The Insurance Regulatory and Development Authority of India (“IRDAI”) has through a Notification dated 10th June 2020 issued the following directions for Insurers and Third-Party Administrators (“TPAs”) related to the Standards for hospitals in the provider network and Disclosure of Quality Parameters.
- As per the provisions of Regulation 29 (iv) of IRDAI (Health Insurance) Regulations, 2016, Insurers have been directed to keep the insured informed of the list of Network Providers and display the same on their website. Such list shall be also displayed geography wise and updated as and when there is any change in the Network providers. Also, as per the provisions of Clause (dd) of Schedule I read with Regulation 23 of IRDAI (TPA – Health Services) Regulations, 2016, it is specified that TPAs shall disclose the list of network hospitals with whom it has valid agreement to policy holders, prospects and general public;
- With respect to the Network Providers engaged for rendering cashless services, Insurers shall also disclose the details of the network providers as per Table – A and Table – B (refer to the attachment) and these details shall be updated as at 31st March of every financial year and be disclosed by 30th June;
- All TPAs to provide the link of the insurance company where the said information is available;
- TPAs and Insurers shall also disclose the web addresses of the network providers enabling policyholders to visit the website of the respective hospitals for up to date information at any given point of time;
- All Insurers shall amend their Service Level agreements (SLAs) with the Network Hospitals to ensure hospitals provide the above data for publication on Insurers website;
- The policyholders desirous of knowing the above details shall be able to access all the above information on visiting the website of their Insurers;
- The above-mentioned directions shall come into effect from 01st April, 2021 and the data for financial year ending 31st March, 2021 shall be published by 30th June, 2021.
Source: Insurance Regulatory and Development Authority of India
