By Anoop Khanna
Insurance Regulatory and Development Authority of India (IRDAI) has issued fresh guidelines and also new timelines for all general and standalone health insurance companies for settlement of all COVID-19-related health insurance claims
A circular issued by IRDAI member (non-life) TL Alamelu on 18 April 2020 said, “Decision on authorisation for cashless treatment shall be communicated to the network provider (hospital) within two hours from the time of receipt of authorisation request and last necessary requirement from the hospital either to the insurer or to the third party administrator (TPA) whichever is earlier. “
The IRDAI circular said, “In light of prevailing conditions owing to COVID 19 as also taking into consideration the need for alleviating the pressure on the healthcare infrastructure all the insurers shall decide health insurance claims expeditiously. In order to ensure all health insurance claims are responded to quickly, insurers are directed to comply with the following timelines.”
The circular further specifies that the decision on final discharge should be communicated to the network provider (hospital) within two hours from the time of receipt of final bill and last necessary requirement from the hospital either to the insurer or to the TPA whichever is earlier.
Mrs Alamelu has also asked insurers to issue appropriate guidelines to their respective TPA.
According to National Health Authority of India, the bulk of treatment for COVID-19 positive cases is India is being handled by government hospitals. The private sector healthcare providers are handling only around 10% of the positive cases, thus playing a smaller role so far. Hence, there are not too many insurance claims up-till now.
Asia Insurance Review