CIRCULAR NO. IRDA/TPA/GDL/CIR/008/01/2011,
DATED 12-1-2011
1. It has come to the notice of the Authority that in some instances policyholders could not get cashless facility at the hospital approached, due to change in the network hospitals and/ or the servicing TPA by the insurers, about which the policyholder was not properly informed.
2. Where the policyholder had renewed the policy well before the expiry of earlier policy, the IT system of the insurer could not update the details of the new TPA in the policy since it was renewed before the date of change of TPA. The inception of the renewed policy was to take effect after the date when the TPA servicing the particular office of the insurer was to change.
3. Since both the network hospitals, as well as the servicing TPA, were changed and the system could not update the details of the same in the policy, the policyholders were put to great inconvenience.
4. All insurers are hereby advised that they should ensure that their systems update the details with respect to network hospitals and the servicing TPAs at the time of issue of policy or any time thereafter during the period the policy is in force. Alternatively, the decisions on change of list of PPN hospitals and/ or TPAs shall be with prospective effect giving adequate time for the IT systems to have the necessary modifications in software in place. All the policyholders must be informed appropriately about the service providers at all times.
