IRDAI asks insurers to formulate rates for Covid treatment

MUMBAI: The Insurance Regulatory and Development Authority of India has directed general and standalone health insurance companies to work with healthcare providers on rates for treatment of COVID-19, similar to rate agreements for treatment of other diseases, according to a circular.

While entering into such agreements, insurance companies can refer to the rates provided by the General Insurance Council in June, along with the rates fixed by state governments and Union territory administration, if any, it said.

“In case of 'cashless claims' under a health insurance policy, the claims shall be settled as per the tariff decided by the parties in compliance to provisions of Regulation 31 of IRDAI (Health Insurance) Regulations, 2016," the regulator added.

After the outbreak of COVID-19 pandemic, insurance companies had started receiving higher-than-expected claims as hospitals were charging higher rates for such treatments as compared to other diseases.

To standardise the rates for COVID-19 treatment, the General Insurance Council had in June, introduced a reference rates for COVID19 treatments, taking into account rates published by various state governments and also after discussions with health claims experts.

Tthe regulator said insurance companies have to ensure that "reimbursement claims" under a health insurance policy are settled as per the terms and conditions of the policy contract. "Insurers are advised to issue suitable guidelines on this to all TPAs (third-party administrators)," it added.