IRDA amends Norms on Non Insurance Services under Healthcare Schemes under IRDAI (TPA – Health Services) Regulations, 2016

Feb 05, 2018 | by Avantis RegTech Legal Research Team

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Insurance Regulatory and Development Authority of India (IRDAI) vide circular dated February 02, 2018 has issued modification in provisions of Annexure-24 of Norms on Non Insurance Services under Healthcare Schemes under Regulations 22 (3) of IRDAI (TPA – Health Services) Regulations, 2016.

·       A TPA may render Health Services to only those healthcare schemes promoted, sponsored or approved by Central Government or any State Government.

Explanation: No Public Sector Undertaking shall come within the ambit of the above clause.

·       A TPA may render services in wellness and Health promoting programmes, only if such activities are covered under insurance policy as issued by the concerned insurer, with whom a TPA has agreement for rendering of such Health Services.

Provided a TPA shall not render any services directly or indirectly to the policyholder or insured, except such health services that are required to be rendered as per agreement with the insurer and within the terms of the concerned policy contract.

These modified norms shall come into force with immediate effect. All Insurers and Third Party Administrators are advised to make a note of these modifications and ensure compliance.





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