IRDA (Health Insurance) Regulations, 2013

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T f^ ^ o ^°-33004/99 REGD. NO. D. L.-33004/99 SlKcl ^ < l3 iW (Lhz (Baxette of ^ndia 3 W r a T T t T T EXTRAORDINARY STFTIII— 4 PART III—Section 4 Mll^MchK V4cf>lIVtH PUBLISHED BY AUTHORITY fr. 491 No. 49) 18, 20I3/HIM 29, 1934 NEW DELHI, MONDAY, FEBRUARY 18, 2013/MAGHA 29, 1934 s f t a r f c t r T ^ m ^ s t Tt f e f r r a y T f ^ n r r 1 6 W R t , 2 0 1 3 ^ c t t f a r f w i T ^ a f r c f e r n p r f e r o r ( ^ t a r ) M w ? , 2 0 1 3 TF T . I T . ' ^ t . ' f e . f ^ . 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RIHllii ~ 'fi'lft <11$~fi ~ ~ ~t91chl'<l TR- >J11q-1 ((ii-jlchl-ii 3iT'x ~~ ~li-llchl~l ~ ~ ITT \iIT 'Bmf 1l ~ FclPl<1lil cfi ™ ~ 1lr,T cpl ell cl f1 Ill fi=q I f8 a cITT" ~ ~ I 2. ~ ; ~ ~Pill'-if if -~ ~ ~ wJit ~ - a) ·~ cpl 3l~ ~ ~ 1938 t I b) ·~· cpl 3l~ t - \Ff ~ ~ ~ ~ t I vlT Fcnffi itlTI" ~ cf> ~ ql~f?l cfi ~ 'cf>T ~«Jd ctr ~ 'ITT I ?) 3lj~£r P!i:;.ifc.if&a cfi ffl mmt I 660 GI/2013 (I) 2 THE GAZETTE OF INDIA : EXTRAORDINARY [ P a r t III— S e c. 4 ] i. ftfr^T z d (TPA) 3fR #TT cPRft cfr #cT ; 3T2RT. ii. ^dc|^r TT^TrTT (f^R?t SfWTTef) sfR cfM t Wt 8^1 RRRcf? cFT ?TTfteT c fR R R F t ft t I iii. f^Rft 3R q?TTcT/M M cf^R cTSTT f ^ T # R W f t $ f^RT^ TPA ^ cRfal tffff (s ^ R ^ f) c fr ^q- if F t R W T 11 C) 'R ^ R R R ' ^ RRbtf, # R fcrf^RRcf) ^ fcR>RT R ^ c fR R ^ t f^RT 3TT^.3TR. StM ^ R , 1999 c£t ETRT 3 3fK ^T-£IRT 1 cfr cf^cT T-ejlftR faRT W err I ;' d) ^ xfrfeRfr cfcfHR R ^ f # C^J zA W F tf TR Fftft t vrTerfcJ?, f ^ t lirfc R fl <& ^TcitcRUT ^ fe R tfrfa R T ^ faElfftcr R ^ cfTt R ^ J R t *TFoT R 3 R ^ 30 f^T, f^ ft % ^frcR *RT W Ft I e) ^ R ' 3TsrfcT T&) # R W R 5 R I ^ R T R W R f ^ 3 F ^fc|R f^RTcfr 3TcPicr efRT R W gRT # M t cf5t ^Tcff *R R R n j R r ^ t r ? CUT RRT ^ K T R fR T ^ R £RT ^ RfoqxT 3I^ ik H $ R M ^ ^ R c R > R R R R t RY f^JT R TR t I I f) 'RH?cT cf 7JR y % R ' RT R R tf ^3R ITfsfRT ^ t , f^RfRT R e R fR T R R 3R^t y|RlcfRU| ^ jf t f^TT f ^ f f / ' q t e f $ 3^ fT R W I f R l ^3RR 3 R T f te ^ R^TT t I ' g) '^RR<R sTRT cZTcHFM (f^vjf^fT)' 3TSRT 'tc R R R T RT 3T&} \R # R 3RpfSTt eft W 3 R | R c1I ^ t ftRR^ ctFcT M ^RTT eTR R ^ c h e i, Rf^ReT 3TOR 31^ cl Id RT CZR 3TTf^ cfTT cTR, f^RT^ ^ P # R T cTR 3fR cff^RlfelR tWHeT, R R #TT cMT czrf^RcT 3nf^ >H-Hlfclc<i (c{h r ) fchk* vriici ^ I h) ^ R t w m ^rcrT^' sTs^tfr €r.-^r.^. ^r t w w m czttitr ^r 3 ^ £ f STcPfH ^ R R cf?r ^ ^cfT^ f^RT^f #TT w f t cPT feRRRT 3faRT TTc2Tar ^TT 3R?^aT W ^ j fR T ^cR TR cf?r ^ jta fcT T ^tt ^ fr^ t 3RciWfcr ^rrf^RT ^ Ftcft i i ) ' ^ R R € 2 T c T& TT ^ f t c R T 3 R R ' 3 T g r fc T ^ W I R v j f t ^ ^ R # R T W f t cfjy ^ c r t o uftcR ^ r t cfxR ^ ^ tst ^ k-^ ffcR 3fR itt / ^ 3 T c # T W R22f efRr c f^ M r cf>T s R R « l 6^ r t T t 3 TR R t I j) '^cfc?§ JTR R ' 3TSftcT ^ 3 R tR M 3TSTR ^RRW? I W R ^RT R R T t 3fR t fR R R c f# cfTt, Pt^je^ ^fcRT 3 IR R ^R 3 R ^ H FT f^rf^KRT ■gf^R vJHel&T cfr^cncT ^ I k) 'tft€WeT€t' - fR T cfRc||^f cn^ f$ y$ \ fR T R W ^ (^ fM t cf^cR RflcT) 3 R R f^RT W cfF 3 f t o R F tR f ftR F t 1% ? R t cTSTT 2 THE GAZETTE OF INDIA : EXTRAdRDINARY . [PART Ill- SEC. 4] i. ~ ~· 'lreT ~<ll~ct> (TPA) 3lTx fcITTfi" ~ ~ cfi ~il" ; 31"~- · ii. ~ccl45 ~ (~ 3H-lk11c1) 3lTx #r=fr ~ "G'fT ~ ~ ~ lHllfl¢ ~ ~ll~c1 ™ "ilTITTlT % I iii. ~ 3H-GC11c1/m-ezr ~TI~~~~ cfi ffi" ~ TPA ~ ~ -qa, (~ llrel) cfi ~ ll <11Mc1 mm% 1 c} ·~· ~ ~. ~ RIPllll'-1¢ ~ Rl¢1fl ~™ ~ % ~ ~.3ITT". ~-'1"- ~. 1999 ~ mxr 3 3lTx '3"1T-mxT 1 cfi ('fITTf x~ fcom ~ QTTI , d} _'."icn ~ cTTfc.1-tfr clct'-111 q1fc;tx-11 q?"f c4 ~ ~ ~ mcfr % ~. ~ q1fc.t-ttl cfi 1cl7¢x 01 cf> ~ ~ ~~ll'-t ffi ~ f.mtfur ~ ~ ITT ~ ~ ITT ~ 30 fz.:r, ~ cfi ~ ~ rf +·WT 7f<TT -m I e} ·t; <J c,q, xffclm' 31"~ ~ 41'-t 1 ¢1-< &RT ~ cm- cft 7m cIB xffcitTI fGl fl cB ~ ~ 'cfRq) &RT q1fc;tx-11 cf~T ~ "CR ¢-<ell~ ~ '34illx Q)f "fl"RT :fTTIA ql'-11¢1-< &m ~ ~ ~11s11c::1 cfi ~ ~ ~c:cJc6 ,~ cm- cITT" ~ '1ffm % I f) ·~ cT ~ ~ Rh ll I' q?"f ~ '3"fl" >ITTPm ~ t fG1 fl¢ 1 "4T&Jrf 41 '-t 1 ¢ 1 x m qITT)-cpx□T &Rf uITTl ~ ~ /~ cf> 3fjflTT ~ 6TTlTT ~ ~jJ..J'1c::1 -gg cfRffi % I 1 g) 'x-<fR-ezf m,:fT ell cl fl Ill (f~ ,JI·~ ~:l )' 31"~ '-g-~ cITTR' q?"f 31"~ '-Y7 ~ ~tlf c~ w:rfqcf)lfulT ~ % fuiflc6 cfITT1 ~fchi:fll "&1"Pl ITT ~hs¢c1, flf0i¢c1 31"~ ~'{-Ge11c1 q?"f an:r m q?"f "&l"Pl, ~ '{jPi~ila ~ 3lTx <fltl¢1f~1¢ ~. ~ ~ TIQTT cllfch'Plci ~Qc.-JI m fl'-tlfcltc (cITTR) fcpq" '3'fffi ~ I h) ·tr.-cfr.\/". &m 1-1c::-n ~ ~· 31"~ tl.-cfr.\/". &m ~ m-ezr ~1~1 "cllT4N "fr ~ ~cr m- ~~~7m~~ ~ ~~cpf ~\il.-lfl 31"~ ~a, ITT ~a, ~ ~ m-ezr ~ cllclfllll 31"~ fcr>m ~ ~ fq1¢14a1 ITT ~ ~{cilcttRl ~ll~c1 ~ m~ I i) '~ TIQTT ~ tJq'1U1¢ ~· 3fmcf ~ ~ \iff ~ ~ ~ ~ Q)f ~ ~ ~ ~ q5cR cfi "fl"Tl2l fcnffi ~-~ miTT 3lTx ITT / ~3wfR x-<TR-ezf mlTT cf>4 PJ lll cf>T x-<TR-ezr ~ ~ ~ ~ 3TT"CITT" cfRTI t1 j} '~ccl45 ~· 31"~ ~ 3N-Gcilc1 31"~ ~ ~ ~ q"l'-11¢1"< &RT ~T-11~~ ~ '1f@T % 3lJx ~ ffl ~ cm-, Pl~C'¢ xjFclm ct, 3ITclR 1R 3l1R W ~fchi:fll xjFclm \i4c1~ ¢-<cllci ~ I k) '41 i!~ f&1 e'l" - '(<l i ~ ~ ¢-< cl I~ cTTR fcnm ~ cl>l" (ll5 ~ c1"1 q5cR ~) >RR fcpm 7f<TT cIB ~ mw % ~ fcn- ~-f;r'clirn, wm oQTT • .. 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(st^ xn^f M3IM3> -^ T R «T #TT^) f ^ m 2001 ^ cfW m t o ^ T SRT oITf#fT f^TT W Ft 3 fk f M t #TT cfjtpfr ^ ^ecfj 3TSTcrr q i f M ^ WT-62T STCFT cf>^ P rg w Ft i n) w ft ^Kt 3TSTc|T 3Tftczrf^T3# -C& ^ f^R P T f if qf^TTftcT ^ i \ f^TT W t erfccf? eJWr 1938 3TSTCTT ftHT ftf^ T T W cTSTT t o m 3 T f^ R R 1999 ^ cT^cT 3T2jf ?# ?T q f t ^ c l f ^ T W t I 3. q u f r ^ T cTSTT W W -c Z T N N cjjj ^FRT (W fa ) a) ^RW T sfrrfi ^ T f ^ T T W TJcf t o R T IT T to ^ r fc tP m 2001 cfr 3TcFfcT ^ M u fl^ Ft I b ) " u f f c F T ^ T T c ^ q p | 4 | 4 l 4 0 l ! e l c b M W v i c ^ K 3 T F ^ c f> ? ^ C Tc F n ft i? 4 ^ ^ F t ^ T R t ^ iftf^ m cft^T m \ cf> W fcfr sejtcfj c£t 3Tcf^t clcj> ^qRc|R^c1 dcM^I'd d W m cpt g^^ftf&cT ^icR iicfpd l^ K ^RTtER f^ IT vfTT ^TWT 11 c) ^ ^ftcpr ctstt w i f r effrr cbMpi^n ^ cTstt st^ c r cft^r ^ 3?criit $ czrf^mn 3 tf? r ^ ^ ? f r t - if t# m if cbl4c^feT cTcp cpt^ iRW cr Ft I d ) ^ 1 ^ 0 W R S 2 T # f T T M l f c l R l ' i i l f c h ' i f l ^ ^ H T T c f ^ f t g | K I 3 T F f v ? cf^T u T T 'M c u o l | f — e r ? ^ ^ f t ^ F t w t k 0 c i c i ^ c f> c i ^ c ^ ^ c ! f i 0 ^ u | a i ^ e r c ^ ^ r F t I % - ^ f t c R c T S fT T ^ w f t W « z f f P W R , W ^ f % c f ) c z r f ^ T c T ' ^ ^ 1 ^ 3 F T R 3fTW cf^ ^ c f t t ^ cf^ ^ cfTff 3Tc# c^ fe R # ^TT ffc $ \ f^t% ^ ‘E J ^ cf>t cbq^\J| yc^M cfr^ft I e) srsTcrr ^Wpti^ c^crcT ^ vftcR ctstt ^ w f t ^K-ezr 4,'mM etrt f t w rtf^m cA t ^tt eft ^ T f r zrt^RT 3 ^ ^ f ^ ? f f ■h I v j ^ i ^ r t v iT ^ r r c ^ w i % 6 ^ f % ^ f r c f > r i l W m m f ^ m ^RT cT 'JJvff T#^1T ^ clFcT ST^'tl^ff t o T W Ft I M " -1!' 15 iS i 1¥ ~ ~ ,ti(, [ I io i. ~ ,ti(, 'I& l lno} ~ ~ I f J I i t.& ';; ~ t 15· ~ -rt ~ r& 15 'Ir i ~ -1& ~ i o; i 1 I ~ - ~ 11, ~ i fj; i l ~ ~ f J.i ~ - ~ l ~ - ~ f i ~ "" f ~ f 15 [ 1 'I& iS t,'fi; 11; 1o [ 1 'fi; 1& !'.' ij I>' ~ ! ~ ~ fj; ~ ~ ~ I t ~ fl ~ & ~ f & ~ lt& ,~ i fi» % I"' I 15 ~,i ~ 1 ~ ti;' Fi' j1c}j ~!~ ,iiti 'lrj1 ~ i! ,i 'I& i ~ _ i It! ~ ! ;~ ! -, Wf ~i 'tic- j ~i f,W !i-!11£ ·t ~11& t ~ !ft~! i~i it! ~l ~~ ~d;i'!j L =1s ~ i xi~ 1'5'ff g ~:,; 1 Ii, !~ rli 'Fi' ~ ~ I.:-~~ 'J;y'!& ~ r. -; 's- 7§' Fi' i t -1& ~ J[ I& '1io [ I ~ : i i I l ,i i ; '~ & iS I ~ Si 'g I ! 0 i i ,tr -~ ~ f ~ fi, 1 g i I ~ ~ ~ ~ t ~ - ~ 1 ; 15 le~~ & ~;1&~1 ~11:. ~i f!' ,i~g~ ' ~i15:.~~ - ~ IF:,; -~- - ~ec tf %~ ~ ~ ~ 1£ '§:i,;1sif1it-~~1& P' I j ·; I % % ~ i 'fi; f ~ ~ i ~ ,~ ·r ~ '"' i ~ iS ~ i t i 1 ~ * i ~ ~ f """'~ 1¥ ~:~'i i i i!!