IRDAI issues clarification on cashless claims in Covid-19 cases

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Insurance Regulatory and Development Authority of India (IRDAI) has clarified that wherever insurers have an arrangement with the hospitals for providing cashless facility, such network hospitals are obligated to provide cashless service for all treatments including treatment for Covid-19.

This clarification comes in the backdrop of some reports that some hospitals are not granting cashless facility for treatment of Covid-19 despite policyholders being entitled for the cashless treatment under their policy.

Finance Minister Nirmala Sitharaman had earlier held talks with the IRDAI Chairman SC Kunthia on the problems some have faced and the need to address it.

The FM had earlier tweeted, “Reports are being received of some hospitals denying cashless insurance. Spoken to Chairman, IRDAI Shri SC Khuntia to act immediately. In March’20 #Covid included as a part of comprehensive health insurance. Cashless available at networked or even temporary hospitals.”

All the Network Providers (hospitals) who have signed Service Level Agreements (SLA) with general and health insurers have to mandatorily provide cashless facility for any treatment to the policyholders including Covid-19 treatment in accordance with agreed provisions of SLA and terms and conditions of policy contract.

Therefore, all policyholders that are entitled to cashless facility at all such network providers (hospital) with whom the insurance company/TPA has entered into an agreement shall avail the benefit of cashless treatment.

In the event of denial of cashless facility at any such hospitals the aggrieved policyholders may send a complaint to the concerned insurance company. The details and email ids of grievance redressal officers of insurance companies can be accessed from the website of the insurers.

Insurance companies have also been directed to ensure smooth availability of cashless facility with all the network providers (hospitals) empaneled with them by actively interacting with the hospitals.

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How your motor insurance comes handy in case of breakdown

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Two neighbours’ daily routine of watering plants leads to an interesting conversation.

Sindu: Hey, you missed the event on plant protection. It was so informative. There are so many simple hacks to grow plants.

Bindu: Oh! I so wanted to come but my car broke down and my entire morning went away in getting someone to bring a mechanic.

Sindu: What? You could have asked your insurer for RSA? Or didn’t you opt for the rider?

Bindu: I don’t even know what RSA is, to start with. So, how do I say whether I have opted for such rider?

Sindu: RSA stands for roadside assistance. It can be of great help, in the event of a breakdown of your car, like it happened yesterday, or in case of an accident. All you need to do is to call your insurer company and inform them about the problem and your location. They either offer help over the phone or send a representative (mechanic) to your location

Bindu: What if the problem isn’t resolved?

Sindu: Then, your insurer/mechanic will arrange for the car to be towed away to a nearby garage for repair. Also, as part of the RSA cover, some insurance companies arrange for your accommodation till the issue with your vehicle is resolved. Alternatively, you can avail of a taxi service to office/house. This facility is, however, provided to only one destination.

Bindu: This is great news! What are all the services that RSA covers?

Sindu: The list of services varies across insurers. But broadly the RSA should provide coverage for mechanical/electrical breakdown, towing the car, fuel delivery (you will have to bear the fuel charges though), flat tyre, minor repair services, spare keys for your car, accommodation, travel/taxi arrangement and cost of legal advisor.

Bindu: Good. If I had known about this, it could have saved me lot of trouble.

Sindu: Hold there. RSA is mostly offered as an add-on cover with your motor insurance. That means, you will have to pay additional premium to avail this rider. So unless you opted for this cover specifically, your policy will not cover you.

Bindu: Killjoy. Oh well, I wouldn’t mind it, if it comes to my rescue during an emergency.

Sindu: True. But think through a few points carefully, before you buy the rider. One, older your car, the higher will be the chances of mechanical problems. So, many insurers will not be willing to offer this cover for such cars. Two, if you use your vehicle to travel long distances frequently, it is advisable to opt for this cover. But some dealers offer RSA for new vehicles too. So, you can go for RSA with an insurer after the expiry of dealers’ services contract.

Bindu: Okay… is there any limit to the number of times I can avail this service?

Sindu: Yes, but Insurers cap the number of times, limit but the cap varies with each insurer. For instance, ICICI Lombard offers RSA for maximum of four claims.

Bindu: So, now that you have told me the positives, what are the exclusions?

Sindu: The general exclusions that apply on your motor cover, apply to this too. But specifically with respect to this rider, you shouldn’t use the vehicle for any illegal activities like motorsports. Your driving should be as per rules and regulations and the insurer should be informed about the breakdown or RSA requirement immediately. If you get repair work done without the insurer’s approval, you claim could get rejected.

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