IRDAI vide Order bearing reference number: IRDAl/TPA/ORD/MISC/98/07/2024 dated July 04, 2024, issued an Order in the matter of M/s. Anmol Medicare Insurance TPA Limited (“Anmol TPA”) with respect to the Show Cause Notice dated November 20, 2023, issued by the Authority for the violation of the provisions of IRDAI (TPA-Health Services) Regulations, 2016.
The observation/ issues raised by the Authority and decisions on these observations are summarized hereunder for reference:
Charge No
Violation
Observations of the Authority
Decision of the Authority
1
Violation of Regulation 14 and 15 of IRDAI (TPA-Health Services) Regulations, 2016 read with Annexure 11 Circular Ref: IRDAI/TPA/REG/CIR/130/06/2020 dated June 3, 2020.
Minimum Business Requirements:
Every TPA registered with the Authority shall comply with such minimum business norms towards health services for the insurers registered with the Authority as may be specified by the Authority from time to time and with effect from such date as may be specified therein.
Provided that the business carried out in respect of the services referred at Regulation 3(1)(c), (d), (e) and (f) of these Regulations shall not be reckoned towards the minimum business norms specified.
After reviewing the submission of the Anmol TPA and the responses submitted by the insurer who had a service level agreement with the Anmol TPA, the Authority is of the view that the Anmol TPA did not fulfil the Minimum Business Requirements during the FY 2022-23 and during April 01, 2023, till September 30, 2023.
Further, the Authority observed that the Anmol TPA fulfilled only the number of lives services but not the number to policies serviced resulting in violation of the Regulation 15 (C)(6)(b) of the IRDAI (TPA-Health Services) Regulations, 2016.
The Authority under Regulation 16(1)(f) read with Regulation 15(C) (6) (c) of the IRDAI (TPA-Health Services) Regulations, 2016, rejected the renewal application of the Anmol TPA with Registration No. 27 filed by Anmol TPA.
The Authority has directed the Anmol TPA to:
1. Remove the word Insurance TPA from the name of their Company.
2. Inform the insurers to take alternative steps and all such insurers who were having the Service Level Agreement with Anmol, shall immediately appoint another TPA as may be necessary to cater the policyholders served by the Anmol TPA.
3. Submit the data collected and the books, records or documents etc. relating to the TPA business carried on by it to the respective insurers.
4. Cooperate with insurance companies in preparing suitable arrangements to service policyholders in respect of whom the policies are in force.
5. Reconcile and close the accounts with concerned insurance companies and network providers, if any.
If the Anmol TPA feels aggrieved by this Order, an appeal may be preferred to the Securities Appellate Tribunal, Mumbai as per the provisions of Section 110 of the Insurance Act, 1938.
A copy of the Order is attached for your ready reference.
Source category: IRDAI
Attachments
- /2024/407_Order_in_the_matter_of_M_S_Anmol_Medicare_Insurance_TPA_Limited.pdf
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