_i,I& i~'lr &~i~jfti[ ~ ~iii,t~ i,no iii~ j li-~il l~1li~•r,i-1& Wilt ~ -E . - - - - - - - 1 :::::- c: ni ro ..o u "'O a, ; ._, • • • ,I • --...,_ 4 THE GAZETTE OF INDIA : EXTRAORDINARY [P art III— S ec. 4] 4 . 4 t v J F T I 3 r f <J> f e R x j? T ^ c T c f ^ u \ s b H \ - a) f W r W ?ezr efftT 4)viHT cpt «ft*fT<JJR ^ ?T^ M^lRa ^ f^ IT ^ ^6[ cfcf> v3Tf £ R T tpj^ef cf ?£3T yfsfrilf c£ 3 i^ K W <f ^ ' fSTT FT I b ) f c f R f t 3 R p T t f c c T ^ I R - W T e ft r T T i f W ^ T S T J c f c f f T p f t e T T 3 T 8 T c f T ^ ? T t £ H cf> f c P ? W f - W ( *R ^3TTft ^P? f^ T T f^ T^ ft cf> 3T^RTR cj? eft 3TTcf^[cfKTT Fttft 11 i. mf^fcp^T sTRT STJRtf^T f M \ ITF5HT c£t ^ ta T T 3McrT ^RTteFf c£ ^ ^ -- vWctfl W eft cTT&W ^ cf>JT ^ cfTTT # T *T ^ t WeT ^fR^ITT *TffcR?t cf>t i *t ^ g^rfraFT M * r ^ T ^ 3 ef^tcTfr ^ 3FEf2JT qRcicf^ cFR^ cf5T ^Frgf^TcT cPR^T ^ifcfT ^TFTT ^[1%^ I ii. ^ rf^ c r f^icRf&icf>T 3 tfffM r ^ w t ^ ^nfra m cr h stt c£t v j| M 0 | 'T | 9 c f ) f ^ ? 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I vJ^T ^TTWlfr 3 ^ftvjRTT cf>T tj?t «zfhfT, ^Tfef cf ^vif jrfjfclT c& cTFcT R)cRfacf>r cfft arjHtf^cT wfrmt, TR^M w f , ■^tffeRfr ITet^ CT9TT tftf^RR ^ ^ - ^cfT Cf^ cTSTT M l ^ #T T I d) ^TFTf^T ^ f^RTcT <}>l4 i. Sffaf^FT 1938 c£f ETRT 39 cfr 3TJffR w f t W fW I effaT ^T5HT3ft cf>t SRrTTcT 3cT ^FRT, ^IHTcpH Mv^c^d chx!cfF1T I ii. TcfRwr effrfj ii'ivji-iisrt cpj cj^ ift sRrnpFfc WTcr ^r ^nft cfRcn f^> 1 <d\H0l 0 c|^vj1 g3TTcTv^ *R 3TTtJlRcl % ^TT e}T*T ^R I ^FfT Ft^ ^R uftcH WI'CT >FRltvjH '#3RT3Tt cf>t efaT 3Tf^R m 1938 cj?f STRT 38 c£ 3T^FfR f t ^nft f^TT ^11^ I e) JT^T ^ f ^ R T 3TT5 i. fctf^m J cfr 3#^c{tT 3F?I ejfar ^5H T3# 3 WTT^JcT: 65 ^ 31Tg cTcp 3TT5 y|c)t|H % I ii. Tm\ fm\ ifrvjurSf crsrr f ^ m j ^ 4 (d) ^ ^RiRcw irf^ ^ ^ r f^Rft tfrfeRft cf?T M^|c| ^cffc^T FtcfR ^fffeRft vTT^t cfR ^f vTRft cT&TT eTR fejHI f ^ r f a $ w r ^ H ^ c i cfRcn^ ^ncft t eft, ^rfcr^T % $ \ « ttw 3TT5 3TTETR ^R ^ f t cfR^ % ^ r ? 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I m ) W ^ f/ "E T tW ^ - i. fcff^TT cf> ^RET 3 #RT ^fffcRft ^ STf^cTRf ^ PfHfolfefT l|t H R ^THTf^T FT, 1. Mffel# <J> H<ftch^u| cj5t W f\ cfJT 2. 3TTg cf> 3TJfTN cbcf^vrf T^cf cf^T 3. cjft 3 * ^ 5 ^ 3TTg cfj? U cb C H / ^ 4luHI ^ 3TFJ erf ju s n ftc r t <tT s m ^ v h ts # g>r w r w i w ^en i 4. q fe 'tft XTcp f^EfcT 3TJT^r c£ ^RTcT cf>cR cf> 3 € < tf\d i 3T2TcJT ^ Rf^trcl 3TT5 cfr WK ^TFef ^ ip f \ cft c ^ u f cfcp '^Tlf^cT ^ T T I 5. cpn Hcjtcf^q W m cf?T TTT^t t 3TSTCTT ^T^TaT^ ^ 3TMN I 6. fclf^lfce tff^R -srfM cf>T fcfcRTiT vJTFT efTTOR ^RT cf5T ’TR vjTT 'Mchcll % (3T8Tc]T f^WTvTS cf§t 'dHll^l) 3fR Rhtl F ? cR j WzjT vj||^j H | 7. fTRj TT% 3TSTcfT cbcl^vjf c^ cpt eRTP^ cf?T Vlfsm TJcT ?T^, HR ^ t ; 8. f^cfTRfr. f^ flcR T IT f M M ?T2TT 9. f^PraHt, f^ n f^ w ff, qRq^i srrf^ c^ 3 F ^ m ^ R§iiqnt ctstt MchcH cf?t ^|c|^i|0dl I jj. TTlW3Tt cfTt c^cTeT M P ^ 'HFT ^ W R a fk ^ wfcRfT 5TeRsT r f fe T ^ t o T viTFJ I WfTcT ^ TfFTcp ^ ftW ^ PlHl^'FlK F'Rff — 1. 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THE GAZETTE OF INDIA : EXTRAORDINARY [PAkr III— S e c . 4 ] 3. / eFT 3TFt W tft ^ t 3T^TTcf TR^cT cfR^t c£ .ifR TRcJ c fM t gRT viftfero 'fcD^frr cPT 3JRT Ft^t ^ W et, ft ftc T /g ^ lf tc l otrfcm $ WTRT WRM 3TSTcn cZfcRTRT 3 ITcPR ^PT ^cR^T ^ t - TR vJ>tfc£| ^JJEPTT lelRsid "^T ^ vTTXpff I 4. ^t/F^T ^ R T cfRcT t cTSTT cfMT <pt 3T^fr W tfcT 3ct t % ^ #^/3R?TTf^cT cqf^T cfr W T A W f^RT 3RqmeT 3 FeTM WTT t ^ fuRT -5I<+C'i! ^ vd'Mc^l ^eTTvf Rh^ll f> 'cFRt, W R^J >He)?5Y vTHcpT^f Wiki cJR f in W c T/lJW rf^ T $ *frfcTcp HT *IH f^ P WR®3 ^Pt WfcJcT c f ^ cTTeT fcpq^Tt $ W T ^ ^ ^fT cR^TH f^ftcfcTT ^ ^ R T 3TRT CfR t afR f^ ffr efRT cfM t ^ W '{JERIT OTRT 3R t ^TFT f^Rfr <ftftcT/3ReTI%T czrf^T e fT^ *R viftRsIH 3Tcf5R, 3?t cfr ^ 3 T T to t o T W 11 5. ^ / f^ t cptpfr cpt w w ?Rsft a rf^ r^ t ^rfer ^ tr ^ c t '{ ^ ’il^, <^c|cH y ^ |c | cpT uftf^sFf 3TcfR cT^fT/ ?JT c;|c) c£ ^ Jld H cfr cfSJT fM \ tfT ^RcPTfT cTsn/^T f t M r W ^ ^ R cfR^ cpf 3T^lcj7d 3Rct |f | n) ' ^ I ' ^ j «frTT ^ftvFITSff cTFcT HHcp qf^TTWT — i. 3 >WgfK\ m w w TTcr ^PT '^Rcp trf^TM3Tf' 3 M R cT 3T4 #?TT I f ^ ^ W -^ F R T TR mf^cfR^ £[RT t o T ^TcTT 11 o) ^ f^ R /^ r fe e f ^ f f f TfPT^ eRTT y f ^ lC ' - '^feeT TTfT ^cf^3T' ^ ^ ^RT TR q^lf^cl ^teft t I p) 3RqmcT -^3fT^3TT Mlfeif^ifl A ^TTf^Tef ^T f^ r ufFT ^ cZRf ; ^FTcfJ ; i. 3T^TcTTef ^aTTWT Ml fa fail) ^ WfT^IcT: ITTte ^ T ^RT W l - W i ^R f^ jiR d cj?t ^llRlel Ftcft I ii. ■RfR ^ W R ^RT 3Rq?fTcr A ^frft WW cfj^ cZR ^ cj?T 't^‘41 3T9TcU ^||Rld ^T <*>cR vji cfTT TRcUcT f^ IT vjTT ^0dl f ^Ff cpT xJvvRl ^ T ^FT Rh^ll vr|I3fR >H^ilRfcT 'tj41 ^ TT MeRl $> ^TTST 'de1J’r1 Ft I q ) w t W f t g f ^ r ™ - i. C H H l R c h l cfTt 3TfqR Cf5t ^ cTTcff W W 4Wr iltviHli* s ftte n jjf, ^ w i t cfWcT # f t TlT%q I crf^s ^TlHTtJRcbl cpt f^Rft w r ^ arfcrRcRT S W t ^ m y A ferf^ r ^TFfcmfr ^t ^ttv i TfffM t vflit cfR^ ^ ^TM R cPt >Ft P R t '2TlcfH cf?t Rl^t) 'HHfrl ef eft ^11^ I ii. ^Tft ^HRpRf cPT c rf^ ^fFTfejf e(5t f^TcpRRft PicTROI, W W 4lHI ^Ft 'MelRtcT ‘^Wt ^tR A 'd'NlRjcT cfr^f c^ feT^ 3TeFT ^TeT WTfcTcT cfR^TT xTTf^l r ) w r t e w f e r f M r - i. ^ fm yRg? f^rf^ERT 3Tcrf^r C^ ^ k R , T^cP ^T 3Tf^cP fm cPRf ^ ^ t ^tt ^ fT ^ 3t% p x rff^ fM r ^ r r t eft ^ ^ ^ trt ctp; FRrt cfKR/eTPT 3TNR f^TT uTTW I i. w f^«R (fQcpFg) ]?c^r cpr i 8 . THE GAZETTE OF INDIA : EXTRA.ORDINARY [PAiu Ill- SEC. 4] 3. il/~T 3TTlT ~ 1ll t.1'lqv11 cfJm ~ TTP ™1cf ~ ffl cf>-~ lRg ~ &RT \JM~l'-i -M)cfifa cpl ti~qv1 ~ rn ~ ~- ~/~ffilfcla C. ~ cf> ti 1 '-i I r<.1 m~ 3l~cfT di q ti Ill ll fm#i WITTx cpl q Rq ct.=t ~ · tR ~ ~ fc1f&d ~ it cfr. ~ I 4. il;~ tTTlfOT m ~ TI~~~~ ti~'-iRl ~~ftp~ cp,ft 1lt ~/~ffilfcla clJfc@ cf> ~tf it, ~ m 3Jfqc'llc1 ll ~ tJl<TT ~ m ~ -slcfc-< ~ ~ ~ fcn<:rr t ~- ~ ~tft \JJl.--fcfjl~ ~ cR ~ ~ m ~ / ~ ffi I R1 a CllRti cf> ~ m '-i H fft ¢ m~ "cfj1" ~ ffl cT@" ~ cf> ~tf it ~ m qct'-il.=t P1~1cJ'c11 ~ ~ ~ cR ~ ~ 3tR ~ 1lt ~ ~ ~ ~ ~ ~ cpx '<1cnct ~ '3f6T ~ ~ / ~ffi1fcla clJfc@ clft ~ tR ,Ji'lRs1'-i 3rcp.--f", ~ clft -H+11frci cf> \iq~~q ~ ~ fcn<:rr ll<TT ~ I 5. il/~ ~ ~ "cfj1" ~ ~ ~ ~ ~ ™1cf ~tft ~ ~ilrf I~. cfiqcVf l,l'{"tllq cpl ullRsl'-i 3fcfj".--f" TI~ /<TT GJil· cf> ~ cf> '3G.~~ll ~ (1~ ~ lfr ti-<¢1~ TI~ ;m RlPlll'l'-i¢ ~ ~ ~ ffl "cfj1" ~ cfJm ~ I n) ~ ~ ii)GF113lT <6 cfficf ~ ~ lfPlq) ~ - i. ~ ~ ~l'il ll'l\11'11311" it i~ qlcflli~I ~ ~16G'i cpl 'l=!Ffcp ~3ft· it ~ 3TQf "ITT-TT ~ I ~ ~-~ tR ~ &RT \J1, ;, fcn<:rr '(jj"TTlT ~ I o) ~/ uiR.c-1 xTl1T ~ lfPlq) ~ Qfi),{41~ - ·~ ~ ¢q~\JJ- ~ clIBT 4IIC"llf1lli ~ &RT ~ - -<1+1q tR q~rRrn- "ITTfil ~ I p) 3tfqalc1 -~31Ti:fuIT 4l~Rim° ~ ~ll~c1 -l ~ ufA cfrn ~ ; ~ 1fAq> ~ ; i. ~fqc'llc1 :!~ q1Plfftll'-i it til'-ilrllc'l: ~ &RT ~-~ 1R ~f~ lfGT ~ ~ ~11f?lc1 -TTff m-ctt I , ii. ~ 1lt 611'-ilcfjl-< &RT 3Jfqe11c1 it "B-Af * ~ rn clIB clflf r;cfj,e1 ~ ' 1TGl" ctr ~r~,-3l~cfT ~ it ~11f?lc1 •f ~ clIB 1TGl" * cfjq~(jj cpl ™1cf' ~ ~ ~ ~ - ~ ftp ~ ~ cpl '3C'e>l-!5l ~ ~ 'ff fcn<:rr '(jjl~ 3fR ~ct ~~,-~ ~ * ~ fic--1l---1 m 1 q) ~ -11~1R<t>1 ~ ~ ~ - i. ~ .--fPIR&:>'i cm- ~ qft '(jj'R cf@l m~ ~ li'hJHli! ~Ri,lliof. 41-<G~TT ~ ~ ~ ~ crfurct m;fr ~ I ~ ~'-i"T~ ~t ~ 1ll WITTx cf> ~ fti R 4'c1 qi f?l ll '-i cf> ~tf ll f~, f~ <:1 (jj 1.--f cfj I~ cfr ~ I q 1 Pl «I "Gfl-fr ~ ~ ~ ~cm ~ ~ W1Rf cf> ~ ~ ~ ~ B ~ vl"TC! I ii. ~ x-<11~ 61"1'-i1¢1-<'l "cfj1' ~ .:w1Rcti1 c1~r ~1¢1lla1· cf> Picl1-<01, m~ ~ ~ ~ -~~(1 GlcIT cf> ~ it -fj-~TR'lcf ffl cf> ~ ~ ~cflT ~ ~ff~~I r) ~ 4'ffc;tRt{li - i. ~ ~ ~ ~ P1f~,:1<:1 3lcffu- cB" ~- ~q5 m ~q5 61l'-i1¢1-ii ~ G1 <TT '300 ~ q'1Plfftll~i Bill ~ "ill ~ it cp~62_!