In order to develop cashless facilities over the country, Irdai has permitted insurers to empanel hospitals that satisfy the standards specified by the insurers.
In order to broaden the availability of cashless facilities throughout India, the Insurance Regulatory and Development Authority of India (Irdai) has granted permission to insurance companies to appoint on their panels network providers or hospitals that satisfy the standards and benchmark criteria specified by the insurers’ respective boards.
Irdai stated in a circular on Wednesday that the insurers are now empowered to empanel the network providers that meet the standards and benchmark criteria as stipulated by their individual boards. When defining the criteria, the board of insurers is required to take into account a number of factors, including but not limited to the minimum manpower and infrastructural facilities.
Regulations for the Hospitals
The regulator has instructed the companies that provide coverage to publish the empanelment criteria that have been approved by the board on their websites on a periodic basis. In addition, insurers will be required to prioritize the provision of high-quality medical services while they are empaneling hospitals for cashless facilities.
Hospitals that wanted to be empaneled were required to register with the Registry of Hospitals in the Network of Insurers (ROHINI), which is maintained by the Insurance Information Bureau (IIB). This was necessary because of the norms and benchmarks that the regulator had established for hospitals that were part of the provider network.
Additionally, they had to obtain either a State Level Certificate (or higher certificate) under the National Quality Assurance Standards (NOAS), issued by the National Health Systems Resources Center (NHSRC), or “NABH Entry Level Certification” (or higher certificate) issued by the National Accreditation Board for Hospitals and Healthcare Providers (NABH) .
Irdai has altered these regulations, though, to expand the opportunity to provide cashless services over the entire nation.
“The regulatory initiative will increase the scope of the insurers’ cashless services, which would play a pivotal role in reducing the financial burden on policyholders. This will also provide a strong network of health care plus insurance services countrywide,” said Sharad Mathur, MD and CEO, Universal Sompo General Insurance.
