The Insurance Regulatory and Development Authority of India (“IRDAI”) has, in a Circular dated June 10, 2020, issued the “Guidelines on Public Disclosures by Insurers on the qualitative and quantitative parameters of the health services rendered to policyholders” (“Guidelines”).
The Guidelines are applicable to all General and Health Insurers (except ECGC and AIC), and to all Third Party Administrators (“TPA”).
Key Highlights:
- All general and health insurers registered with IRDAI rendering health services both through TPA and/or in-house must make the captioned TPA wise public disclosures in the format Annexure -1. The data must be duly signed by either CEO or one of the Whole Time Directors of the insurer. The information must be published within a period of 90 days after the close of every financial year.
- All TPAs must provide the link of every insurance company where the said information is available. The link must be made available in respect of the insurers with whom the TPA had a service level agreement.
- All TPAs shall also provide the requisite data or information to the insurers, wherever called for, in order to enable insurers publish the above information in their respective websites.
- The policyholders desirous of knowing the details referred in Annexure-1 will be able to access such information on visiting the website of respective insurer or the TPA.
- In case of termination of services of a TPA, the insurer must publish the information on its website along with the reasons for termination within 3 days from the effective date of termination.
These directions have been brought into force with immediate effect and data as at 31st March, 2020 must be published by 30th September, 2020.
Source: Insurance Regulatory and Development Authority of India