~1--i 'cfc1RT filll .,-gr ~ ~ cf)cR /c,11f ~ TTn<TT \J1 IC!' 11 I 1. ~ ~ (fQ~) ~ m-1" 6T1TT I • • ['RFT III— 4 ] ’TRcT =rt Ti^nra ; o t w t 9 2. ftrfowr ctftct ^ x r fft w r ^ f f f i ii. T?cJ>Tto $ W T *t ufr ft«R M ITcTR cfReft Ft - #RT ^ ^r% T ■etc^ c£t fM rr 3 ^tftt sjrcp ^ fr 3^q Tfff^R # ^ f^ fr, WFT ^ ^t%cT qTfel^ c£ clFcT ^FTC 3R ^FPcTT 11 iii. ^ fW r fm w cf) £RT TTcfj f^#cRT 3T^r cf> cffcFT, ?TT 3t£FP cilRkl^' ^ WEJR ^ cf> ^3TFT3t 47feRft eft '3TR?T % eft ^T ^f, 4lHl<+>K c^ g^ M cfcTRT elH^ <*>^11 ell^M <JlHI^K<+> cpf 3T ^ w f f f 1% w m^\ f^ fr qifei^ ^ cTFcr 3rcFt cnir cj>t ^edAe ^ I 1. ^F?t ■MI'HcHI ^ ^ P k l 'TifeRfl vTlft cfR^ cTTeT 4)+1l<*>K cfrt cj|c) cpr '^TcFtS c|7d$1dl^4cf) cfcTRT cf> fcHk* RtK fch^ (el’ll cjr? xjlf^k’ — efYT^ fk, f^TT TRTT ^TcfT WfeT# cjft #FT $ tfm cTOT TRT# wf\ $ 3FJ?TR f^qT W ^ I 2 . i r i l c f?r T r f t r ftrner ^ f f f M r fFrr ^ 3 r t o F t c fr, f m m R c f ? c f>r ■qrer w ^tecFfc cfR^ cfTef fNT^Rf ^ ^g^Ft cpt 3 rto R f f f I ^Ft 3 frtw R ^ft <& cf^rt $ 3tt?ir f? cfR ?tcf>ctt t i 3 . e f F t c f ^ r q j f e r f ^ ^ ' < b s r t f r f ^ r ^ ^ 3 r t o ^ F f f c ^ F F c p f i f t t t eft ^Ft 3 fm m w cfTf cfxTeT 3RqcTFT 3 *Rff #^t c^T ^sncMT, wfeRfT c£t ^Tcft 3TFTR TR foMl I 6! vjftfe^f sfcfFf - (Underwriting) a . ^ n ? r f F f T c ^ q p r a l c ^ r fm \ 3 ? ^ q t f e R ^ s r w ^ r ^ f t w f r IRT 3j^t^cT Ft I 3Rq g ^ t C^ ^T2T-^fTST cfTt ^ yrmcT ’ft M I^ cT cfT^TT xrrf^ , ^ ^RWT qffeRfr c^ Y 1? fcIcR^T ^ w f^ I ^ WF3 A cfMt cf?T ^ R T qffeRft cfft 3T^RT^ cfR^t 3M?W ^FR?T WFTcPTfr W%rT I b. ^ fT T ff^ R ft cpt m t e ^ T Tf W ?eT f^ T T W f T cpt ^ffe R^ ^ ^ici^iicbdij'HW ^ frf^ r cm" srf^cpR #nr tr^ c^r yif^TcfRUT ^ /WT^\ cfR^TT 3TTcT?^ ^Wt I c. W T-W T efrRT ^ ^fif^rcT ^ TRcTTcT e fti cJ?T SF^ftf^cT 3 t ^ R Iff^ T ^TfcRft ^ 3TFTR TR ^WcT 3TaFn SRcfTc^cT to T ^TT ^FPcfT 11 f^R?T W M ^ 3Rcft^fct cjft ferf^TT ^ ^fxld cf7RTT[f ^ c T 9 R t e f^FqT v^TFFF I d . f F f F T R c P c fTT 3 ] ' ^ R I ^ T T ^ ^ N I ^ F T 3 T f r t f ^ F T P T i ^ R ^ f t P R F T ^ W ^ S f R ^ J T 3lRlR<TO efk Wet ^Rld cfR MlfcH'jTl vJll'Tl cfR^ ^ft ^ ^t ^FfFTRcfj ^ fcT?t^ W tfrt et c?t I e. ^ fFncm cfMt Cf5t 3TFt cf^ ^ tRT 3Tcrf^m Ft mfel'^l ^ ^ PrRtTd W 3T2TCTF Hcilcb^l c^ ^FFI oJIcRtft ^ f RcR^T eft ^ - i. efFfFTRcf? ^ pFrff^cT WF3 iRcfTcfR, ^ TFFTt c^t mfcRft Mel^l' ^ Xjcf) iJPT cfR ^R 'H d H cfR^TT I ii. ^ ^TT3Tt/%rfeFTt cf?t ^T $ ^e T cp^ f^F!^ ^ T vjimcjji^ cf?f STFRlfcPcF ^TS IFPcft ■§■ I iii. f^ffrt ^ eTFj; Ft^t ^cff cfTT cTF W S ^ft x3c^W cf^ ! f. fHFPRf cpt FffeRfr efRcpf cfTt ^fFT TT^?T f^ReR H^lcb^ ^?cp/cTFfcpkt ^Tcff 3nf^ cf?f 3TR 3l|cpf^d cfR^ TTtofTTF^ 4lvji«1l3ff 3T?Tc|T ^ W T f^T c^t a 2. RI Fchct1 I ~ ~ ~ ~ fflt:T ~ m1TT I ii. ~ 4~fc.t R-iJi cf> fflt:T if iJfT ft~ c>fJ1l RR~ "ITT - ~ ~ ~ ~C--11 ~ ~ ft~ if mlTT l:TRcP ~ ~ q)faffllll ~ 6CCf5x, ~ ~ ~ ~ cf'ifC'lft) ~ ~ ½fcff cfR" ~ t I iii. ~ ~ ~ &m lfcp Pl~ila ~ ~ ~- ~ m ~ 121Fcra<11 ~ '34ill-< xJfu cf)~~ ~~ cnFR-ill m ~ t m ~ if. 4'1+-t1¢1'< cf)~6q_~H crc>rR, ~ .-iii ~ ~ ~"+-tltl"R-cn <m ~ ~ ~ fct cm 3TlAl fcITTfi ~ cnfafil ~~~~'PT tk&P·k m1 1. ~ ~~if~ q)fafft ~ m ~ {(i+-!1¢1'< cITT Ct·rct cf)T flc&f''4c clzc1$1dlg~¢ q)sf,~~~1--1 ~ ~ ·~ m· ~ ~ ~ ~ -=mw, - ~ fct. fctm -rrm ½fcff ~ q1faft1 ~ ~ cf> ~ ~m ~ mrr cf> ~fclRJT-rrmm I 2. ~ ~ ~ xrftr ftfrl"R q1fcl-tt1 ctr ~ xTfu ;~ ~ m m. ~co ~r ~ cnT flc&P·k ffl cTT&l 4'1+-tl¢1~)- cm ~ cf)T ~ it1ff I ~ ~ if ql'il<hl-< ~ cm cpsfti.2i~,1 ~cf>~~ ~ cITT WITTTT t I 3. ~ cnf<'ifflll1 cf> aiR1Rcffi ~ ~ ~ ijj '11 cfJ1'< ~ cnf~ffl;a, iil1c11a1 t m ~ if ~ cm ~ aif4a1c1 if ~ ~ q)T ~3TTcflJTT. q1f<'ifft ~ ~ID cf> ~~ ri&Pll I 6'. ~If 3TcfR - (Underwriting) a. ~ ~ ¢qj;i4) cm ~ ~ V1'1@P1 3fcfR 4lre>lffi ~411-fl ~ ull ~ ~ &RT ~jsri~a m 1 3Rl ~ ~ m~-m~ ~ crit ~ ~ ~ ~ ~ ™ ~ , KJlti~ ~ ~ q1fclfft ~~G~ ~ TT f~ct-! 01 ~ ~ ~ I ~ ~ if ~ ~ ~ q1r~41 cITT 3i,s-!-!l~c m mj Jllq~ll¢ ~ \ill1¢1~ tl+-tlffia t>"1 .-f1 -q1f%~ I b. ~ q)fclffi ~ ~ if ~ fcnm V11~ I cf51AT cJ5T ~ q1fc1-B1 cm ~lcf~ll¢dljtil'< mnm ffl cpl ~ "ITT1TT ~ ™ ~ cm ~nfqcf>xtJT if ~ /~ ~ 3llcl~ll¢ 'ITT1TT I c. ~ ~ ~ ~ ~ ~ >Rfficf mi~ JljS1l~d ~,s-!-!l~fe,1 q'if~-ttl cfi ~ ~ W¢d 31~ ~tm<hd fcnm vfT ~ t I ~ ~ ~ 3lf<ficf>c.fa C. C. cm f&Rsla if tljf¾a ~ ~ ~lfllcfc cnT -tt~~{l fcn<TT 'Jil~'II I d. ~cp ~ Ji-s-< .. u~fe,1 ~ ~ aiR1RcR1 >l1lR !.flf1i;a+-t ~ ~ m ~R1RcRi cfi ~ if ~ ~ tl- ~ cITT q1f~t11 w~ m ~ ~ tl- ~ ~ ~ tlt;+-tfa B m \111~ 1 e. ~ ~ ~'11¢1-< ~ cm 3TT1l' ~ ~ ~ m ~ q1fc.1~1 cfi ~ Pl~ilc1 ffix 3l~cfT 16)¢"1°1 cf) ~ i:21cftilll if qRc1ct1 err ~ - i. ~ ~ ~ m 1i-<cll¢'<, ~ ~ ~ ~ qff~fft ~ cfi lfco 1WT * TIR ~ ~ ~ ~ 1 ii. ~ tfc-TT3TT/~ ~ ~ ~~~ cf>~~ "3cffi ,i11--tct>I~ ctt ~l<Hll¢dl -er,~ ~ t I iii. ~ ft-laj~ if ~ ~ ~ m=IT cpl erg ~ ~ it \j~~ cR ! f. ql+-tl<hl-<1 cm q'lf<1f11 mxcm ~ ffiU" ~ fuITT 14'icb-! 01 Qf-?8¢ /~ ~err~ ~ 3lR 3ll¢fila m ~ l.flctilt\1 ;q'l"t-113rf 3l~cTT "111 ~cplfrt\il-i cm - I . 9 THE GAZETTE OF INDIA : EXTRAORDINARY [ P a r t III— S e c. 4] 3JCRHT Wf%rr | W t o 3TSRR tftc^fTF^ ^?FTT3# cPT ^ R|ckR|cP| cTSTT TfffeRfl PTel^ A *PT^et cf ^ ^ 3 R J * t o cf> 3RS}R TR McpC'i RhiJl vj||^ [ 7. w r m j 4Wr iflvrfh iart ^ ^ RicdRT — a) W R « J f f R T w f M t cpj d W m P lM fc lR R i cTazfr t R 3TT£TTf^T - i. cqfcRFRT MlfelRliil cf> fen? '’TlfcRft' cj?t VJ'MTRT 3TSTclT vRRF> 'l4W>(u| cf^t dl^l'isl *R PFRTRRP cj?f tjof 3TT^ I ' _ii. $ M q-dlcix! cf> wcT c f ^ wcrqpr ^ wRcrrf^p ^ r ^ r f ^ cpcRul cpT W'i-Cllcl F l^ T R eTg l^ft^RT ^ t 3RETR *R I b) qffcrcft titftm srq fM ^cT # r t - i. chci^ eft 3Tcd^r $ fen? wft afft ^T5n 3Rt ?rn3HT3Tt # teR? I ii. <frRT ^5FR3ff c& 3RTRR wf^FTcT ^ W t’cR ^KJRTSft cfr fcR ftRR jft ‘-iMdH 3Tcrf^r # fft - 1. 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(w fM t e n w f ^ flc ff cf^T TRSRT) f ^ F f , 2000 c^ 3TeTTcIT ^ffeRfT ^ f^Tferf^T cjTT WiTcRT ; Ft^n wr%^ I j. ^fT ^RT 3T^fcT cf?t ^xjt, | ii. ^Tcft IR^frT WW #fTT3Tt cTSTT ^PTTf^T cj51^qi4 ^rf^TT, ^ ^Tcft cf?T 3R^frT ^ ^fRRT #TTT cf5T ^TcRT ^ f^TT WH? eft ^ ^TcTT TTeRgt ^ feR ITf^qT cf?T 3TTcR^m Fftft 1 1 iii. w w efrfRf ifivRTTsff ^ y ^ iftd ftRft ^ c r eft m #fTT3rt ctstt M t ^T-^fTTSTt cpT ^ #5PTT ^ IR ^ lftd 3RJ[ cf>cRt TR cfT^ 'SnTlcT 3Tlf^ cffr ^ m $ ] $ \ v?nTj i iv. 9 (6) (T#fMr erRcpt ^ fM cct ^rsrt) 2002 ^ 3 t^ tr W fM r TT^RI ^ ^TM ^T WcreiH 3Tl^FT WT ^ X F R lf^ t o T v. cjrr fctcRTiy, c f^ cfr ^ ^ (t# t) ^ iR f c^ ^TRT ^rffcRfr ^ g - ^ f ^ T v3TTT? I ^t.-dfr.TT c^ eTcRRf IR vSMijctd XjTFicm^r 3RTcFf c^\ uTR I 9. ^R&2T q ffe T te t ^ £ b K H I - a) -qtfeR?T ^ ^Tcft c^ 3TT£TR ^ f^TcpR ^RT ^*fT STRcpf cf^T ^ xg^f^cT A FeTM cfRcfj^ f W R T ^ XiTFfr 12 · THE GAZETTE OF INDIA : EXTRAORDINARY [PART III- SEC. 4] d) ~1f-l1cn1x &RT efcl" cpl Pfqc1x1/31«llqzR1 i. ~ ~lf-llCf)I'< cnl" ~ •~• ~ ctl" >II~ cf> 30 ~ cf> 1flcR ~ cfjf Pl q CI'{ I 3f~cf[ 3H-<11 i:Q fa cfR t-TT ~ I -- . ii. ~ '1:r>m' cf> ~ 1fflwTT * m. · fl1Ji1;;q(r q1R;ix-1"1 cti- WITT cti- ~rr 1l ~ll~c1 ;, ~ cJrcfT ~ 1fT ~ '3llcl~llcfi' ~ m \JJl~JII I ~"IJilcfilx Iffi ~MR'Clci cITT ~ fcn ~ ml ~Rhlll ~ ~rfi ~ ~cm-~ 61 ~ q~ 1TT1lT \JJl~Jii -;, fcl) ~-61TT I iii. ~lJilcfilx &RT ~ >l'lf.:J 1l ~ x-q1cfilx cnm ~ ~cfi8ict ~ ~ \JJH,cfil{l _. tjffC'l-al cf> ™ ~x-ctlfclct WITT, 1l::f 1l ~ ~ zyif it ~cfifect ~RN41<$)ll ~RH:\lfl 3Tift ~ V1Hcn1.f1 cfjf ~a,ur ~ ~C'l~IPlcfi ~ cf> ~ 1l fclRTT ~ -=cnfm: I ~ cpl Pl q CI'{ I ~ ~. ~ miTI'tITTcP ~ ~ t9C1 I t9 ~ c#t \111'11 'Clll6~ I ~ ~ ~ aj1fi Vll<il t cTT ~ '311q~~cn' ~ m~I iv. ~ ~ cti" ft~/tlc-7T G1 tj1fc1fflli1 ml ~ cf> ~ if~ mcft t m Gfcr cpl ~ G1 q)f&-ai 3fcliw.rr 1l ~ xlftr * 3lmlx ~ fclm-r -qr,,r 'Cl 116 C: I ~ cf) "fl1,Il ~ -cn-rcffll ml ~ ml cfj ti fa lll cit 1fr ~II jfj t>1 fclm"r ~ I ~en cnl" ~ \:3 q 9,cfct ~ cPT :! • 1<11"'1 ~ ~ ~ ~ 3PTC'l' !.l1~l1Ji ~/.