Page 9 - Insurance Times October 2019

IRDAI penalized Policy- IRDAI, NHA suggest measures to ensure effective
bazaar with Rs. 1.11- healthcare by insurance

crore The IRDAI and National Health Authority have recently launched a collabora-
tive report suggesting best practices, common
IRDAI has recently levied a penalty standards, collaborative measures and IT
of Rs 1.11 framework for data standardisation and to
crore on check frauds. IRDAI and NHA has formed a joint
Policybazaar working group in order to work on key areas of
for failing to mutual interest and co-operation that focus on
comply with their work on four crucial areas, such as, Hospital Network Management, Data
regulations governing insurance
Standardization and exchange, Common IT infrastructure for health insurance
web aggregators. The Policybazaar is
claims management and Fraud and abuse control.
an online insurance aggregator. The
regulator has also issued warning for The experts in the report on Hospital Network Management, has recommended
violating the norms. building a national repository of empanelled hospitals under insurance/govern-
ment schemes with defined standards for quality and package rates and codes.
On October 7, 2016 and October 10, Meanwhile, the report on Data Standardization and Exchange emphasizes on
2016, the regulator had received a the creation of standard data formats all over health insurance payers for analy-
complaint with allegations that
sis and policy-making by developing standardised data tables to capture and
Policybazaar had floated an offer, titled
report the data, identifying data elements common with IRDAI and PMJAY.
‘Navratra Offer’, under which certain
monetary incentives in the guise of The suggestive measures also included setting up a framework for capturing
complementary benefits were being and exchanging data. The report on Fraud Control sheds light on in detecting
offered to prospective customers. and deterring frauds through common repository and capacity building by de-
veloping a standard reporting format for fraud and abuse to be used across
PSB merger drive: IRDAI the industry and government schemes.
initiates talks with insur- The report also suggests of creation of a repository of fraudulent transactions,
ance companies modus operandi and entities and develops standards for field verification and
investigation and developing the "name and shame" guidelines. The report on
The IRDAI has re- the Common IT Infrastructure for Health Insurance Claims Management throws
cently initiated light on increasing service efficiency and transparency amongst stakeholders
informal consul- in the delivery of Health insurance services by defining the roadmap for elec-
tations with in- tronic, paperless, codified data exchange between payer and provider, colla-
surance compa- tion and analysis.
nies whose shareholding structure is
in a fix after the merger of 10 pub- IRDAI warns Reliance Nippon Life for excessive expenses
lic sector banks into four, according
to the sources. The IRDAI has warned Reliance Nippon Life Insurance (RNLIC) for excessive
expenses; nearly Rs 600 crore above the prescribed limit, IRDAI’s July order
The insurance regulation does not reveals. The regulator only warned RNLIC since it observed that the expenses
allow an entity to promote more had not affected policy holders, the order further stated.
than one insurance company. The
mergers, however, have created a The regulator said that in seven years if RNLIC received two warnings, it would
problem as many of these banks are lead to an investigation and valuation of funds and expenses under applicable
promoters of insurance firms. provisions. IRDAI said that the company was asked to give an explanation as
the regulator had observed RNLIC has incurred management expenses to the
However IRDAI has not given any
time frame to banks to bring down tune of Rs 1,632 crore against the allowable limit of Rs 1,069 crore.
their stake in the insurance firms as It had observed that the insurer had been non-compliant with the expense on
the banks are yet to be formally management (EoM) limit in six out of eight years, between financial year 2008-
merged, said the official source. The 09 and 2015-16. IRDAI had further asked RNLIC to furnish a certificate from an
banks are to officially merge form “actuary of the insurer” with regard to the fact that its policy holders or their
April 1, 2020. interest were not impacted and there was compliance with product regulations.
The Insurance Times, October 2019 9