Thursday, August 26, 2010

Insurers cannot refuse cashless cover midway

gr8 step taken by IRDA.Medical policy holders undergoing treatment can continue to enjoy cashless benefit even if the hospital where they are admitted is delisted by insurers from cashless cover. Coming out with a direction to insurers for the first time after four PSU firms suspended cashless mediclaim facilities in major private hospitals from July 1, regulator IRDA said the companies will also have to constantly update policy holders and customers on any change in the list of hospitals offering cashless cover. 

"Where a policy holder has been issued pre-authorisation for the conduct of a given procedure in a given hospital, or if the policy holder is already undergoing such treatment at a hospital and such hospital is proposed to be removed from the list of PPN, then the insurers are directed to continue to provide the benefits of cashless facility for such policy holders as if such hospital continues to be in the 
PPN list," it said in a circular. 

Insurance companies have a network of hospitals, known as preferred provider network (PPN), which offers health insurance services under cashless facility. IRDA said the PPN is dynamic and subject to change from time to time. 

IRDA also said "To ensure that the interests of policyholders are not adversely affected when a change of PPN is effected, insurers are directed to inform them all times, the nearest possible alternative hospitals, where the cashless facility is available and the conditions thereof." 

IRDA directions assume importance since customers are left in a quandary following deadlock between the four PSU insurers and major private hospitals over resumption of cashless facilities