Irdai flags issues at 8 insurers over health master circular norms

Regulator begins phased inspections of health insurers; issues linked to claims settlement and compliance with the new Health Insurance Master Circular

As part of routine supervision, the Insurance Regulatory and Development Authority of India (Irdai) initiated inspections at some health insurance firms, and flagged concerns with some companies on implementation of certain regulatory norms in the new health insurance master circular, people aware of the development said.

 

According to a CNBC TV18 report, eight general insurance companies – New India Assurance, ICICI Lombard General Insurance, HDFC ERGO General Insurance, Tata AIG General Insurance, Star Health and Allied Insurance, Niva Bupa Health Insurance, Care Health Insurance, and ManipalCigna Health Insurance – were under the scanner for violations around claims settlement and implementation of the master circular.

 

The report said that violations detected by the regulator included improper implementation of the master circular, which could lead to enforcement actions. 

 

In response to a Business Standard query, New India Assurance said: “These inspections are not adversarial but are intended to promote stronger operational practices and compliance within the insurance sector. We wish to clarify that the Master Circular issued by the Irdai has been fully adopted by New India Assurance, both in principle and in practice.”

 

The company said during the course of the inspection, Irdai made a few procedural observations regarding the overly detailed Customer Information Sheet (CIS), which has since been simplified in line with the advice, inclusion of product management panel member on the Claims Review Committee, which has been put into effect, and timelines associated with portability data submission to Insurance Information Bureau (IIB), for which appropriate systems and protocols are now in place.

 

The statement added, “All necessary corrective measures have been taken, and our compliance has been duly communicated to the Regulator. At New India Assurance, we uphold the highest standards of customer service. Our claims process is designed to be fair and responsive, supported by a structured grievance redressal mechanism to resolve any concerns raised by policyholders.”

 

Similarly, ICICI Lombard’s spokesperson said, “In order to review the implementation of health prescriptions, Irdai had initiated inspection of all insurers in a phase-wise manner, as part of its regulatory supervision and oversight. Accordingly, regulatory inspections were initiated for eight general and health insurance companies as part of the initial phase. The inspection report was shared with the insurance companies. The observations mainly related to industry-wide challenges in implementing the new prescriptions."

 

“The company had submitted its response to the inspection report, in keeping with our endeavour and spirit of upholding the regulatory prescriptions. At ICICI Lombard and as an industry leader, we follow high standards of regulatory compliance and corporate governance in all our operations,” the spokesperson added.

 

Queries sent to the remaining insurance companies remained unanswered till the time of going to the press.