IRDAI, by Order No. IRDAI/F&I/ORD/MISC/110/8/2026 dated August 19, 2026, has rejected Niva Bupa Health Insurance Co Limited’s request for forbearance for exceeding Expenses of Management (EoM) limits for FY 2024-25. Against allowable expenses of Rs.2403.75 crore, the insurer incurred actual expenses of Rs.2652.12 crore, resulting in excess expenditure of Rs.248.37 crore. The insurer had sought forbearance citing business expansion initiatives, technology investments, brand transition, efforts to achieve scale, reduce costs and enhance customer centricity. IRDAI noted that the insurer had also exceeded EoM limits for FY 2023-24, for which forbearance had previously been granted. The Authority found that the insurer had not complied with the EoM limits specified under Regulations 6 read with Regulations 10, 11 and 19 of the IRDAI (Expenses of Management, including Commission of Insurers) Regulations, 2024. IRDAI accordingly warned the insurer and directed it not to open a new place of business for six months under Regulation 22(1)(b) and (c). The Order is also to be placed before the insurer’s Board, with minutes to be provided to IRDAI within 15 days of the meeting.
Insurance Regulatory and Development Authority of India
Order No. IRDAI/F&I/ORD/MISC/110/8/2026 | Date:19th August, 2026
Order of Insurance Regulatory and Development Authority of India in the matter of M/s Niva Bupa Health Insurance Co Limited
Based on the:
1. IRDAI letter reference No. 796/F&I(NL)/EoM/2024-25/43 dated 15th January, 2026 and letter no.823/F&I (NL)/EOM/Misc/2025-26/53 dated 27th January, 2026 issued to Niva Bupa Health Insurance Co Limited (hereinafter referred to as “the insurer”).
2. Response of insurer vide their letter dated 27th January, 2026.
3. Submissions during the personal hearing on 28th January, 2026 and submission of revised EoM return along with Board meeting resolution, vide email dated 6th February, 2026.
Background
4. The Insurance Regulatory & Development Authority of India (herein after referred to as “IRDAI” or as “the Authority”) granted Certificate of Registration No. 145 dated 15th February, 2010 to M/s Niva Bupa Health Insurance Co Ltd (herein after referred to as “the insurer”) to carry out health insurance business in India under Section 3 of the Insurance Act, 1938. In terms thereof, the Insurer was subject to the terms and conditions of the Certificate of Registration and was also required to abide by the provisions of the Insurance Act, 1938 (herein after referred to as the “Act”), the Insurance Regulatory and Development Authority Act, 1999, other directions issued by the Authority from time to time including by way of Regulations, Guidelines and /or Circulars.
5. The Authority on examination of revised Return on Expenses of Management (EoM) of the insurer for the financial year 2024-25 had noted that the actual expenses of the insurer exceeded the allowable expenses (EoM limits) by Rs.248.37 crore. It was also noted from the return that the excess was charged to Profit and Loss Account (Shareholders’ Account) as required under the Regulation 19 of IRDAI (Expenses of Management, including Commission, of Insurers) Regulations, 2024 (“EoM Regulations, 2024”).
6. The insurer had requested forbearance from the Authority for exceeding the EoM limits. In this regard, the Authority had received a recommendation from General Insurance (GI) Council vide letter dated 30th May, 2025 for consideration of the forbearance request of insurer submitted to GI Council vide letter dated 25th April, 2025.
Explanation sought, Reply and Personal Hearing
7. After examination of the EoM return and submissions made by the insurer, an explanation was sought vide letter dated 15th January, 2026 for non-compliance with the EoM limits for FY 2024-25 as specified under Regulation 19 of EoM Regulations, 2024.
“19. General or Health Insurer: Insurers carrying on General Insurance Business or Health Insurance Business shall ensure that its expenses of management are within the allowable limits on the overall basis. Where the General Insurer or Health Insurer has exceeded the limit of expenses of management, excess of such expenses shall be charged to Profit & Loss Account.”
8. The insurer submitted its reply vide letter dated 27th January, 2026 and requested for forbearance during the personal hearing held at IRDAI head office at Hyderabad on 28th January, 2026 and submitted revised return on EoM vide email dated 6th February, 2026.
9. The non-compliance set out in the letter dated 15th January, 2026, the insurer’s written reply dated 27th January, 2026, filing of revised EoM return vide email on 6th February, 2026 and submissions made during personal hearing on 28th January, 2026 has been duly reviewed.
Observations:
10. The total allowable expenses of management for the FY 2024-25 were Rs. 2403.75 crore. However, the company incurred actual expenses of Rs. 2652.12 crore, thus exceeding the EoM limits by Rs 248.37 crore. In this connection, the insurer was advised vide letter dated 15/01/2026 to explain, why its forbearance request is to be considered by the Authority and why appropriate proceedings should not be initiated under regulation 22 of IRDAI EoM Regulations, 2024.
Submission of the insurer:
11. The insurer requested the Authority to grant forbearance, taking into consideration its business expansion initiatives including expansion of its presence, investments in technology and brand transition and its efforts to achieve scale, leverage technology, reduce costs and enhanced customer centricity. The insurer stated that these initiatives enabled it to achieve faster year over year growth in gross written premium as compared to industry growth.
Decision of the Authority:
12. The Authority has carefully considered the material available on record, including the revised Return on Expenses of Management for FY 2024-25, the explanation furnished by the insurer vide its letter dated 27th January, 2026, the submissions made during the personal hearing held on 28th January, 2026, the insurer’s past compliance with the specified EoM limits and the circumstances cited by the insurer in support of its request for forbearance.
13. It is noted that the insurer exceeded the EoM limits in respect of FY 2023-24 and the Authority had granted forbearance as regards compliance with EoM Regulations 2023 for the financial year 2023-24, vide letter dated 27th December, 2024.
14. The insurer has again exceeded the EoM limits during FY 2024-25. Against the allowable expenses of Rs.2403.75 crore, the insurer incurred actual expenses of Rs.2652.12 crore, resulting in excess expenditure of Rs.248.37 crore. The insurer has not complied with the EoM limits specified at Regulation 6 read with Regulation 10, 11 & 19 of the EoM Regulations, 2024.
15. In view of the above facts and circumstances and after considering all the relevant material on record, the insurer’s request for forbearance for financial year 2024-25 has not been acceded.
16. The insurer is hereby warned for its failure to ensure compliance with the applicable EoM limits for the FY 2024-25 and is directed not to open new place of business for a period of six months from the date of this order under Reg. 22 (1) (b) and (c) of the EoM Regulations, 2024.
17. This Order shall be placed before the Board of the Insurer in the upcoming Board Meeting and the Insurer shall provide a copy of the minutes of the discussion within 15 days of meeting.
18. If the insurer is aggrieved by this Order, an appeal may be preferred to the Hon’ble Securities Appellate Tribunal in accordance with the provisions of Section 110 of the Insurance Act, 1938.
19. This Order is issued with the approval of the Authority.
Sd/-
(Rajay Kumar Sinha)
Member (F&I)
Place: Hyderabad
Date: 19th August, 2026
