Irdai empowers insurers to empanel hospitals for cashless facility

Regulator asks companies to publish board-approved empanelment criteria on their websites periodically; insurers to focus on quality of healthcare services of hospitals being empanelled

The Insurance Regulatory and Development Authority of India (Irdai) has permitted insurance companies to empanel network providers or hospitals that meet the standards and benchmark criteria specified by their (the insurers') respective boards so as to enhance the scope of offering cashless facility across the country.

In a circular issued on Wednesday, Irdai said, “…the insurers are now empowered to empanel the network providers that meet the standards and benchmarks criteria as specified by their respective boards. While specifying the criteria, the board of insurers shall, amongst others, consider especially the minimum manpower and healthcare infrastructure facilities”.

The regulator has directed insurance companies to publish the board-approved empanelment criteria on their website from time to time. Also, while empaneling hospitals for cashless facilities, insurers will also have to focus on the delivery of quality of healthcare services.

Under the regulator's norms on standards and benchmarks for hospitals in the provider network, hospitals wanting to be empaneled had to register with the Registry of Hospitals in the Network of lnsurers (ROHINI) maintained by the Insurance Information Bureau (IIB).

Also, they had to obtain either “NABH Entry Level Certification” (or higher certificate) issued by National Accreditation Board for Hospitals and Healthcare Providers (NABH) or State Level Certificate (or higher certificate) under National Quality Assurance Standards (NOAS), issued by National Health Systems Resources Centre (NHSRC).

However, Irdai has modified these guidelines to enhance the scope for offering cashless facilities across the length and breadth of the country.

“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&CEO, Universal Sompo General Insurance.