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Life insurers must submit a half yearly compliance certificate from their statutory auditors for the Financial Year 2015-16 regarding group insurance claim settlement guidelines. All life insurers submit the certification for their entire group insurance portfolio within 45 days after the expiry of each half year. The first half year ends on 30 September 2015. The certificate follows the prescribed proforma in Annexure 1.
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[Image omitted. See the official document.]
IRDA/Life/2014/129
8th April, 2015
To the CEOs of all the Life Insurers
Re: Settlement of Claims under Group Insurance Policies
Authority vide its Circular ref IRDA/LIFE/CIR/GDL/285/12/2014 dated December 29, 2014 has issued modified Guidelines in respect of Group Insurance Policies/Schemes administered by certain category of Master Policy Holders.
In order to monitor the execution of the modified guidelines dated 29th December, 2014 in the matter of the settlement of the claims under Group Insurance Policies all the insurers are directed to submit the half yearly compliance certificate from their respective statutory auditors for the Financial Year 2015-16 in the prescribed proforma attached as Annexure - 1. The certification in the prescribed proforma shall be submitted in respect of the entire group insurance portfolio of the life insurers and be filed with the Authority within 45 days of the expiry of the respective half year. The first such half year ends 30/9/2015 for which certificate as above is required to be submitted.
(V Jayanth Kumar) Joint Director (Life)
Parisrama Bhavanam, 5-9-58/B, $3^{\text{rd}}$ Floor, Basheer Bagh, Hyderabad 500 004 Phone: 040-23381263, Facsimile: 040 66823334 www.irdaindia.org
[Image omitted. See the official document.]
ANNEXURE - 1
Name of Life Insurer: Information for the Half Year ending ___________________
| I | Total Number of Non Employer-Employee Group Life Insurance Schemes / Policies | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| II | Total Number of Group Life Insurance Schemes / Policies under Lender Borrower Schemes | |||||||||
| Sl No. | Where Master Policy Holder (MPH) is | Number of Schemes | Number of Members Insured | Where claims settled in full drawing cheques in favour of MPH | Where claims settled in full drawing cheques in favour of MPH | Where claims settled in full drawing cheques in favour of Nominee / Beneficiary | ||||
| No. of Claims | Benefit Amount | No. of Claims | Benefit Amount | No. of Claims | Benefit Amount | |||||
| 1 | RBI regulated Scheduled Commercial Banks | |||||||||
| 2 | NBFCs having Certificate of Registration from RBI | |||||||||
| 3 | NHB Regulated Housing Finance Companies | |||||||||
(1) It is certified that;
In respect of all the group insurance schemes where claim cheques (whether for full claim amount or partial claim amount) are issued in favour of the master policy holder the life insurer has (a) obtained specific authorization from the individual members of the group life insurance scheme / policy in compliance to Clause (2) (I) (a) of the Guidelines dated $29^{\text{th}}$ December, 2014 (Guidelines) (b) enabling clause was there in the terms and conditions in compliance to Clause (2) (I) (b) of the Guidelines (c) obtained a Credit Account Statement from the Master Policy Holder in compliance to Clause (3) (I) of the Guidelines.
Parisrama Bhavanam, 5-9-58/B, $3^{\text{rd}}$ Floor, Basheer Bagh, Hyderabad 500 004 Phone: 040-23381263, Facsimile: 040 66823334 www.irdaindia.org
[Image omitted. See the official document.]
(2) In respect of the following group schemes where claim cheques (whether in part or in full) are issued in favour of Master Policy Holders non compliance is observed as mentioned hereunder.
| Number of Schemes / Group Insurance Policies | Number of Claims | Amount of Benefits | Details of Non Compliance to the Guidelines dated $29^{\text{th}}$ December, 2014 |
|---|---|---|---|
(3) In respect of the Certification furnished for the half year ending $31^{\text{st}}$ March, 2016 in addition to the above, the statutory auditors shall also certify the following:
(i) In respect of the following cases the life insurer complied with Clause (3) (VII) of the Guidelines.
(a) Number of Group Insurance Schemes where complied with Clause 3 (VII) of the Guidelines
(ii) In respect of the following cases the life insurer does not complied with Clause (3) (VII) of the Guidelines.
(a) Number of Group Insurance Schemes where non compliance to Clause 3 (VII) of the Guidelines is observed
It is certified that the above information is furnished after examining the relevant records of the life insurer. The information furnished is correct.
Place: Date:
Seal
#Signature of the Statutory Auditor
Parisrama Bhavanam, 5-9-58/B, $3^{\text{rd}}$ Floor, Basheer Bagh, Hyderabad 500 004 Phone: 040-23381263, Facsimile: 040 66823334 www.irdaindia.org
