Title: To all Insurers and Third Party Administrators
Reference No.: IRDAI/HLT/REG/CIR/015/02/2018
Modification of Annexure 24 of Circular Ref. No IRDA/TPA/REG/CIR/059/03/
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 No: IRDA/TPA/REG/CIR/059/03/2016 dated 28th March, 2016 stands superseded with revised ‘Annexure – 24’ attached to this circular.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.
Member (Non Life)
Annexure – 24
As per Regulations 22 (3) of IRDAI (TPA – Health Services) Regulations, 2016
Norms on Non Insurance Services under Healthcare Schemes
1. 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.
2. 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.