Irdai said if a policyholder tests positive for covid-19 and is admitted into a makeshift hospital on the advice of a medical practitioner or government authorities, then notwithstanding the definition of hospital mentioned in the policy contract, the claim shall be settled by insurance companies
With the number of fresh covid-19 cases hitting a new high with every passing day, hospitals in most metros are running out of beds, resulting in governments and private healthcare providers provisioning for makeshift or temporary hospitals. But disputes around the settlement of claims, including those for treatment at makeshift hospitals, are on the rise in some parts of the country.
To ease policyholders’ woes, the Insurance Regulatory and Development Authority of India (Irdai) said last week that it is important to recognize makeshift hospitals permitted by the government for settlement of health insurance claims.
“In order to ensure that the cost of treatment of covid-19 is covered as per terms and conditions of policy contract, a makeshift or temporary hospital permitted by central or state government shall be regarded as a hospital or network provider and insurers shall settle the claims," said the Irdai circular, dated 16 July.
Naval Goel, CEO and founder, PolicyX, an online insurance aggregator, said the move will benefit policyholders. “This is definitely going to improve the claims experience up to a great extent."
Further, Irdai said if a policyholder tests positive for covid-19 and is admitted into a makeshift hospital on the advice of a medical practitioner or government authorities, then notwithstanding the definition of hospital mentioned in the policy contract, the claim shall be settled by insurance companies.
Also, if an insurer’s network provider has arranged for a temporary hospital then such hospital shall be considered as an extension of the network provider and cashless settlement of claims will have to be made available. Third-party administrators have also been asked to take note of this.
“Policyholders are facing a lot of issues because many hospitals in spite of being in the network list are not allowing cashless claims. If this new directive from the regulator is implemented properly, it will be a big relief," said Goel.
Covid-19 treatment is costly and may be unaffordable for people facing pay cuts or job losses. Irdai’s directive may help such policyholders.
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