--iq1cfixo1 ctt ~ cm-, q)lc fc1<rr ~ ~ ~ 'T@R -;, fclm"r 7Tm it I V. ~Jilcfilx &RT~ 3l~ ~ ~ ~ ~ 1fr-ctx ~/q'"ff?;i-ffl ~ ~ cf> ~ 311 cl ~ll cf> >1 t>1~ >ffiJct" cfR ~ I r:nx 1fr '3""fl" ~ cf> {ffG 1fr GTct 4>1~t>1 ~ ml ft~ 1l ~c-i~ * cpRUTT cf> ~ cm UfR -.r x~e1 ~ ~cIT cnl" «n cfi Ix cfR R<TT \Jl"FfT ~ I e) cffffi.t-ttl !,H~~-1 ~ ~-1as:i ~cf>c-i - ~.3TR.~.'C!"- (q1f?;if?1 ~ cfJ f%m cpl *aror) RlPlllJi. 2000 cf> m q1R.ix-1~ >1e1~ 1l Plk-!R.iRslct cpl' flJil~~1 , ~~I .,..,...,.,-,,-,.-,,. : i. ~ ~MllJi &NT ~ l.lcnc.--i'i c#l" ~-en, I ii. ~ ctl" • ~ xfrrr3lt Tim ~ cfil~cl I~ c#f >ITTP<TT, ~ ~ ml • * ~ ~ xfrrr cpl -qrc;,., -;, ftnm ~ m 'fl1fr ~cn ~ * ~ GTcfT >ITTPllT c#t 311 cl ~ll cfict I mcft t I iii. ~~ ~ lll\JJ.--i13l1 1l ~'{-(ilfclct ~ cf)"cR ~ '31:l" xfrrr3lt Tim ~ '31:l"-~3lt cpl '3""fl" 4l \JJ .--i 1 1l ~ «11 Rl ct ~ q>cM ~ ~ crrR m 3Tift q;T ~ ~ ~ flJi$lllll ~ I iv. fqP,w1 9 (6) (q1f?;i-ffl tTRcITT cf> ~ cfjf *aror) \tjPtll~ 2002 cf> ~ q1f?;ix-11 ~ 1l ~ ~ ~ cpl >ITcfcTR ~ ~ ~ flJilRlt:c'. fclm-r ~I V. ir.1fi.'C!". cpl fclclx 0 1, ~ ~ 'ITT "ITT ~ ~ "C«t Tim ~ (m) fflT cf> 'ffl~ q"jfc;rn1 ~ ~ ~ fclm"r ~ I ir.1fi.'C!". cf> ~ ~ 04~cfct \JJHcfil{l ~ml~ I 9. ~ q,ffi.t~lll <f>T "t<ftct>l'<--11 - a) r?t,~1 q1fc.ix-1"1 ml WITT cf> 3TTtTR ~ ~1Jilcfil-< &RT 'fl1fr q1fc..i,m ~ cf)1' ~ '{!Pf~-tjct >1Ri~1"'1 1l ~ cfixcll-i ~ R:~ ~ ~ml \JlAT • [*IF I III— -Taws' 4 ] : SRfTtrRiJT 13 w f ^ 3T9TcfT fcfr$\ W % v m Tf ^ c fM cf^cTf^ ^ vRTC> cZR g$t Trfcnjfcf cfft vjtttt i b) ^cfeT srfclfQl^ff tc j HT-cirfcTcT c£t vtTHsT frrf^oFTT ^cTT^ tfcTFT fm iW R Tt 3T^f£T Ft I W p f f cfTf '^'dcfc^ utciis^r w wtht t i yfcn^jcf cf?t 3 ^ # f ^ f r RiRk>m yfer^H w r ^Tcfnft t l ^ ^T# c ^ / W p f f / 3 T f c l w f r cf>Tf e jlc l^ ijc b c ll^ K w % r 3T9Tcrr f ^ r 3~rt e n ? # r e 3T^fcn4 t I C) WR82I f ^ftcR 'H^fl'jff l -qtvjpTT3ff cpT W R ^FT fc rf^ R cf>t 3 T 5 ^ t II cfr ^rjJTR #TT f^RT^ ? m -? 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'eft+41 iffvjFTT' epy <41 +iIcf)|\J eTSfT ^ R t 4lH|ebkl c^ eft^T fchnvFT 0l4ebdN'l c?>t ^m tcfR i ii. fTRT 3T^TpRFT 1938 eft £TRT 58 eft tR $)f^pqH_ ^ x f f t eft ^rfT ef>^ y^lfcfcT yf^TTi iii. ^Tf^FT ^eT ^RTepR eft ^qf^rfcT ^RnfT Ft cR ^ ffrne^R gRT qffcRfr ^Tf^FT eft ^TFff ^TTl%^ | TiT# cR) q ffM r qRep ef^ ^R£f t fFTRTR eft ^ R f T 3 T ^ T TTFcT efR^ e^ feT^ cTSTT W rfM ^nfT efR^ %5cT e^ eft? ^R Pl^eKl feh-41 v3TTq | iv. ^n^TcTT—3TKFFT $ mR°IIH, W M r ^RT t^T eft ^ ffM r ^ ^5^1 flHlebK cR 7 q|t|[^ f | v. ^ f t fFTRRT gRT eTFTcT—eTTH f^ ^ F T 3FH R ^ F t cTSTT cft^fr ^5FTT ifrf^FFT TR f ^ ^ c^T IRcTR ^FTt eft WTfcT ^ f^TT ^TFFTTI 24 THE GAZETTE OF INDIA : EXTRA.ORDINARY (PARt III- SEC. 4] \,l'(-(llf~lcl ~ ll'l,>1-11· ~ j~ 4''iicblx ~ ~ f.rBR cfi ~ ~ -~ \ifIB1 t1 ii. ~ q1'"11cblx· cITT ~ l1)\>1'11 ~ ~('f ~ '(1ql~ ~ ffl cf> ~ ~,ifacb 11fiicn1 ~ mcfi t I iii. ~ 4)01-11~ ~ >PTTc!l q1fc.lffl--wrr ~ -~ q1'"11cblx ~ 1iGcn1 °4TbR -~ ctcAl qft 91'-1:GI \,lill<:1'1-$-Wl~cfil'< ~ frrR m 1l ~ ~ m;:fi -q1f%~ I iv. 3144'1 ~ 4lf&t~41 qft ~ cf> ~- GRT 1l ~ ~ ~ ~ ~ cf> ~ ~4ct~ elm 3fxl Gl~cill ~ ~~ ml ~ I 4. '11lf:&'1 ~ :- -~ 41\>1'11' cf) ™· vllml~ ~ ~ct ~ cnT 3lCP'l cnT 'c6l<l Gl°'1T ~~ ~ ¢4~l11 ~ ~ '(J1"RT ~ I 3l~ ~-~ cf> \J1'lftl'i cnT 3lCP'l ~ mlfT ~ ~ elm ~ ~ cf> \Jllrtl'-1 cf> ~ cn1 ~ ~ ~-~ I ~q,jJft ~ ~-~ ~ ~ ~ I a) ~ -~ 47v1-11' cf> ~ °4x 1,1-H11Rlc:1 ~ .til\J1-1I elm ~ ~-41\J1'11 ~ 61 ~ ~ ~ cf> ™ ~ ~jifl~c:1 ITT ~ 1 b) .GRt ~j'-il~a ~ lll\>1-11-m cm ~~clta q)x ~ t11'"11.-x1 ~ ;,fl, ~ ~ cbxclll11 ~ c) ·~ 41\J1-il' cITT ~ ~ ~ cf> ~j'i,IG'i ~ ~~cbx 01 ~ ~ ~ \JIFTT mm t - ~ ~ Fcn~ ITTT fen, ~ °4x ~ ~jJ.ilG'i fc;rm l"Tm m 3l~~I d) -~ 41,11.-11' l{>1$fc;jJI cf> ~ l.f?I~~ ~ ~ furr-f.vhrr cpf ~ ~ ~ ~ ~-WPl °4x ~ ~ \ifRt ~ \J1Tct 6 I e) ~ 41\ii-11· cITT ~ cf> ~li-!ifcncn ~ 1l, ~ ~ ~ ~ 1l ~ ~ '(J1"RT ~ t I f) ~ 41vl-i I ~ ~ ~ xT)q 1l ~~ IDxT ~js:il~-1 ~ ~ I g) ~ 41'11'11 ~ ~ ~ ~j1,141JI ~ ~S-.ife1~d 'c6T ~ ftjlr!R~ ~ '(J1"RT ~I i. -~ 47(>1-11' cn1 ~ Jli-ttct>lx c'Jm ~ G11'"11c61-<'i cf> #ri!' ~ ct>14c6c114'i cnl -«l'iicb-1 I ii. ~ ~ 1938 ~ tlffi 58 ~ w '4x ~1f?tl1'"1--ilfefl'i cm ~ ffl ~ 1,1«-11Rlc1 1,1Rhl11 1 iii. ~ t1fc1ftiJ1 cf) GRR ~ q1'ilc61'< ~~~~'ITT (fij ~ q1'"11c61'< ~ tjff& fll f1 fc1~ JI ~ '1fA1 ~ I '1fITT c'Jcp 41 f?;i fll tITTcp cnT 'ffijtf t ~ 4l'ilc61-< cm t1fc'i~J1 ~ ~ ~ cf> ~ c'Jm q1cJfal11 \iTTft ffl ~ ~ ~ cf>~-qx ~g@f$m~, iv. ~dT-3l'tiflA cf> qR 0ll'i, q1f?;i~ '5TcT ~ cnT WlTift q1f?;if11 xlcJT ~ cf>1 ~ q1'"11¢1'< c'Jcp 4§imi 6 I v. GRt 4')'"11¢1xi IDxT 'c111IB-'c111, Rl~~ 01 ~ ~ c'Jm ~ lll\>1-11 cf> ~1f?tl1'"1 -qx ~ vfR cf@ ~%1\je. cn1 ™Tcr ~ GFif ~ f1!5'"1Rl ~ ~ \iil~JII I [SIFT III— ' 4 ] ■Hkd '3iT TT-SPT? : 3TffTtJKui 25 6. cf> PlMdl^ cj> W W t o ^ R I M ^ftf^TcT f ^ W I^ a) ^ 37^R c£ 3TTETR *R 3T^T fT TO R gRT tfT cflctf cf> cfr tcH? cjp? \3WJ f M WT% | f^ jft $1 fteffcT 3, 4lHlcbK £RT c£f^ to c f> R eft 3TR %, cTRt cfr f^PT2T^ cf?r ^TR^t 4 t ^TT^ft I b) ^ 3 H T' cf> ^ T ^ «ClH|c^W £ R T ^cjtcfjR % Zf mTT^ crieT X jfW r cf>T ^HTTcr 3TRT t o ^ ^ f ^FTT Wf^rr | C) W t ?RF> 'W ^ t iftvSHT' cf> 3T3T cf>T W T t , ^ T TR fcrf^TER cTaTT fc?TT-f^?T cTF^ I d) TTFTeff 3 W ffM M r ^T ^ T ^efcf) t W f to ^ > R ^ ^ ^ f ^ jte T | e) 'c f^ rt ifl'vipll3Tt c£ q tfe f# SfTC (Bond) T F R T O ^ fcT?, ^WlfeTd W TcT^ irfff^TT m ^ \ i WT^r i 7 . R d ^ T ^ M : - a) 'W # ^JFTT eft fiTsft f^rfeff^cT tTTKFTI ^ W feRT eft ^5TFfr w f^ :- i. TTc^rar f r w r (H i$ f^ i) ^ tct ii. ^TcTt/sTfaRt cT&TT iij. t o fm jcpR f cfc mRRJcI o>|f^c1J|c1 TJcf cbfijfte ^ b) 'cf^Nt ^ P fT 3 T f' cfTT fcfTRH, "fcf> ^ fR o f' cZJcReTT c£ ^Tro^T ^ f t o mTFTT Wf%^ I c) f P W R ?TF ^PiR^Jci 3R 3 f% 'cf?Nt '«iWHI' 3>T fcftFH t o - W ^ f s|RT f t o W R ^ flHlcbR ^ft f ^ t zfT3RT cfr fcTTRH m f^ c f f t o W l 8. ^ T clH STftcfpf W ^ T : - a. f ^ f r ^ftvHT cf^T ^JW T 31 Pi <314 W ^ T P lM lf^ ^ T 3 Ft:- i. #3ptt 't?M\ frm ( ^ ^ frc H /w ffr w f« i fm w R ^tft) 3fR "xyz ^FT c f ^ t ” (^frcPT eftTTT ^ eTlHlcbW ^ ^^TFT) ^RT ^ R T WT ^ M^-cflf^Td ^?T ^ % I ii. iiYvim c^ vji'iRsjh ^ f^ c T cfrgM r ^ r t f r ^RFZT/'^cTl^d M uTT^tl iii. m m t o eTFff ^ ■^rf^TeT ^FTt ^ cf5T ^ it e r ^f^Ter fP W R T ^R FTHT I W ?wi cfFT fcR abc t o (% ^frcPT/WpfT cf^f) cTSTT u?Tcpr t o eTFff c£ 1epr "X Y Z to w r f \ ” (^ P T t o t o ^ R cf5T ^fFf) I iv. ^ff^RT eTTHt ^ ^ ^T^fT fcTm^t ^T PlMdM ^ff^cT fn W R f ^RT fT f^ IT viTlW I V. chi ^41 ill Mi’ll M lfel^ 9Rcpt cf^t H lfel^ 3 # % ^ ^TFT cf^t mII^ >^51^ cTSTT 3p?J W T cpt cfR^f cpT 3T^F>R $)i\] | Vi. ImRT ^flMHT $ t o to^TT $ HcTlcb^ui cf>T ITIW^T ^TT, ^ mi h i ^ w m am cpt f u r ? ^ ett f ^ f r i vii. 'W ^fr t o ^ 3 tr vJtTeW ^f^ilH -^TcTH to e q f cPT Icrftn^ 3Jcfj^T | , q t I h - 1 - i(l ~,'[§ I ~ 1s i ~ ~I rw i .~ ~ I ~ t i ~ l 1 4 ! ~ ,I, 1 ;~ :. I ti f JI! i i '~-i 1 ri ~. ~ ~ 1 , ,i -~ 1& 1!' 1 ltJ 1 , ~ ~ ; ~ W ~ ! l i t ~$ "'J ~ ~ :~ ~ ! ~ i 4!>: "' 1E: · ~ 1& - ~1& I! ~ ! i1 1& ~ I,' g 1s 1i, ~ - ~ w. -: 1 ·~ I ~ -c_ I& I - . . : J i I ! I I ! ~ I ! ! I ,. I,' ·~ ,- ~ ; ~ - "" t : r~ ~· ~ i ·~ ~ i 1 ~ 11' [ii [ :l: i t ! ,~ t i ? , : I - 1s ~ - Ii' -= _If l I£ 1& t !rt ~ i _ "'11' <g; _ rr 1s i 1&1:~jl r:t;i !!j1&]; li i i1~ i 1 if; ~ f~ ii _ ! !1;i,~i1iil .I. i!