The Insurance Regulatory and Development Authority of India (Irdai) has decided to allow insurance companies to appoint network providers or hospitals that meet the standards and benchmark criteria established by their (the insurers’) respective boards in order to expand the scope of providing cashless facilities throughout the nation. This decision was made, according to Sharad Mathur, MD, and CEO.
Insurance companies have been urged to prioritize the provision of high-quality healthcare services while appointing network providers for cashless facilities, according to a statement from Irdai.
The minimal labor requirements and the facilities for the healthcare infrastructure should be given special consideration by the board of insurers when defining the criteria, according to Irdai.
An insured person can receive recommended care at any network hospital without worrying about covering costs on their own thanks to the cashless function. According to their policy, the insurer will pay the medical fees directly. A cashless claim settlement method is the greatest choice for hospitalization since it is convenient and saves you from having to run to various locations to arrange payment.
It stated in a circular to insurers and third-party administrators that “…in order to enhance the scope for offering cashless facility across the length and breadth of the country, The insurers now have the authority to appoint network providers who satisfy the norms and benchmarks outlined by their individual boards (TPAs). Previously, the insurers could only impanel network providers who were listed in the Hospital Registry ROHINI kept by Insurance Information Bureau (IIB).
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The National Accreditation Board for Hospitals established pre-accreditation entry-level standards that hospitals delivering cashless services had to also achieve (NABH).
“The regulator is consistently enhancing business accessibility. According to Kapil Mehta, co-founder of SecureNow, “this circular enables insurers to make independent decisions regarding which hospitals to impanel and then be transparent about it.
IRDAI added that before hiring a hospital, the boards of insurers should take into account the required staffing levels and available medical facilities.
The circular instructed insurers to periodically post the board-approved empanelment criteria on their websites.
Sharad Mathur, MD, and CEO of Universal Sompo General Insurance commented on the IRDAI’s decision by saying that the regulatory move would broaden the insurers’ cashless services, which would be essential in easing the financial strain on policyholders.
He added that this will create a robust nationwide network of insurance and healthcare services.
The regulator has also urged the insurers to prioritize the provision of high-quality medical care while partnering with hospitals to create cashless facilities. NKD CS MR PTI
Additionally, the ability of the insurance companies to expand their network of hospitals where the insured can take advantage of the option of cashless treatment will increase access to comprehensive, high-quality health care services, according to Amit Chhabra, Head – of Health Insurance.
According to Sanjiv Bajaj, joint chairman and managing director of Bajaj Capital Ltd., hospitals desiring to be empaneled formerly had to register with the Insurance Information Bureau’s Registry of Hospitals in the Network of Insurers (ROHINI).
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Additionally, they had to obtain certain certifications, such as the State Level Certificate under the National Quality Assurance Standards, issued by the National Health Systems Resources Center, or the NABH Entry Level (or higher) certification, issued by the National Accreditation Board for Hospitals & Healthcare Providers (NABH).
“Irdai modified the regulations to improve the customer experience.” With this, you can receive cashless treatment at your selected network hospital in addition to receiving superior healthcare through your health insurance policy. This will enable clients to choose the best medical facilities close to them and will benefit insurers in expanding the reach of their network of cashless facilities, according to Bajaj.
