INSURANCE LAW PROJECT | HEALTH INSURANCE AND REGULATORY ISSUES UNDER IRDA ACT 1999 | Rudresh Pratap Singh Roll No. 49 Semester V RMLNLU |

Contents INTRODUCTION 4 The Insurance Regulatory and Development Authority 5 Regulatory issues in the health insurance business 5 It should be the duty of the regulator (IRDA) to ensure that the new entrant in the health insurance sector: 5 II. Regulations Pertaining To Consumer Protection 8 Relationship Between Insurers And Providers 9 Is A Health Insurance Policyholder A Consumer? 10 III. Regulations Pertaining To The Functioning Of Third Party Administrators 10 Operational Requirements 11 Other Requirements
200 crores, in case of a person carrying on exclusively the business as a re-insurer.

Maintains the Solvency Margin Limit, i.e., minimum lower bound of Rs. 50 crores for the solvency margin along with a requirement of 20 per cent of the net premium, or 30 of the average of the average of the net incurred claims in the three preceding years.

2. Operational Requirements

* Once the players’ starts operating in the health insurance market, it shall be the duty of the regulator (IRDA) to establish and evaluate the solvency status of the players by conducting periodic investigations and reviews. The regulator may conduct audits, ask for submissions of annual reports, appoint directors, take over management, or even shut down the operations of the insurance company through a court order in furtherance of it. * It shall also be the duty of the regulator (IRDA) concerned to ensure that the insurers of health do not undertake additional business that (1) involves speculation and (2) is not directly linked to insurance e.g., banking. This is to prevent insolvency law of one business to creep into the other.

* It is also the duty of the insurers to ensure that “reasonable” restrictions be imposed as regards the nature of investments that can be undertaken by an insurance company in India dealing in health insurance. The following provisions seem to be in conformity with the much desired objective:

1. Section 27-C of the IRDA