> i_~~ I i l; t-'i:l_i]i1&;t;- j 1 ;i~!r!t!i!I j !:!:!t!i~ J ii:<W ~il-tif l~~~i ~f E ' n, ·- :: :: > > ·>- :: II;) !, co ,-.: aj . ·- ·- > ~ 26 THE GAZETTE OF INDIA : EXTRAORDINARY [Pa^t III—Sec. 4] viii. ■'TffcRft >nfcfRH'j| ^fctm \ ix. f ^ cT5cT qfferfW WWlRd | x. ^IRsr efrrt am ^ fen? 27^ ^mrcreft (tpa) cfft ^Tef^rrr wi M c n C - l i xi. IpT W 6|t i|S|vj1'1l3Tt e£ ?T?cT viMel&T Rl^ma—Pic)Kul R^eMl cff[ wcf>c*1 | xii. w fM t erReft cf#r ^ Tien? efr uncfr t % t <rrfer# ^ *r?cr, ^rej> cTPTf cTSTT qlvjHf' ej> T ffM t-# iT ^R tRT ^ HofNlfcT 3TcFTcT uTT^ I v b) 'W«ft #jHT3Tf ef> Mlfel'rfl yeRgf *t ef^T ^ ejR vjq^eRT crffrfa f% (iii) ^ (xi> cTef> W f^ T I C) «'kllc|ef> fcRTT vSTH? vW^efcl ^ W ^ f t eft ^FPR^T fcRTT t 3lk <R7 xr5f eft WTTcT <& W T ^feF^T eJR ^ | 9 . ' W « f r A l V i H i a f f ' cfr W T 3 ^ T f # R 7 c f j R f £ R T # f T T 3 T f £ r f ^ W 1 9 3 8 3 jf f c 3 r f £ R jf % T d fcTpRP#, 3T^T f ^ T T - f ^ f t, qf^q^l cf>T WR-ezf #ffT cT vftcR ^ ^Nf^IcT T O 3T5^?ff cfTT 3^TTeR f^TT vSTHJ I / 10. f ^ T T - f ^ f t $> \dc^*i| % -^1cFT eft^TT W ?T fTTT eftpft -mf^TeT 11 , 11. *j)vHI eft cZTRefHTr eft ^mlcr eft T[fpRR eJR^t cRTT &5T eft ^ a R iR F t e£ fcHJ ^fTWf -c^qf^rar Nifr 'eft^fr ^ R T ' eft Hlcfcf^l cR ^ t 3M UT^fefrm ef> ^FTST *R ^ T T IR^cT efT^ft rn%IT | 12. 'w 3 t iilvjHiafr eft HWlfeld efleft ^TT c f j # t eft eft TTTPr R efR^ HlR)ef)^u| g|^| XR f^ lR d eft vTT^ft I s r^ jx fr 111 fp u cftrM r ^ s r ^ t wRt ^ w m ftm fft HIWI, 3TKq^ [t5fWHIII/4/ 161/12/3Wl.] 26 viii. ix. x. xi. xii. THE GAZETTE OF INDIA : EXTRAORDINARY [P~T III-SEC. 4] \:S4C1~ q1fc.tt1"1 fiftj~ll w~ cnT ~ ~cnc-1 I ~ . . ,-..._ ' cfRT ~cn,x cT> "11~+-i'i cT> ™ ~ tj1fc.tfflll'i "$T !,l'{f11Fc1a G1q1-'(1qJ cnr 1q~1~ !,4q>C'1 I ufi~'-t cf) ~ ~ ~ cTi ~ ~ -cntT ~~ll"ficnl (TPA) c#r ~ Q)f ~cr,c--t I ~ ~ lllvi--tldTT cT> ™ ~ ~1cr,1~a-f.iq1x 01 Fc1cr,c-li1 cnr ~cnc-1 I q'ffc.tf1'7 tlRcITT cITT ~ ~ <ft \ifIBt ~ fcn" ~ cffR.i~ ~'(IG.; ~ ~. ~ ~ TI~ 'q,1"'1 ~)m.:n· cTi q'ffc.tt1'1-~ xixi'.l--11 ~ ~ 3TTTlRf "ITT ~ I ·, b) •~ '47vi--tl311" cfj 41fcHfl ~ if cnl=f ~ cnl=f \;3q4ctt1 mu@ ~ (iii) ~ (xiY ~ i:tcbfea m =q, 1%~ 1 C) ~ {<11 cl cf> ~ ~ ~-"Q?I' fc>rm ~ fcn" ~ -.:Sq 4 cRl ~ ~ er, 6--11 cf>T ~ fRm ~ ~ \ffi i:r5r cfTT ~ cT> m~ ~ cnx ~I 9. '~ lfh,1--tl.Jff' cf> ~ if zj.:it 61'7'-tlcf,lxi 6lxT ~ ~ 1938 3iiR ~ f"21Pt~~'i. 3Rl ~-Pt<h~. qRq~'i cpy ~ ~ ?I" ~ ~ ~ ~ Wfffi ~ cnT ~j4161--t fctm ~ I I 10. ~ ~-~ m· ,3c,~~l1 ~ i'R-~ ff ~ if l,!cni 4fl ~ ~ ~ ~ ~11f?tc1 ~ I 11. lll\Jl--11 ~ cl.114¢dl ~ ~ ml" '-tlPtcx ffl TI~ ~ ar::r cfTT ~t;ctN ~ cf> ~~ ~ ~ cfiqf.i~j \Jrr -~ ll'1vi--tl' ctr '-tlcBfei1 cnx ffl t ~ 3ltR ~ cfj "fr1al '(-1'1~- ~ °4x ~ ~ ~ ~ I 12. -~ li),,1--tl.JIT' cf>T ~«11Fcla ffl cnC1T ~ cfiqf'ill'i ctr ~ cfTT lff Ptcx -m ~ qrf~cITT"OT 8Nr ~-~ °4x ~ W ~tRc, ~ "vi"AT ~ I ***** 31j~~ Ill ~ ctiqPt~li ~ ~ ~ ~ ~ ~ ifrlTT ~ . m ~. 311:Z!~ [~ III/4/161/12/a:mT.] ---· ---- -- - - - LZ Mrnime : khML life mih ' |> SnR — III Mh ] g g l i ji g l j? '.■■... ; gB V . / I I I f t t t f i i f i I l l l l 1l 1! . 1! 1l ~ ~ 9t' ~ i i i i w 0 !4 ' i ~ ~ ~ ~ I: i ... ... ... .... 0 0 0 0 91" i i 5i" -!I' t;; LZ loll.t..11:lli.' : .l:.b..ltlt. · 1.'£. illJh [ t 2.al§l- III l..t..lb,] 28 THE GAZETTE OF INDIA : EXTRAORDINARY [Part III— S e c . 4] 28 THE GAZETTE OF INDIA : EXTRAORDINARY [PART lll- --SEc. 4] i ~ ; h, [ i _4f i i I I ~l i tll tli I I f i I f I f £6'. £6'. £B'. £6'. 6'. £ 6'. f' -· t! i' i' t' f' f' t' & gf if & if N N iv iv "' ~ "' "' "' ... ... ... ... ,lf ~ ,lf ,lf . ,lf -~ -~ -~ -~ -~ ~ ,lf ,lf ,lf ,lf ,lf i 'If i i i rt _, i ~ ~ ~ ~ ~ ~ ,lf ,lf ~~ ff ,lf ,lf ,lf ,lf I I 1 ,1 I I ( ~ ~ i i i i rf~, i ! • [«TFT 111— 7 3 * 5 4 ] ; w c t i r w : 3TOt w i 2 9 <•- * ■ ; ■ 4f*c Ig Ilf m i f IT -ho- 1 •S’ 45) ■ * ■ ' ■'•■■ . .Jy -wg • *W •>v<£ ■ J. V, ro « rs 45 H 4* | i5 1 I & f 4 I I t « ‘ ’ [ I S I £ ty ts i 1 X~lF>$ ?hl*£ 1* i hJ U 6 * pH 7 *\ s ! ? E Z 4 f ' 5 f ![ f s p 1 . n lu * r i | l | fr d £ • 1 1 t _ £ tp " c 1a fr ^ 15 te<2 g fr <£ i t ’ 5 | I I * s i * h l - S 1 1 * 1 1 1 jho ! 1? £ <? J ^ . ■ j jr f ✓ 5 *fc - <N is [ 'q'fl1 III- ~ 4 J ( '4mf cfi1 ~ : arnT'<ITTUT i '29 l ' ~· I @N,t I lli . ' -lf4;; I fiki "' r- ... 1~ . "' ~ t,~ m~ I . ... . ! 1i -.. i ' ... I! i~ i I I ·I I l , i l ~ ffi re i ,If t I If ~ If -g ! lo' ~ e i 1!i'! m· t ~i ,.,, ... ,ic; ;~ 1! I ... , ~ ' 1.; ,~ 11 it ri ~; ~ r.~ i I .. ... N ~ ~ .... ,~ 11 ;11 rll ~ --:~ -,~~i Ir i ii M ~! i I 'lie, 1, ; ~t i kn ~-; 1[· !Ji~ f 1!-~1 . !IF ,! iii ~ '·11i ii I - ' ·- ...... 30 THE GAZETTE OF INDIA : EXTRAORDINARY [Part III— S e c. 4] 30 THE GAZETTE OF rNDIA : EXTRAORDINARY [PART III-SEC. 4] ' . - I r ! i ; i e ! itr f ~ i i ~ , i t I fi fE l h f t ji( i ~~ t · - i i t ' t I ~ :a i ~!Nti ~! Jt ~ I N ~ .,; Id ,..; cd 0\ ~ ~ ~ IS: r I .. .. J i ·-- -~ a•i r ~ Ii, Ill l~ ~t -~ 1·~ , . ll~ ll ~ ♦ Iii- i i i , fi ~ ! ~ ! I I ~ I 1 I ! ~ ~ i~ ~ ~ i l4i i i! I ~ . ~ l ! I ii l ii ~ J I s i ,If i 1I I Ii~ t i i I t I i rt I !I I 'ffi :ti ~ 4f Ii Ii g i r I i i flf t Ii i Ii I I l i; ~ E I l i.1 i ! it t t J ~- l ~ Ii-, If ~ ~ ~ U'I ~ 1 ID ~i I ~ ,._ .. ;;;i a, 0 t:, ~ Iii~ g~ ~~ ... :l I I . !JI , ; fl • i' ' I !I l' ll . ! ~ 11 ! tl,21 "'; 1~ ~ ! = I! fl ~ fi ~ i ii i1 i1 ij i i i ~ ~I Ii I I tt; ~I ! i i 1~ Ii .~ i ~ t I t ; i i ~ i i it ai i j1 t I -i 1 j 1 ti ~ ~ ~ t ~ ..... j .a i .. ..... i ... 1 i) ~ ~ "'l I ! J-1 j a, * ! * i ! ' I ' : !~ j Ii ~ ' = 1 . ~ ' .. 1£ lllllalfil£' : ~ l!e lll1b 32 THE GAZETTE OF INDIA EXTRAORDINARY [Part III— S e c . 4] 32 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III- SEC. 4] . I . , . - U'I ' f· I • ' r~ ... ' i~ :f N i~ i' ... i~ i' • i i Ii ( I ~ I ~ i ri .If f If I ii If l ' ~ ::;-Ii i ~ I ( i ~i ~ If bk, It ... i ~ ~! 11 i,I f ~t;: I 1-t,, s li - .... N ~ 1 .. .._ ~ i .. ~ I :i-~. 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""'" VfiJ" ""' P."' r• J11$VI "' ,.., I ~1 #1} 7Jr.tt 66 THE GAZETTE OF INDIA : EXTRAORDINARY [ P a r t III— S ec. 4] I I THE GAZETTE OF lNDlA : EXTRAORDINARY [PART lll-SEc. 4] [ ’TFT III— W^S 4 ] *ttot ^rr TRtr? : arenwrrr 67 [ '!WT IIl- "&Us 4] '!TI«f <fiT ~ : :m:rrmrur 67 Ii-,..........,. g ,_ THE GAZETTE OF INDIA : EXTRAORDINARY [ P a r t III— S e c . 4] 68 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III- SEC. 4) -r-r-T"'T"T""---r-r"T"T""T-rT'"T"TT"'T"T"i [ \WT Ill- ~ 4] (J) .. . '!1-! I 'Ir 4i j,lf t,t1! 11' : i~i! t t~i! 11' I 1!~1! t R iJ11i~ l! .ff .If 4i i,.. I .ff""' 'Ir I: ?t l4i I lff , .. I 11.jfi: ~ l!tii•1! l1i I 11i14il! ... I I ! I ; ; 4f * I ; Ii I! ~! ii rm i ~ ; t l ; ... l ;; if lloi, I I i' ( ~-1 ! !!1 ii i i • .-, N ..., ~ "' "' ,... .. "' ::l ::: ~ '=I~ ~~ rl ·ii t; ... If I "' l 1 ~ ,,~ I ~ i ~ii ~ I i l1t L; i . r I 70 THE GAZETTE OF INDIA : EXTRAORDINARY [P art III— S ec. 4] 70 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III-SEC. 4] . , r j J . , I i I Ii ~ ~ Q l: I It ii Ii ,I ii .i ~ ;! ii fffi J;t ~ t i ? >I; 11;' IN, ~- ~ I i;1' ~l,lf1 'ti.If I ~~ rlt t iiif Ii ii t i ~~ ::; ~ 21 ~ ... N ...... :Q ~ ~ is ~~ - N ~~ ~ .. il N N N N ...... r~ ~' ~! ~ i ~,i' lei; ;~«, ; r~ i'!I Iti ~1; j If. [*TFT III— ^ § - 4 ] < 71 [ 'IWT III-~ 4] 'TT«lcfil~:3ffill-.ITTUT 71 , . , : ' 1t-,f! Ill ~ If ,, t ! ! i ,fi l l-1r ii;J .. 1.; I ill .I-If ,le, ~ ~ i ; ri~ i~ hf!- ~11 ih i 'Ii i i I 1t?j!H ii'lfJi ~ ~ I IJ., itt ii ij ij i i II ~m:il ~ .. il ~1-!-- 11i I I-If 1i: * i- U\t i i i-! i-! ~!tt~i i~l ,~~m f~~ I • ... N .... • • t. . . . . . . . . . 72 THE GAZETTE OF INDIA : EXTRAORDINARY [ P a r t III— S ec. 4] < 4* 15i l l 1 f r ' i .1 Jy5 ) •M£ * l l i f t l « *to> f * i . 1 *5 - 7fr to totv 'i£ 41 t £ J *> 45i J f 1 ! r s i i t i ! i i f : * .1hr J - 7ff ‘-1s 1 IP ; a f * i .1 toJ rH e c ‘ ! 5#<1* l » * b i :* ' i . i& J - ? 5 1 ! 1 i 1 1 * i t 1 fe1 I ' 1 ET * u & E £ 5 / = p r * Ifr -TW 1 ‘ \ I I I J p I ! ! ! ! 1 dzw I & £ * H fN n rr ln u> 72 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III-SEC. 4) ( - ·, .. ~le t·Al <Ii t r~ 11l" ' ) ~-i4i 1-! r~ 11l .. i ..... r; -~ ., i cti 11; j I ~ !,i' ·! -Iii t• .. r ' I;. · iitr1! iii.: 1P t~•ilil" ;,f.1! 