Pass on health insurance claim discount to policyholders: IRDA

In a circular to insurers and Third Party Administrators (TPAs), <g data-gr-id="26">IRDAI</g> said they may be obtaining discounts from various network providers and other hospitals outside the network during <g data-gr-id="25">settlement</g> of claims under health insurance policies. "While every insurer and TPA shall endeavour to get the best and cost effective services to the policyholders or the claimants of health insurance policies, it shall be ensured that the discounts obtained from the hospitals, if any, are passed on to the policyholders or the claimants of the underlying health insurance policy," it said.

Insurance Regulatory and Development Authority of India (<g data-gr-id="19">IRDAI</g>) said that insurers and TPAs should pass on the benefit of the discount to the concerned policyholder or the claimant. It also asked them to put in place procedures including mandating the hospitals to reflect such agreed discounts in the final hospitalisation bill of each claim, whereby the policyholder or the claimant can also be aware of the actual bill raised by the hospital.

Also, in cases where the admissible claim amount comes more than the sum insured, the agreed discount shall be on the gross amount raised in bill, before letting the policyholder or claimant bear the costs over and above the eligible claim amounts. Further, it said if health insurance policies have co-payment or deductible conditions, co-payment or deductible should be effected only after netting of the discounts offered by <g data-gr-id="21"><g data-gr-id="20">hospital</g>,</g> if any.

<g data-gr-id="15">IRDAI</g> said the discount should be in absolute monetary terms and every insurer shall make these procedures as part of their detailed guidelines on claim settlement.