To all Insurers The Authority under the IRDA (Third Party Administrators-Health Services) Regulations had licensed some organizations to carry out the basic objectives of those regulations. The system of TPA has been in vogue sometime now. As part of the regulations, the insurers and the TPAs were required to file with the Authority copies of agreement that had been concluded between them. The purpose of this requirement was for the Authority to know the exact scope of work which an insurer has entrusted the TPA or the jurisdiction in which the TPAs act on behalf of the insurers. On going through some of those agreements which have been received by the Authority, in some cases the Authority finds that copies of the agreements still not have been filed with it, Authority feels that the agreements require clarity in many cases and the coverage in the agreement is not to the extent that has to be. A list of items that the Authority would like the agreements between the insurers and the TPAs to cover these is enclosed hereto. The parties are now required to see to it that the agreements entered into bring out clearly the scope of the work the TPA is to carry out in various areas. It is requested that both the insurers and the TPAs be aware of their obligations under the regulations. A
worrying development has been for some institutions which have not been
registered themselves as TPAs under the regulations offering assistance
in the development of medical insurance schemes in the country. What is
more apprehensible is that the fact that some of these organizations which
seem to have the support of insurance companies. The insurers by aligning
themselves with these unlicensed organizations would be compromising their
interest. It is, therefore, directed by the Authority that any agreement
with an unlicensed organization to act as a TPA in those areas of work
which have been allotted to be done by the TPA would be outside the scope
of the provisions of the Act and the regulations and the insurers as well
as the organizations who style themselves as service providers would attract
penalty from the Authority. The receipt of this circular may be acknowledged
to Mr. R.C. Sharma, Assistant Director of this office within 7 days of
the issue. Yours faithfully, (N. Rangachary) |
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