1i t~ 11l .. ·i, 1-1 1:- ' ,~~•i'i' .. .. .. "'ii .. ·I' i! ~: iJl 1 " ""i I ~ii i ~I j .. ~ i;f ' ; i i ( !E~~ " ... "' "' ., ..,, "' .. Jj I' ti elf ~ r:i; i i ~ ,, i ii Ii~!~ l .. I I~ ~I~~ i ,1~ JI ,,.~Ji I~ I! ! ~ ,i~ I .(! I "-' I I ~~~ t - a, VI ... w ...., .... - j 1~ ~ I :i ~·•1 I 1 ... - ~ ;1 j ' !! 1! .. Jt,~~ ~ iltU·4 I I .. Jt,~~ ill I • ~ I I rr • ~;, • g ~ + • !> ~-- .. Jt,~~ ~ ii' 1 ~ I I 4:1 II t!l' :j .. ~-~ -Gt + ...... fl hl!R~ : Jchlt-1) ~ illlli [ t> ~ - Ill Wh ] 74 THE GAZETTE OF INDIA : EXTRAORDINARY [P art III— S ec. 4] 74 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III-SEC. 4] t .. [WT. Ill— 4] *ntcT =FT TFsm ; 3TOTWT 75 [ 'llfll III-~ 4] ,:IT«! cfiT ~ : 3lm'l:ffi:UT 75 I 1i ~ . ~i ~ ~1 I ~ ~ i f I ii ~, ii ' ! i I c ~ ;~ ! l ID ,-... 00 a, 0 ... ::::l ro ~ :(l ID ,-... 00 gi ~;;; N ::i;,; ~ .. ...... ...... N N N N N ,.., 76 THE GAZETTE OF INDIA : EXTRAORDINARY [P art III— Se c . 4] INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY NOTIFICATION Hyderabad, the 16th February, 2013 Insurance Regulatory and Development Authority (Health Insurance) Regulations, 2013 F. No. IRDA/Reg./14/72/2013.—In exercise of the powers conferred under Section 114A o f the Insurance Act 1938 and Section 14 read with section 26 o f the 1RDA Act 1999 and in consultation with the Insurance Advisory Committee, the Authority hereby makes the following regulations, namely:- 1. Short title and commencement. a. These Regulations may be called Insurance Regulatory and Development Authority (Health Insurance) Regulations, 2013 b. They shall come into force from the date of their publication in the Official Gazette o f the Government o f India. c. Unless otherwise provided by this Regulation, nothing in this Regulation shall deem to invalidate the health insurance contracts entered prior to these Regulations coming into force d. These Regulations are applicable to all licensed life insurers, non-life insurers and health insurers, conducting health insurance business as defined under these regulations in India. 2. Definitions. In these Regulations, unless the context otherwise requires,~ a. “Act” means the Insurance Act, 1938. b. "Agreement" means an agreement prescribing the terms and conditions o f services, which may be rendered to the holders of health policies of an Insurance Company entered into between i. a Third Party Administrator (TPA) and an insurance company ; or ii. a Network provider and an Insurance Company, which may include a TPA as a third party. iii. a Network provider, a TPA, and the insurer. c. “Authority” means the Insurance Regulatory and Development Authority established under sub section 1 o f section 3 o f the IRDA Act 1999. d. “Break in policy” occurs at the end o f the existing policy term, when the premium due for renewal on a given policy is not paid on or before the premium renewal date or within 30 days thereof. e. “Cashless facility” means a facility extended by the insurer to the insured where the payments, of the costs o f treatment undergone by the insured in accordance with the policy terms and conditions, are directly made to the network provider by the insurer to the extent pre-authorization approved. f. “File and Use Procedure” means a procedure to be followed for health insurance product approval by the insurers in accordance with guidelines/circular issued by the Authority. g. “Health insurance business” or “health cover” means the effecting o f insurance contracts which provide for sickness benefits or medical, surgical or hospital expense benefits, including assured benefits and long-term care, travel insurance and personal accident cover. 76 THE GAZETTE OF INDIA : EXTRAORDINARY INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY NOTIFICATION Hyderabad, the 16th February, 2013 Insurance Regulatory and Development Authority (Health Insurance) Regulations, 2013 [PARr m- SEc. 4) F. No. IRDA/RegJt4n2/2013.-ln exercise of the powers conferred under Section 114A of the Insurance Act 1938 and Section 14 read with section 26 of the IRDA Act 1999 and in consultation with the Insurance Advisory Committee, the Authority hereby makes the following regulations, namely:- 1. Short title and commencement. a. These Regulations may be called Insurance Regulatory and Development Authority (Health Insurance) Regulations, 2013 b. They shall come into force from the date of their publication in the Official Gazette of the Government of India. c. Unless otherwise provided by this Regulation, nothing in this Regulation shall deem to invalidate the health insurance contracts entered prior to these Regulations coming into force d. These Regulations are applicable to all licensed life insurers, non-life insurers and health insurers, conducting health insurance business as defined under these regulations in India. 2. Definitions. In these Regulations, unless the context otherwise requires,-- a. "Act" means the Insurance Act, 1938. b. "Agreement" means an agreement prescribing the terms and conditions of services, which may be rendered to the holders of health policies of an Insurance Company entered into between i. a Third Party Administrator (TPA) and an insurance company ; or ii. a Network provider and an Insurance Company, which may include a TPA as a third party. iii. a Network provider, a TPA, and the insurer. c. "Authority" means the Insurance Regulatory and Development Authority established under sub section I of section 3 ofthe IRDA Act 1999. d. "Break in policy" occurs at the end of the existing policy term, when the premium due for renewal on a given policy is not paid on or before the premium renewal date or within 30 days thereof. e. "Cashless facility" means a facility extended by the insurer to the insured where the payments, of the costs of treatment undergone by the insured in accordance with the policy terms and conditions, are directly made to the network provider by the insurer to the extent pre-authorization approved. f. "File and Use Procedure" means a procedure to be followed for health insurance product approval by the insurers in accordance with guidelines/circular issued by the Authority. g. "Health insurance business" or "health cover" means the effectifig of insurance contracts which provide for sickness benefits or medical, surgical or hospital expense benefits, including assured benefits and long-term care, travel insurance and personal accident cover. [•RFT III— 4 ] 77 h. "Health Services by TPA" means the services rendered by a TPA to an insurer under an agreement in connection with health insurance business but does not include the business o f an insurance company or the soliciting either directly or indirectly, o f health insurance business or deciding on the admissibility o f a claim or its rejection. i. “Health plus Life Combi Products” mean products which offer the combination o f a Pure Term Life Insurance cover o f a life insurance companies and a Health Insurance cover offered by non-life and/or standalone health insurance companies. j. “Network Provider” means hospitals or health care providers enlisted by an insurer or by a TPA and insurer together to provide medical services to an insured on payment by a cashless facility. k. “Portability” means the right accorded to an individual health insurance policyholder (including family cover), to transfer the credit gained for pre-existing conditions and time bound exclusions, from one insurer to another insurer or from one plan to another plan o f the same insurer, provided the previous policy has been maintained without any break. 