Health insurance policyholders may soon be able to get an idea of the infrastructure facilities and healthcare providers at network hospitals with the Insurance Regulatory and Development Authority of India (IRDAI) planning to make such disclosures mandatory for insurers and third party administrators (TPAs).

“To improve information flow to policyholders about the hospitals engaged by insurers and TPAs for providing cashless health services, it is proposed to mandate insurance companies and TPAs to disclose various parameters about the network hospitals, in their respective websites,” said IRDAI.

The regulator said this issuing a draft circular on disclosure of hospital quality indicators. Stakeholders have time till February 14 to send in their comments or suggestions.

Network providers

Under the existing provisions, the insurers ought to keep the insured informed of the list of network providers (hospitals) and display the information on their websites.

Such lists shall also be displayed geography-wise and updated as and when there is any change in the network providers. Likewise, every TPA ought to disclose the list of network hospitals with whom it has a valid agreement to policy holders, prospects and general public.

It is now proposed to make it mandatory for insurers and TPAs to provide various other details with respect to the network providers engaged for rendering cashless services. It includes particulars regarding the number of beds, doctors – full time and consultants – surgeons or interventionists, qualified nurses, intensive care unit beds, doctors exclusively available for ICU and qualification of doctors.

The exposure draft listed various other information parameters insurers and TPAs need to share, including doctor-bed ratio; nurse-bed ratio; average admission time; average length of stay (for surgical cases); as well as C-section rate.