The Insurance Regulatory and Development Authority of India (“IRDAI”) has in a letter addressed to all General and Health insurers (except ECGC and AIC) advised that “Cashless Claims” under a health insurance policy, be settled as per the tariff decided by the parties in compliance with provisions of Regulation 31 of IRDAI (Health Insurance) Regulations, 2016.
Insurers have also been advised to have agreement with health providers on rates for treatment of Covid-19 like other diseases (for which rate agreements are in place). Also, while entering into such agreements, insurers have been advised to refer to the ‘Reference rates for COVID-19 treatment’ issued by General Insurance Council for guidance along with the rates fixed by State Governments and Union Territory Administration, as relevant.
Further, all insurers have been directed to ensure that the “Reimbursement claims” under a health insurance policy are settled as per the terms and conditions of the respective policy contract and honor all the health insurance claims as per the terms and conditions of the policy contract. Insurers have been advised to issue suitable guidelines on this to all TPAs.
Source: Insurance Regulatory and Development Authority of India
