INSURANCE REGULATORY AND

DEVELOPMENT AUTHORITY OF INDIA

CIRCULAR

Ref. No. IRDA/HLT/CIR/CSC/097/05/2017

03rd May, 2017

To

All the General and Health Insurers,

Re: Offering Existing Health Insurance Products that are in Compliance with  IRDAI (Insurance Services by Common Service Centers) Regulations, 2015 as  CSC Insurance Products, for distribution through Common Service Centers JCSC)

1. Reference is invited to Regulation 13.1 of IRDAI (Insurance Services by Common Service Centers) Regulations, 2015 (hereafter referred as CSC Regulations, 2015) which specifies that every insurer shall develop insurance products to be marketed exclusively through the CSC model and file such products with the Authority for approval. Reference is also invited to Regulation 13.2 that specifies the sum assured limits for products allowed under CSC model and Clause (2) of Schedule — Ill of CSC Regulations, 2015 that specifies the types, procedures and conditions in respect of General Insurance Products allowed under CSC model.

2. Reference is invited to Clause (d) of Schedule V of CSC Regulations, 2015 that specifies that insurers shall develop simple insurance products, which are easy to understand by RAPs, rural customers and other lower income segments. Clause (g) of Schedule V of the same regulation specifies that insurers shall develop suitable systems to ensure continued insurance protection and servicing to the targeted market segment.

3. In compliance to the norms specified in the above referred Regulations, it is clarified that Insurers are permitted to adopt the existing Health Insurance Products that meet Sum Assured limits specified in Regulation 13 (2) and the terms and conditions specified in Schedule — Ill of CSC Regulations, 2015 as CSC Insurance Products for distribution through Common Service Centers (CSC) by complying with the following conditions.

i) Insurers at their discretion may offer the existing Health Insurance Products that comply with the product parameters specified in CSC Regulations, 2015 as Health CSC Insurance Products.

ii) Where existing Health Insurance Products comply with the product parameters specified in CSC Regulations, 2015, on the basis of a certificate to that effect filed in the format prescribed at Annexure — I, the Insurers are permitted to offer such existing Health Insurance products as CSC Health Insurance Products by prefixing the word CSC to clearly distinguish the product as CSC product.

iii) In order to determine the compliance with norms specified CSC Regulations, 2015 specifically at Clause (g) of Schedule – V of the Regulations, the Insurers shall place the proposed CSC product along with the systems in place to service customers in the Product Management Committee in accordance to Clause (2) of Chapter II of Guidelines on Product Filing in Health Insurance Business dated 29th July, 2016. The PMC apart from the norms already specified in the within referred guidelines shall also examine the following before sign off:

a) The suitability of the product to the targeted market segment in the CSC model.

b) The availability of Network Providers to offer cashless services in order to comply with Regulation (30) of IRDAI (Health Insurance) Regulations, 2016 (HIR, 2016).

c) Adequacy of systems in place in order to comply with Regulation 26 of HIR, 2016 to render policy services to the targeted policyholders.

4. The Authority, on recording the proposal of the Insurers, may allow the Insurers to offer the existing Health Insurance Products as Health CSC Insurance Product by suitably allotting a different UIN.

5. On examining the product submitted in accordance to this Circular, the Authority reserves the right to direct the Insurer to file the product afresh in accordance to the provisions of CSC Regulations, 2015 and other applicable regulations or guidelines relating to Health Insurance Products.

6. There shall be no changes of any nature to the existing Health Insurance Product. Where any changes are necessitated in order to offer the product as Health CSC Insurance Products, such products shall be separately filed in accordance to the provisions of CSC Regulations, 2015.

7. The above procedure is applicable only in respect of those existing Health Insurance products that otherwise fulfil the norms specified in Regulation 13 and Schedule – Ill of CSC Regulations. 2015 subject to the conditions specified herein. It is clarified that CSC Health Insurance Products filed as per this circular shall also comply with CSC Regulations, 2015.

This Circular is issued by the Authority under the powers vested in Chapter IV, Regulation 20 of CSC Regulations, 2015.

ANNEXURE – I

Certificate

(Separate Certificate is to be filed for every existing Health Insurance Product
proposed to be offered as CSC Health Insurance Product)

Date:___________

The following existing approved Health Insurance product is proposed to be offered as a CSC Health Insurance Product. It is certified that the product proposed is totally compliant with the product parameters specified in Regulation 13 and Schedule and Schedule V of IRDAI (Insurance Services by Common Service Centers) Regulations 2015 (hereafter referred as CSC Regulations, 2015). Further, it is certified that the product is in compliance with other provisions of the CSC Regulations, 2015 and that no modifications are effected relating to benefits offered, premium bases, loadings levied or discounts offered in the product.

TABLE – I

Sr. No (1)

 

Name of the  Existing Product (2)

 

Risks covered (Health, Personal Accident etc.) (Please check norms  specified at Clause (2) of Schedule – lll) (3)

 

UIN, if any

(4)

 

Datel/ear of filing for earlier  approval (including  deemed approval) with the Authority (5)

 

Proposed Name of the CSC Health lnsurance Product

(6)

 

Remarks*

(7)

 

* where any of the information sought in any of columns above is not available/ can not be provided, please furnish the reasons substantiating the same.

i) It is certified that the above product is placed before Product Management Committee of the company on dd/mm/yyyy (specify date).

ii) The suitability of the product to offer through CSC Channel, systems in place to service the customers are examined. It is clarified that the product is in compliance with Schedule – V of CSC Regulations, 2015 and that the following systems are in place to render the requisite services to targeted market segment.

(Specify the systems in place to service the claims and grievances)

iii) It is further certified that on being offered as CSC Insurance Product, the product will continue to be financially viable.

We also certify that on approval, the proposed CSC Health Insurance Product (mention the name of the proposed CSC Insurance Product) would be offered by complying with all the norms relating to distribution and other relevant parameters specified in CSC Regulations, 2015.

Chief Compliance Officer

Appointed Actuary

MD&CEO/CMD

With office Seal

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