Order No. IRDA/HLT/MISC/ORD/032/02/2012,

dated 2-2-2012

The health insurance segment of the insurance industry has been growing significantly. The IRDA has underpinned the growth of this market by registration of standalone health insurance companies, by nurturing the development of Third Party Administrators (TPAs) to enable a cashless system of claim settlement. It has also constituted Working Groups with major representatives such as FICCI and CII for suggesting measures to further improve the efficiency of the health insurance system in India. In the background of these developments, the IRDA is of the opinion that it is necessary to create a Forum for an effective dialogue between service providers (hospitals), the insurance companies, Third Party Administrators and the consumers in general, which body could perform a consultative role in order to enable the evolution of a regulatory structure which would better meet the needs of this growing sector taking into account the interests of all stakeholders.

2. The IRDA has approved the constitution of a Health Insurance Forum vide its Resolution No.69:5 dated 13th September, 2011. In furtherance of the above mentioned Resolution, the following order is issued under section 14(f) of the IRDA Act, 1999.

3. The Forum shall be constituted as follows:

I. CEOs of three insurance companies carrying on health insurance business in India from amongst the general insurance companies;

II. CEO’s of three life insurance companies offering health cover from amongst the life insurance companies;

III. One representative from standalone health insurance companies;

IV. One representative from Ministry of Health & Family Welfare;

V. One representative, from Directorate General (Law Welfare), Ministry of Labour & Employment dealing with RSBY;

VI. Chairman of NABH;

VII. Superintendents of two Government hospitals/or other representative as State or Central Government may decide, which have been providing services under Government sponsored schemes such as RSBY or other Schemes sponsored by State Governments;

VIII. CEO’s/Representatives of 12 service providers from amongst those which have been providing health services to insurance policyholders selected in such a manner as to cover general hospitals, specialty hospitals and nursing homes having regard to the geography of India;

IX. CEO’s of two Third Party Administrators;

X. The Chairmen of the Advisory Groups, if any, on Health Insurance of the CII and FICCI;

XI. One nominee of the IRDA representing consumers;

XII. ED/JD (Health) of IRDA;

4. The Member (Non-Life), IRDA shall be the Chairman of the Forum and Ms. Nimisha Srivastava, Senior Assistant Director, IRDA shall be the Convener and Member Secretary of the Forum.

5. The functions of the Health Insurance Forum shall be:

(i) to aid, advise and assist the IRDA in evolving regulations relating to health insurance business in India;

(ii) to facilitate the creation and adoption of standard processes and definitions in the insurance industry and in health insurance administration and in health services where applicable;

(iii) to aid, advise and assist the IRDA in collecting, maintaining and disseminating data required for the efficient conduct of health insurance business in India;

(iv) to act as a consultative forum as between insurance companies and other stakeholders;

(v) to aid, advise and assist the IRDA in developing regulations for rendering Health Insurance Forum more effective.

6. It is the intention of the IRDA to extend the membership of the Forum to cover, in an appropriate manner, all stakeholders relevant to the health insurance business and to enable this Forum to evolve into a self-regulatory organization. However, till such time as the architecture of the Forum is fully delineated, the IRDA shall nominate Members of the Forum in all categories mentioned in para 2 above, except those who are members by designation.

7. Till such time as the Forum evolves into a Self-Regulated Organisation with its own financial resources, the IRDA will meet the following expenses of the Forum:

(i) Travel and accommodation costs of Members of the Forum when attending meetings of the forum.

(ii) The cost of arranging a meeting including lunch and refreshments.

(iii) Secretarial expenses, if any.

8. The Forum is expected to meet at least twice a year and more often if deemed necessary by the Members

9. The members nominated to the Forum shall be in office for a period of two years from the date of their nomination.

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