Co-payment in health insurance only after netting hospital discounts: Irdai

 

The Irdai had recently notified that in health insurance policies with co-payment or the deductible conditions, the insurer or the third party administrator (TPA) should ensure that the co-payment or deductible is effected only after net discounts offered by the hospital, if any.

 

The regulator said during the course of settlement of claims, either the insurer or the TPA might be obtaining discounts from various network providers or also from other hospitals outside the network. Whereby virtue of any agreement, discounts are agreed to be received on the aggregated bills raised by the hospitals, Irdai said every insurer or TPA should appropriately identify and apportion the eligible amount of the discount to the underlying health insurance policy in respect of which the claim is settled so as to pass on the benefits to the concerned policyholder or the claimant.

 

Insurers have been asked by the regulator to mandate 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.