1. “Senior citizen” means any person who has completed sixty or more years o f age as on the date of commencement dr renewal of a health insurance policy. m. “Third Party Administrators or TPA means any person who is licensed under the IRDA (Third Party Administrators - Health Services) Regulations,2001 by the Authority, and is engaged, for a fee or remuneration by an insurance company, for the purposes o f providing health services. n. All words or expressions not defined in these Regulations but defined in the Insurance Act 1938 or Insurance Regulatory and Development Authority Act 1999 shall have the same meanings respectively assigned to them in those Acts. 3. Registration and Scope of Health Business a. Health Insurance products may be offered only by entities with a valid registration under the Insurance Regulatory and Development Authority (Registration o f Indian Insurance Companies) Regulations 2001. b. Life Insurance Companies may offer long term health products but the premium for such products shall remain unchanged for at least a period of every block o f three years, thereafter the premium may be reviewed and modified as necessary. , c. Non-Life and Standalone Health insurance companies may offer individual health products with a minimum tenure o f one year and a maximum tenure o f three years, provided that the premium shall remain unchanged for the tenure. d. Group Health Insurance Policies may be offered by any insurance company, provided that all such products shall only be one year renewable contracts. However, the non-life and standalone health insurers may offer group personal accident products with term less than one year also to provide coverage to any specific events. e. Overseas or Domestic Travel Insurance policies may only be offered by non-life and standalone health insurance companies, either as a standalone product or as an add-on cover to an existing health policy, provided that the premium for the add-on cover is approved by the Authority under File And Use Procedure. 4. File and Use Procedure for health insurance products a. No health insurance product shall be marketed by any insurer unless it has the prior clearance o f the Authority accorded as per the File and Use Procedure. b. Any subsequent revision or modification o f any approved health insurance product shall also require the prior clearance o f the Authority as per the guidelines issued from time to time. i. Any revision or modification in a policy which is approved by the Authority shall be notified to each policy holder at least three months prior to the date when such revision or modification conies into effect. The notice shall set out the reasons for such revision or modification, in particular the reason for an increase in premium and the quantum o f such increase. ii. The possibility a revision or modification o f the terms o f the policy including the premium must be disclosed in the prospectus. c. File & Use application for the prior approval of the Authority shall be certified by the Appointed Actuary and the CEO o f the insurance company and shall be in such formats and accompanied by such documentation as may be stipulated by the Authority from time to time. I ............ ■ • ■ . . • - ...I:.. ■ . .:... // Tl h. "Health Services by TPA" means the services rendered by a TPA to an insurer under an agreement in connection with health insurance business but does not include the business of an insurance company or the soliciting either directly or indirectly, of health insurance business or deciding on the admissibility of a claim or its rejection. i. "Health plus Life Combi Products" mean products which offer the combination of a Pure Term Life Insurance cover of a life insurance companies and a Health Insurance cover offered by non-life and/or standalone health insurance companies. j. "Network Provider" means hospitals or health care providers enlisted by an insurer or by a TPA and insurer together to provide medical services to an insured on payment by a cashless facility. k. "Portability" means the right accorded to an individual health insurance policyholder (including family cover), to transfer the credit gained for pre-existing conditions and time bound exclusions, from one insurer to another insurer or from one plan to another plan of the same insurer, provided the previous policy has been maintained without any break. I. "Senior citizen" .rieans any person who has completed sixty or more years of age as on the date of commencement or renewal ofa health insurance policy. m. "Third Party Administrators or TP A means any person who is licensed under the !RDA (Third Party Administrators - Health Services) Regulations,2001 by the Authority, and is engaged, for a fee or remuneration by an insurance company, for the purposes of providing health services. n. All words or expressions not defined in these Regulations but defined in the Insurance Act 1938 or Insurance Regulatory and Development Authority Act 1999 ~hall have the same meanings respectively assigned to them in those Acts. 3. Registration and Scope of Health Business a. Health Insurance products may be offered only by entities with a valid registration under the Insurance Regulatory and Development Authority (Registration of Indian Insurance Companies) Regulations 200 I. b. Life Insurance Companies may offer long tenn health products but the premium for such products shall remain unchanged for at least a period of every block of three years, thereafter the premium may be reviewed and modified as necessary. , c. Non-Life and Standalone Health insurance companies may offer individual health products with a minimum tenure of one year and a maximum tenure of three years, provided that the premium shall remain unchanged for the tenure. d. Group Health Insurance Policies may be offered by any insurance company, provided that all such products shall only be one year renewable contracts. However, the non-life and standalone health insurers may offer group personal accident products with term less than one year also to provide coverage to any specific events. e. Overseas or Domestic Travel Insurance policies may only be offered by non-life and standalone health insurance companies, either as a standalone product or as an add-on cover to an existing health policy, provided that the premium for the add-on cover is approved by the Authority under File And Use Procedure. 4. File and Use Procedure for health insurance products a. b. No health insurance product shall be marketed by any insurer unless it has the prior clearance of the Authority accorded as per the File and Use Procedure. Any subsequent revision or modification of any approved health insurance product shall also require the prior clearance of the Authority as per the guidelines issued from time to time. 1. Any revision or modification in a policy which is approved by the Authority shall be notified to each policy holder at least three months prior to the date when such revision or modification comes into effect. The notice shall set out the reasons for such revision or modification. in particular the reason for an increase in premium and the quantum of such increase. 11. The possibility a revision or modification of the terms of the policy including the premium must be disclosed in the prospectus. c. File & Use application for the prior approval of the Authority shall be certified by the Appointed Actuary and the CEO of the insurance company and shall be in such fonnats and accompanied by such documentation as may be stipulated by the Authority from time to time. I J 78' THE GAZETTE OF INDIA : EXTRAORDINARY [I^art III— S e c . 