Cigna TTK denied cashless approval for hospitalised policyholder due to lack of Aadhaar card. It shows the extreme inconvenience, which can be caused for policyholder at the time of utmost requirement. The case proves the adverse impact of November 2017 terse circular from Insurance Regulatory and Development Authority of India (IRDAI).
IRDAI’s November 2017 circular says that linkage of Aadhaar number to insurance policies is mandatory under the Prevention of Money-laundering (Maintenance of Records) Second Amendment Rules, 2017. It said that the amended rules have made it mandatory to link Aadhaar, PAN/Form 60 for availing financial services, including insurance. Due to lack of any more details, IRDAI circular can cause more confusion among insurers and the insured.
Is Cigna TTK is not following Supreme Court (SC) decision? The date for linking Aadhaar with existing accounts and other services, benefits, subsidies, insurance policies, post office accounts —about 140 items in all — has been extended to 31 March 2018. '
The cashless payment is done to the hospital for its services. Customer does not get any money and hence insurance company should not deny cashless due to lack of Aadhaar card. The case proves exactly what we feared in November 2017. Read: Regulation: Aadhaar Link with Insurance Can Be a Challenge
It states - “If the policyholder does not have Aadhaar and files a claim with policy in-force, will the claim not be paid?”
Moneylife took the case of cashless denial to Cigna TTK. They responded that the cashless has been approved without giving reasons why the TPA had rejected it. Cigna TTK TPA denial for cashless in this specific case was contradictory to Cigna TTK response – “However, it may be noted that currently Cigna TTK is not denying any claims based on the non-receipt of Aadhaar number. The request for Aadhaar has been made also to ensure that Cigna TTK is able to provide seamless customer experience in the future as the same is then registered in our records.”
It is not just insurance companies, but even hospitals may wrongly ask for Aadhaar card for treatment. Recent news of Kargil martyr’s wife being denied for want of medical care at a private hospital in Haryana’s Sonepat as it insisted on having the patient’s Aadhaar card.
IRDAI November circular has made it mandatory for companies to link Aadhaar with insurance policies from general, life and stand-alone insurers without awaiting further instructions. The move can create logistical challenge for insurance companies for life, health, vehicles and all other types of covers. There is a possibility of insurers even stopping claims payments until policyholders submit their Aadhaar details.
Will the policyholders get a raw deal and insurers another reason to keep the claim payment float under the garb of Aadhaar compliance? If the policyholder does not have Aadhaar and files a claim with policy in-force, will the claim not be paid? If the policyholder dies without having Aadhaar linked to the policy, will the nominee/legal heir face difficulty with claim payment? Time will tell if pending claims get delayed and the existing policyholders are made to rush for compliance.