Here’s how IRDAI wants insurers to settle cashless health insurance claims for Covid-19 treatment


The General Insurance Council’s COVID-19 benchmark rates will apply to cashless and reimbursement claims.

The cost of hospitalization due to COVID-19 can run up to a few lakhs as the hospital stay is typically around 14 days. The General Insurance Council (GI Council) has prepared a rate table for COVID-19 treatment, taking into account the rates published by different state governments and also after discussions with experts in health claims. The prices are proposed by the GIC to be taken into account during treatment in a hospital environment. The IRDAI sent a communication to all life and health insurance companies regarding the settlement of health insurance claims against the instructions of the General Insurance Council dated June 20, 2020 on the “ Reference rates for COVID- 19 ”.

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Treatment for treating the coronavirus appears to be different from treatments for other medical conditions as it involves the use of PPE kits and specific procedures for drugs. It is important that hospitals across the country follow a standardized rate chart and that insurance companies ensure a smooth and straightforward claims process for policyholders.

In the communication to insurers, IRDAI stated that in the event of “ cashless claims ” under a health insurance policy, the claims will be settled according to the rate decided by the parties in accordance with the provisions of the IRDAI regulation 31 (health insurance). Regulations, 2016.

However, insurers will strive to reach an agreement with healthcare providers on treatment rates for Covid-19 similar to those for other diseases for which rate agreements are in place.

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In addition, when concluding such agreements, the reference rate of the General Insurance Council may be kept for guidance, as well as the rates set by the governments of the States and the administration of the territory of the Union, if necessary. applicable and if applicable.

In addition, all insurers have been tasked by IRDAI to ensure that “claims for reimbursement” under a health insurance policy are settled in accordance with the terms and conditions of the respective policy contract.

The GI Council’s COVID-19 benchmarks will be applicable to both cashless claims and Covid-19 reimbursement where a government authority has not issued standard rates for Covid-19 treatment. Wherever the Covid-19 treatment fee has been published by a government authority, these fees are applicable to insurance claims against member companies.

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