Helping policy holders caught in the fight between insurers and hospitals, regulator Irda today said companies will have to constantly inform customers about the hospitals, which offer cashless treatment.
"In order to ensure that the interests of the policy holders are not adversely affected when a change in Preferred Provider Network (PPN) is effected, insurers are directed to inform the policy holders at all times, the nearest possible alternative hospitals, where the cashless
facility is available and the conditions thereof," Insurance Regulatory and Development Authority (Irda) said in a circular.
The Insurance Regulatory and Development Authority (Irda) also directed insurers not to discontinue cashless facilities even if certain hospitals are removed from the PPN list in case policy holders have pre-authorisation to get treatment from these medical centres.
"Where a policy holder has been issued a 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 policyholders as if such hospital continues to be in the PPN list," it said.
This is the first direction from Irda to insurers after four PSU general insurance companies -- New India Assurance, United India Insurance, National Insurance and Oriental Insurance -- with effect from July 1 suspended cashless medical facilities at certain super specialty medical centres on grounds of over billing.
Earlier this month, the Delhi High Court had directed Irda to take steps to restore the cashless facility provided by the four PSU general insurers to policyholders.
