IRDAI circular asks insurers to settle COVID-19 claims as per tariffs for other diseases

Insurers could probably now negotiate for lower rates and infectious disease treatment packages, says industry

As per a circular on January 13, the Insurance Regulatory and Development Authority of India (IRDAI) reportedly asked insurers to make efforts “to have an agreement with health providers on rates for treatment of COVID-19 similar to other diseases for which rate agreements are in place.”

Responding to the circular, Dr Alok Roy, Chair FICCI Health Services Committee and Chairman Medica Group of Hospitals explained that for cashless reimbursement with hospital if insurers do not have specific agreement for COVID-19, they will have to work as per the agreed tariff and discounts only.

He explained that in this recent circular, the authority has recommended that specific rate negotiations must happen with hospitals with respect to COVID and COVID-like treatments based on GIC rates (which) are the state government rates but the same has to be in writing and mutually agreed upon. Otherwise reimbursement should be at hospital rates, according to Dr Roy.

He also pointed out that the authorities have also urged the insurers not to give lower rate for reimbursement of cases where cashless was denied. He opined that this has been a sore point between the insured and the insurance companies where “arm twisting attitude” has been seen by the insurance companies. But this opens the doors for insurance companies to negotiate lower rates or packages for infectious disease treatment, is his analysis of the situation.