Order in the matter of M_s_ Rothshield Insurance TPA Limited

IRDAI has issued an Order bearing reference no. IRDAI/HLT/ORD/MISC/203/09/2022 in the matter of M/s. Rothshield Insurance TPA Limited (Rothshield TPA or TPA), basis Show Cause Notice (SCN), submission of the TPA and personal hearing conducted in this matter.

Background

M/s. Rothshield TPA was granted certificate of registration (COR) No.030 on July 16, 2007. While applying for renewal of COR, the Authority observed that the TPA did not comply with the minimum business requirement as stipulated in Annexure-11 of Master Circular TPA, dated June 03, 2020 read with Regulation 14 and 15 of IRDAI (TPA-Health Services) Regulations, 2016 which prescribes the provisions pertaining to minimum business requirement applicable to TPA and renewal of certificate of registration respectively.

Charge

TPA did not comply with the minimum business requirements as prescribed by the Authority

Summary of submissions by TPA

• The TPA accepted that they were not able to meet the stipulated MBR for the 4 th (2019-20), 5 th (2020-21), and 6 th year (2021-2022).
• Sincere efforts were taken by TPA to sign SLA with insurance companies and continuous follow-up to gain business was done. However, the TPA couldn’t succeed to get the business.
• The TPA business performance was also affected majorly because of COVID-19 pandemic.
• The TPA also faced issues during Covid-19 such as manpower shortage, administrative and financial issues, etc. which resulted in its inability to meet the MBR.
• TPA has requested to consider a one-time exception and grant renewal of their license as the it has in place strategies to meet MBR in future and requested to renew the Certificate of Registration.

Decision of the Authority

The Authority did not appreciate the submissions of the TPA and consequently rejected its application for renewal of certificate of registration with following directions.

• TPA shall remove the word “Insurance TPA” from name of its Company.
• All insurers having TPA agreement with Rothshield TPA, if any, shall immediately take such alternative steps including appointment of another TPA, as may be necessary to continue to cater to the policy holders served by Rothshield TPA
• TPA shall immediately submit the data collected, the books, records or documents etc., relating to the TPA business carried on by it to respective insurers
• TPA shall cooperate with insurance companies in making suitable alternate arrangements to service the policy holders in respect of whom the policies are in force
• TPA shall, reconcile and close the accounts with concerned insurance companies and network providers, if any

An appeal to Securities Appellate Tribunal (SAT) may be preferred in case the TPA feels aggrieved by the decisions of this Order.

Source category: IRDAI

Attachments

• /2022/88_2022-09-27_Order_in_the_matter_of_M_s__Rothshield_Insurance_TPA_Limited.pdf