(a) the details of the diseases covered under the cashless treatment facility available to the
medi-claim policy holders ;
(b) whether private companies have stopped to provide this facility to their medi-claim policy
holders in the recent past;
(c) if so, the details thereof and the reasons therefor; and
(d) the steps taken/being taken by the Government to restore the said facility?
THE MINISTER OF STATE IN THE MINISTRY OF FINANCE
(SHRI NAMO NARAIN MEENA)
(a): The cashless treatment facility available to the mediclaim policyholders
is form of a claim settlement procedure under the contract whereby the insurer
agrees to settle the admissible claim directly to the network hospital. The list
of diseases covered under the cashless treatment facility vary as per the coverage
of the diseases under the policy issued.
(b)&(c): No, Madam. The Insurance Regulatory and Development Authority
(IRDA) has informed that the cashless facility continues to be available
in all hospitals forming part of the network hospitals of insurance companies.
However, it is subject to issuance of pre-admission authorisation by Third Party
Administrators (TPA)/Insurer and they can decline cashless form of treatment in
case the insured person is unable to provide the relevant medical details required
by TPA/insurer, depending on the terms and conditions of the specific policy given
to the policyholder.
(d): Does not arise.