Page 50 - The Insurance Times July 2020

against such hospitals that are enlisted as network 1. Reference is invited to IRDAI circular Ref. No: IRDAI/
providers. Insurance companies shall also put in place HLT/REG/CIR/054/03/2020 dated 04th March, 2020,
continuous communication channel with all the network specifying guidelines on handling of claims reported
providers for prompt resolution of the grievances of under Covid-19.
policyholders. 2. In view of increase in number of COVID-19 cases, in
6. Where any network provider denies cashless facility and order to leverage on the extant healthcare systems put
deviates from agreed terms of the SLA, insurance in place, it is important to recognise the make-shift or
company shall take an appropriate action against such temporary hospitals permitted by Government for
network providers as provided in SLA. settlement of health insurance claims for insurance
7. Also, where policyholders’ interests are adversely companies.
affected because of the conduct of the network 3. In the above backdrop, in order to ensure that the costs
providers, such instances may be immediately reported of treatment of COVID – 19 are covered as per the
to the appropriate Government agencies of the terms and conditions of policy contract, a make-shift or
concerned State/area. Action taken against such temporary hospital permitted by Central / State
network providers may also be published on the website government shall be regarded as a hospital or network
of the insurance company for the information of the provider and insurers shall settle the claims as per the
insured public. following norms.

8. This has the approval of the competent authority. a) Where a policyholder who is diagnosed as Covid-19
positive is admitted into any such make-shift or
(D V S Ramesh) temporary hospital on the advice of a medical
General Manager (Health) practitioner or appropriate Government
authorities, notwithstanding the definition of
hospital specified in the terms and conditions of
Discount in premium in Corona Kavach
policy contract, the treatment costs shall be settled
Policy to Healthcare Workers by insurers.

Date:14-07-2020 b) Where any network provider has set up any such
make-shift or temporary hospital, such make-shift
As mandated by IRDAI, all the 30 general and health insurers or temporary hospital shall be regarded as the
that offer indemnity based health insurance, have started extension of the network provider and cashless
offering Individual Covid-specific Standard Health Policy facility shall be made available.
called “Corona Kavach”. 4. Insurers are advised to expedite settlement of all such
claims in accordance to the applicable regulatory
As a gesture of acknowledgment of the contribution of framework.
healthcare sector in the nation’s fight with Covid-19, the
insurance companies will provide a 5% discount in premium 5. All insurers are also advised to incorporate the above
of “Corona Kavach” to doctors, nurses and other healthcare norms in claim guidelines and inform to all the TPAs
workers, in terms of the guidelines issued by IRDAI. immediately.
6. These guidelines shall come in to force with immediate
All eligible individuals may avail the discount at the point of effect.
purchase of ‘Corona Kavach’.
7. These guidelines are issued under the powers vested
with Regulation 27 (vi) of IRDAI (Health Insurance)
Guidelines on settlement of claims on Regulations, 2016 read with Section 34 (1) of Insurance

treatment at ‘make-shift or temporary Act, 1938.
hospitals’ as permitted by Government 8. This has the approval of the competent authority.

IRDAI/HLT/MISC/CIR/190/07/2020 (D V S Ramesh)
Date:16-07-2020 General Manager (Health)

50 The Insurance Times, July 2020