Page 40 - Life Insurance Today April 2018

IRDAI stalls TPAs move to Suspension of Certificate of Registration of E-Meditek
run PSU health schemes Insurance TPA Limited
The IRDAI had received a whistle ture that it is detrimental to the inter-
blower complaint dated 04.09.2017 ests of policy holders and the insurers
against E-Meditek and allowing E-
Insurance TPA Lim- Meditek to continue
ited (hereafter re- their activities as
ferred as E-Meditek TPA shall have ad-
IRDAI has rejected a proposal by TPA) under the pro- verse impact on the
TPA's to manage healthcare plans visions of Whistle policyholders and
for public sector companies without Blowers Protection insurers.
group insurance. This means that Act, 2011 alleging Therefore, the Authority after careful
companies will need to buy group misconduct, corruption, malpractice, consideration of the seriousness of
health insurance to avail the ser- money laundering and financial ir- violations observed and in exercise of
vices of TPAs. regularities committed by E-Meditek the powers vested with Authority in
TPA.
IRDAI had earlier said that TPAs can Regulation 16 (3) of IRDAI (TPA-Health
manage healthcare for state and Consequently, inspection of E-Meditek Services) Regulations, 2016, hereby
central governments in addition to TPA was carried out from 13.11.2017 suspends the certificate of registration
to 17.11.2017. of E-Meditek Insurance TPA Ltd with-
insurance companies. Recently,
ONGC had invited bids from TPAs to During the course of onsite inspection out notice. The Certificate of Regis-
manage a healthcare plan that the the following grave Irregularities are tration of E-Meditek Insurance TPA Ltd
energy major was providing as part reported; stands suspended with immediate ef-
of its employee benefits. The TPAs I. Irregularities in respect of Policy / fect till further orders.
then sought a clarification from the Claim servicing From the date of this order E-Meditek
regulator as there was a view that II. Irregularities in respect of Ac- TPA shall cease to do the business of
PSU undertakings can be seen as an counting Practices TPA, however, it may continue servic-
extension of the government. ing the existing health insurance poli-
III. Other Irregularities. cies based on the discretion and direc-
However, IRDAI, through a circular, The irregularities are found to be in tion of the respective insurers. No In-
clarified that PSUs do not come un-
violation of various provisions of IRDAI surer shall entrust servicing of new
der the ambit of the relaxation which (TPA - Health Services) Regulations, policies or servicing of new lives under
allows TPAs to provide healthcare 2016 as modified from time to time. the existing group schemes / policies
schemes 'promoted, sponsored or The violations observed in the inspec- to E-Meditek TPA. Securities appellate
approved by central government or tion of the Authority against the E- tribunal has put a stay on the IRDAI
any state government'. This relax- Meditek TPA are of such serious na- order as per latest development.
ation was provided four years ago to
enable states that provide health IRDAI asks Insurer's to transfer sum to Senior Citizens'
schemes under the assurance model
appoint administrators. Welfare Fund
IRDAI has asked all insurers to transfer the deposits of policyholders that have
Some corporate employers and
state-undertakings are reluctant to been laying unclaimed for over 10 years to the welfare fund. "All insurers hav-
take the insurance route as the 18% ing unclaimed amounts of policyholders for a period of more than 10 years as
paid on premium adds to the cost. on September 30, 2017 shall transfer the same to Senior Citizens' Welfare Fund
"Health insurance is not a cata- (SCWF) on or before March 1, 2018," the Insurance Regulatory and Develop-
ment Authority of India has said in a circular.
strophic risk and some employers
feel that what they need is only ad- The directive comes under the Department of Economic Affairs accounting proce-
ministration expertise that is avail- dure for transfer of funds to SCWF. An interest bearing account in the public fund
able with TPAs rather than risk man- of the government, SCWF has been set up for promoting welfare of senior citi-
agement, which is with insurance zens through schemes such as old age pensions, long term savings instruments,
companies," he added. promotion of health care and nutrition and affordable health care among others.

40 April 2018 Life Insurance Today