to put in place an exclusive grievance redressal mechanism to address the grievances of policyholders relating to the denial of the cashless facility for COVID-19 and other grievances against such hospitals that are enlisted as network providers.
The IRDAI also said any network provider denies cashless facility and deviates from agreed terms of the SLA, the insurance company shall take appropriate action against such network providers as provided in SLA.
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