Document Detail
संदर्भसं.: आईआरडीएआई/
परिपत्र
Circular
प्रति
सभीसाधारण औरस्वास्थ्यबीमाकर्ता(ईसीजीसी औरएआईसी कोछोड़कर)
All General and Health insurers (except ECGC and AIC)
विषयः
1. साधारणबीमा परिषद(जीआईसी)द्वारा जारीकिये गयेपरिपत्रसंदर्भः
Attention is drawn to the Circular ref: “Reference rates forCOVID-19 treatment” dated 20th June 2020 issued by General Insurance Council(GIC).
2. स्वास्थ्यबीमा पालिसीके अंतर्गत
In case of “Cashless Claims” under a healthinsurance policy, the claims shall be settled as per the tariff decided by theparties in compliance to provisions of Regulation 31 of IRDAI (HealthInsurance) Regulations, 2016. However, the insurers shall make efforts to haveagreement with health providers on rates for treatment of Covid-19 similar toother diseases for which rate agreements are in place. Also, while enteringinto such agreements, the reference rate of GI council can be kept in view forguidance alongwith rates fixed by State Governments and Union Territoryadministration, if any and as relevant.
3. सभीबीमाकर्ताओंको यहसुनिश्चितकरने के लिएनिर्देश दियाजाता है किस्वास्थ्यबीमा पालिसीके अंतर्गत
All the insurersare directed to ensure that the “Reimbursement claims” under a health insurancepolicy shall be settled as per the terms and conditions of the respectivepolicy contract. Hence, the insurers shall honor all the health insuranceclaims as per the terms and conditions of the policy contract.
4. बीमाकर्ताओंको सूचित कियाजाता है कि वेसभी टीपीए कोइसके संबंधमेंदिशानिर्देशजारी करें।
Insurers are advised to issuesuitable guidelines on this to all TPAs.
5. इसेसक्षमप्राधिकारीका अनुमोदनप्राप्त है।
This has the approval of Competent Authority.
हस्ताक्षरित
(डी वी एसरमेश /
महाप्रबंधक(स्वास्थ्य)