Don’t turn down COVID claims from make-shift hospitals, regulator tells insurers

NEW DELHI: The insurance regulator IRDAI said general and health insurers should not turn down claims from make-shift or temporary hospitals set up for COVID-19 patients.

In view of the increasing number of coronavirus cases, several state governments have set up make-shift or temporary hospitals. The number of coronavirus cases is rising rapidly and is expected to soon cross the one-million-mark in the country.

“…in order to ensure that the costs of treatment of COVID-19 are covered as per the terms and conditions of policy contract, a make-shift or temporary hospital permitted by Central/State government shall be regarded as a hospital or network provider and insurers shall settle the claims (as per the specified norms),” the Insurance Regulatory and Development Authority of India (IRDAI) said in a circular on Thursday.

The regulator said when a policyholder, who is diagnosed as COVID-19 positive, is admitted into any such make-shift or temporary hospital on the advice of a medical practitioner or appropriate government authorities, notwithstanding the definition of hospital specified in the terms and conditions of policy contract, the treatment costs shall be settled by insurers.

It further said if any network provider has set up such make-shift or temporary hospital, such make-shift or temporary hospital shall be regarded as the extension of the network provider and hence cashless facility shall be made available.

The regulator also directed general and health insurers to expedite settlement of all such claims in accordance with the applicable regulatory framework.

The insurers have also been advised to incorporate the above norms in claim guidelines and inform all the third-party administrators (TPAs) immediately.


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