IRDA Guidelines: If the customer does not get any response from the insurance company or the response is not satisfactory, then the customer can contact the complaint resolution cell of IRDAI.
Treatment is getting expensive amidst the second wave of the Corona epidemic. Those who are unable to get a place in government hospitals, have to be admitted to private hospitals. In such a situation, the cost of treatment is reaching millions of rupees as well. The cost of treatment of corona is now diverting on people’s savings and financial plans. In such a situation, health insurance policy is a big relief for the people.
Insurance Regulatory and Development Authority IRDAI (IRDAI) has made a big announcement to provide relief to the corona victims. Policy holders can also avail cashless treatment facility for corona like other diseases. For this, IRDA has also asked hospitals under the network of insurance companies to treat corona in a cashless manner. For this, IRDA has also issued guidelines.
TV9 Digital spoke to CA Manish P. Hinger , founder of tax and financial advisor startup Fintoo, to answer the important questions that arose in people’s minds about this . You also know the answers to those questions.
1. Have the hospitals been instructed not to refuse the cashless Kovid claim?
According to the new announcement by IRDAI, hospitals cannot refuse to provide cashless health insurance facility for Kovid-19 patients. This is a big relief for many patients who were being denied cashless facilities and had to spend money from their own pockets. Given the current lockdown and corona epidemic, it was difficult for such people to spend money out of their pocket. By the way, the truth is that Kovid is covered under all comprehensive health plans, the information of which was given by IRDAI last year. Therefore, there is no reason for hospitals to reject cashless claims.
2. How much has such claims increased since March last year?
So far, the total claims related to Kovid i.e. insurance claims have been Rs 14,287 crore. Of these, claims worth about Rs 7,561 crore have been settled by the insurance companies. Insurance companies estimate that there has been an increase of about 50 per cent in such claims.
3. What is the size of the insurance sector in India?
A total of 57 insurance companies are active in the Indian insurance industry. Of these, 33 are non-life insurance companies and the rest are life insurance companies. The total size of India’s insurance sector was about 280 billion dollars in the year 2020.
4. If a customer is not given the facility of cashless claim, what are his options?
If a policyholder does not get the benefit of cashless claim, then he chooses the option of reimbursement. This means that they will have to pay the entire cost of hospitalization from their own pocket and later they can collect all the documents and take the claim from the insurance company. For this, bills of all kinds of expenses, receipts, reports etc. will have to be submitted.
After this, the insurance company will examine these documents and it will either approve or reject this claim. It is decided on the basis of coverage under the policy. Whatever amount the insurance company approves, part or whole of the claim, goes directly to the policyholder’s bank account.
5. If a customer does not get a cashless claim, where should he complain?
If the insurance company refuses to give the cashless claim, then the customer can first complain to the insurance company by mailing it. Insurance regulator Irdai has directed the insurance companies to take appropriate action against those hospitals not providing cashless facility.
If the customer does not get any response from the insurance company or the answer is not satisfactory, then the customer can contact the complaint resolution cell of IRDAI.
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