Insurance Regulatory and Development Authority

20.07.2022

Insurance

Standards and Benchmarks for the Hospitals in the Provider Network

MANU/IRDA/0050/2022

1. Reference is invited to IRDAI Circular ref: IRDAI/HLT/REG/MISC/199/07/2021 dated 23rd July, 2021 on the captioned subject with respect to the standards and benchmarks at clause (a)(i) and (ii) and clause (b) of Chapter IV of the Guidelines on Standardisation in Health Insurance under Section I of Master circular (ref. IRDAI/HLT/REG/CIR/193/07/2020 dated 22nd July, 2020).

2. In partial modification of the above guidelines, in order to enhance the scope for offering cashless facility across the length and breadth of the country, 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.

3. The board approved empanelment criteria shall be published in the website of the insurers from time to time.

4. While empaneling network providers for cashless facility, insurers are also advised to focus on the delivery of quality healthcare services.

5. These instructions shall come in to force with immediate effect.

6. This circular is issued under the provisions of Regulation 31(e) of the IRDAI (Health Insurance) Regulation, 2016.

7. This has the approval of the competent Authority.

Tags : Standards Hospitals Provider Network

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