The Insurance regulatory authority of India on 14th July 2020 has directed insurance companies to ensure that the policyholders are notified about the availability of cashless facility at the empanelled network provider and the cashless facility of such network provider shall be made available to the policyholder in accordance to the terms and conditions of the policy contract and as per the terms agreed in Service Level Agreement (SLA).
General and health insurance companies may offer policies providing cashless services to the policyholders. For the purpose of providing cashless services insurers / Third Party Administrators (TPAs) shall enlist network providers (hospitals) to provide medical services and shall also enter in to a service level agreement.
The insurance companies are also advised to put in place an exclusive grievance redressal mechanism to address the grievances of policyholders relating to the denial of cashless facility for COVID-19 and other grievances against such hospitals that are enlisted as network providers.
Further, if any network provider denies a cashless facility and deviates from agreed terms of the SLA, the insurance company shall take appropriate action against such network providers as provided in SLA.
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