The Insurance Regulatory and Development Authority of India (IRDAI) has instructed insurers to settle claims arising from COVID-19 patients being treated in makeshift hospitals across the country.
The regulator has taken this step to ease policyholders’ woes, as a large number of makeshift hospitals are being set up all over the country with hospitals running out of beds. These are mostly set up by local state governments and private healthcare providers to ease the pressure on the main healthcare centres.
This had given rise to disputes with regard to claim settlement which led to the regulator’s intervention. The IRDAI has said that if a policyholder tests positive for COVID-19 and is admitted into a makeshift hospital on the advice of a medical practitioner or government authorities, then notwithstanding the definition of hospital mentioned in the policy contract, the claim shall be settled by insurance companies.
“In order to ensure that the cost of treatment of COVID-19 is covered as per terms and conditions of policy contract, a makeshift or temporary hospital permitted by the central or state government shall be regarded as a hospital or network provider and insurers shall settle the claims,” said the IRDAI.
Moreover, if the insurer’s network provider has arranged for a temporary hospital then such hospital shall be considered as an extension of the network provider and cashless settlement of claims will have to be made available. The circular also advised third-party administrators to comply with these claims settlement instructions.