Page 131 - IC23 life insurance application

28 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC. 4]

INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY OF INDIA

NOTIFICATION

Hyderabad, the 12thJuly, 2016
Insurance Regulatory and Development Authority of India

(Health Insurance) Regulations, 2016
F. No. IRDAI/Reg/17/129/2016.—In exercise of the powers conferred under Section 114A of the
Insurance Act, 1938 and Section 14 read with Section 26 of the IRDA Act, 1999 and in consultation with the
Insurance Advisory Committee, the Authority hereby makes the following regulations, namely:-
CHAPTER I : GENERAL

1. Short title and commencement.
a. These Regulations may be called Insurance Regulatory and Development Authority of India (Health
Insurance) Regulations, 2016.

b. They shall come into force from the date of their publication in the official Gazette of the Government
of India.

c. Unless otherwise provided by these Regulations, nothing in these Regulations shall deem to invalidate
the Health insurance contracts entered into prior to these Regulations coming into force.

d. Unless otherwise mentioned herein, these Regulations are applicable to all registered Life Insurers,
General Insurers and Health insurers, conducting health insurance business, as defined under the Act.
These Regulations shall also be applicable to all TPAs wherever mentioned.

2. Definitions. (i) In these Regulations, unless the context otherwise requires,--
a. “Act” means the Insurance Act 1938.

b. "Health Services Agreement" means an agreement as defined in IRDAI (Third Party Administrators -
Health Services) Regulations, 2016.
c. “Authority” means the Insurance Regulatory and Development Authority of India established under
sub section 1 of section 3 of the IRDA Act 1999.

d. “AYUSH Treatment” refers to the medical and / or hospitalization treatments given under
‘Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems.

e. “Break in policy” means the period of gap that occurs at the end of the existing policy term, when
the premium due for renewal on a given policy is not paid on or before the premium renewal date or
within 30 days thereof.
f. “Cashless facility” means a facility extended by the insurer or TPA on behalf of the insurer to the
insured, where the payments for the costs of treatment undergone by the insured in accordance with
the policy terms and conditions, are directly made to the network provider by the insurer to the
extent pre-authorization is approved.
g. “Product Filing Guidelines” mean the Guidelines specified by the Authority on the procedure to be
followed by insurers before marketing or offering a product falling under Health Insurance Business.

h. “Health insurance business” means Health insurance business as defined under Section 2(6C) of the
Act.

i. "Health Services by TPA" means the services specified in Regulation (3) of IRDAI (Third Party
Administrators - Health Services) Regulations, 2016.

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