Insurers must settle COVID-19 hospitalization reimbursement claims in accordance with the tariff for cashless treatment and the policy terms, says the Insurance Regulatory and Development Authority of India (IRDAI) in a circular intended to clarify claim procedures.
This guidance, issued on 13 Jan 2021, follows a circular issued by General Insurance Council (GI Council) on 20 Jun 2020, calling for COVID-19 hospitalization claims to be settled using rates set by government authorities or published by the GI Council.
For cashless claims under a health insurance policy, IRDAI advised that
For the reimbursement of claims under a health insurance policy, IRDAI said that claims should be settled in accordance with the terms and conditions of the policy contract.
IRDAI also advises insurers to issue suitable guidelines to third party administrators.