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The Insurance Regulatory and Development Authority of India replaces Annexure 24 of a previous circular to align norms with regulation provisions. All insurers and third party administrators must follow the revised norms for non insurance services under healthcare schemes. The modified norms take effect immediately on the date of the circular. A third party administrator may render health services only to specific government promoted healthcare schemes. Public sector undertakings do not fall within the ambit of this clause. A third party administrator provides wellness and health promoting programmes only when an insurance policy covers those activities. The third party administrator does not render any services directly or indirectly to the policyholder or insured except as required by the agreement with the insurer.
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Ref: IRDAI/HLT/REG/CIR/015/02/2018
02nd February, 2018
All Insurers and Third Party Administrators
Re: Modification of Annexure - 24 of Circular Ref. No: IRDA/TPA/REG/CIR/059/03/2016 dated 28th March, 2016
Reference is invited to the provisions of 'Annexure - 24' of Authority's circular Ref. No: IRDA/TPA/REG/CIR/059/03/2016 dated 28th March, 2016 where norms on Non Insurance Services under Healthcare Schemes were specified.
In order to align the norms with the provisions of Regulation 22 (3) of IRDAI (Third Party Administrators - Health Services) Regulations, 2016, 'Annexure - 24' of the above referred circular stands replaced with revised 'Annexure - 24' attached to this circular.
Accordingly, 'Annexure - 24' of Authority's circular Ref. No: IRDA/TPA/REG/CIR/059/03/2016 dated 28th March, 2016 stands superseded with revised 'Annexure - 24' attached to this circular.
These modified norms will 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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Member (Non Life)
सर्वे नं. 115/1, फाइनेंशियल डिस्ट्रिक्ट, नानकरामगुडा, हैदराबाद-500 032, भारत Survey No. 115/1, Financial District, Nanakramguda, Hyderabad-500 032, India (9) : +91-40-2020 4000,फैक्स : +91-40-2020 4555 © : +91-40-2020 4000, Fax : +91-40-2020 4555 वेबसाइट : www.irdai.gov.in Website : www.irdai.gov.in
Annexure - 24
As per Regulations 22 (3) of IRDAI (TPA - Health Services) Regulations, 2016
Norms on Non Insurance Services under Healthcare Schemes
Explanation: No Public Sector Undertaking shall come within the ambit of the above clause.
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.
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