Irdai’s common empanelment drive gains momentum, insurers begin onboarding hospitals for cashless treatment network

Mumbai: The common empanelment process mandated by the Insurance Regulatory and Development Authority of India (Irdai) in January has kickstarted with the General Insurance Council, along with insurers, reaching out to more than 600 eye hospitals and 150 general hospitals across the country, according to officials.

The general insurers have reached out to eye hospitals for bringing them on board for empanelment. "With simpler, procedure-based treatments like cataract and LASIK, eye hospitals are being onboarded separately for the rollout," said a source.

The target is to onboard 4,000-5,000 general hospitals in the next two to three months. The phased rollout, officials said, is designed to manage complexity, with eye hospitals being approached separately due to the limited nature of procedures like cataract and LASIK.

The empanelment of hospitals means officially adding a hospital to a list or network of approved healthcare providers. Once empanelled the hospital can offer cashless treatment to people covered under health insurance plans. Irdai's plan, which is a directive to insurers, hopes to make insurers enrol more hospitals in the network. While such a move will help in standardising hospital charges, it hasn't been well received by all hospitals.

The larger hospitals have expressed reservations about standardised pricing models which, they say, is expected in such reforms.

While some hospitals have welcomed the initiative, others remain hesitant, citing concerns over reimbursement rates and operational integration. "Pushback is not unexpected," the source said. "But collaboration between insurers and providers is key to making this work for patients."

As the process gathers momentum, insurers are expected to negotiate treatment package rates based on the PMJAY (PM Jan Arogya Yojana) framework, which is seen as a model for cost-effective solution.

In January, Irdai had said that insurers should move towards common empanelment and standardised procedure pricing, like the government's health schemes.