Re: Updating policyholders about change in network hospitals and TPA’s IRDA has noticed that in some instances, policyholders could not get cashless facility at
the hospital approached by them, due to change in the network hospitals and/ or the servicing TPA by the insurers, about which the policyholder was not properly informed.

Where the policyholder had renewed the policy well in advance 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.

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 policy holders were put to great inconvenience.

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 and inform all the policyholders about service providers at all times.

This article has been prepared by Datacomp Training Academy for private circulation and quick reference. For complete details please refer to circular IRDA/TPA/GDL/Cir/008/01/2011 dated 12/01/2011 issued by the IRDA.