4] d. Withdrawal of Health Insurance Product i. To withdraw a health insurance product, the insurer shall take prior approval o f the Authority by giving reasons for withdrawal and complete details o f the treatment to the existing - policyholders. ii. The policy document shall clearly indicate the possibility o f withdrawal o f the products in the future and the options that would be available to the policyholder on withdrawal of the products. iii. If the existing customer does not respond to the insurer’s intimation, the policy shall be withdrawn on the renewal date and the insured shall have to take a new policy available with the insurer, subject to portability conditions. iv. The withdrawn product shall not be offered to the prospective customers. e. All particulars of any product shall after introduction be reviewed by the Appointed Actuary at least once a year. If the product is found to be financial unviable, or is deficient in any particular the Appointed Actuary may revise the product appropriately and apply for revision under File and Use procedure. f. Five years after a product has been accorded File and Use approval, the Appointed Actuary shall review the performance o f the product in terms of morbidity, lapse, interest rates, inflation, expenses an^ other relevant particulars as compared to the original assumptions made while designing such product and seek fresh approval with suitable justifications or modifications o f the earlier assumptions made. 5. General Provisions relating to Health Policies j a. Health insurance product may be designed to offer various covers i. To specified age or gender groups ii. To different age groups iii. To treatment in all hospitals throughout the country, provided the definition o f hospital is met iv. To treatment in specified hospitals only, provided the morbidity rates used are representative v. To treatment in specified geographies only, provided the morbidity rates used are representative etc i provided, such specifications are disclosed upfront and clearly in the product prospectus, documents and sale process. b. Insurer shall not compel the insured to migrate to other health insurance products, if it is to the disadvantage o f insured. c. Insurers shall ensure adequate dissemination of product information on all their health insurance products on their websites. This information shall include a description o f the product, copies o f the prospectus as approved under the File and Use Procedure, proposal form, policy document wordings and premium rates inclusive and exclusive o f Service Tax as applicable. d. Nomination and Assignment i. All health insurance policies shall provide for a nomination registered at the time of the proposal in accordance with Section 39 o f the Insurance Act, 1938. ii. No assignment o f health insurance policies shall be allowed irrespective of whether the coverage provided under such policies are indemnity based or benefit based. Provided that, in Life-Health Combi products, assignment may be allowed only for the life insurance component o f the product in accordance with Section 38 o f the Insurance Act, 1938. e. Entry and Exit Age i. Except as provided for in regulation j, all health insurance policies shall ordinarily provide for an entry age o f at least up to 65 years. 78' THE GAZETTE OF INDIA : EXTRAORDINARY [PART III-SEC. 4] d. Withdrawal of Health lnsunrnrc Product i. To withdraw a health insurance product, the insurer shall take prior approval of the Authority by giving reasons for withdrawal and complete details of the treatment to the existing , policyholders. ii. The policy document shall clearly indicate the possibility of withdrawal of the products in the future and the options that would be available to the policyholder on withdrawal of the products. iii. If the existing customer does not respond to the insurer's intimation, the policy shall be withdrawn on the renewal date and the insured shall have to take a new policy avail~le with the insurer, subject to pottability conditions. iv. The withdrawn product shall not be offered to the prospective customers. e. All particulars of any product shall after introduction be reviewed by the Appointed Actuary at least once a year. If the product is found to be financial unviable, or is peficient in any particular the Appointed Actuary may revise the product appropriately and apply for revision under File and Use procedure. f. Five years after a product has been accorded File and Use approval, the Appointed Actuary shall review the performance of the product in terms of morbidity, lapse, interest rates, inflation, expenses andj other relevant particulars as compared to the original assumptions made while designing such product and seek fresh approval with suitable justifications or modifications of the earlier assumptions made. 5. Ge~eral Provisions relating to Health Policies a. Health insurance product may be designed to offer various covers i. To specified age or gender groups ii. To different age groups iii. To treatment in all hospitals throughout the country, provided the definition of hospital is met 1v. To treatment in specified hospitals only, provide~ the morbidity rates used are representative v. To treatment in specified geographies only, provided the morbidity rates used are representative etc provided, such specifications are disclosed upfront and cle~rly in the product prospectus, documents and sale process. b. Insurer shall not compel the insured to migrate to other health insurance products, if it is to the disadvantage of insured. c. Insurers shall ensure adequate dissemination of product information on all their health insurance products on their websites. This information shall include a description of the product, copies of the prospectus as approved under the File and Use Procedure, proposal form, policy document wordings and premium rates inclusive and exclusive of Service Tax as applicable. d. Nomination and Assignment 1. All health insurance policies shall provide for a nomination registered at the time of the proposal in accordance with Section 39 of the Insurance Act, 1938. 11. No assignment of health insurance policies shall be allowed irrespective of whether the coverage provided under such policies are indemnity based or benefit based. Provided that, in Life-Health Combi products, assignment may be allowed only for the life insurance component of the product in accordance with Section 38 of the Insurance Act, 1938. e. Entry and Exit Age i. Except as provided for in regulation j, all health insurance policies shall ordinarily provide for an entry age of at least up to 65 years. • [ ’TFT III— 4] nrer ^ t TT3TO : smrwm 79 ii. Except travel insurance products and for products in accordance with Regulation j and 4 (d) herein, once a proposal is accepted and a policy is issued which is thereafter renewed periodically without any break, further renewal shall not be denied on grounds p f the age o f the insured. f. Renewal of Policies i. A health insurance policy shall ordinarily be renewable except on grounds o f fraud, moral hazard or misrepresentation or non-cooperation by the insured. ii. The renewal o f a health insurance policy sought by the insured shall not be denied arbitrarily. If denied, the insurer shall provide the policyholder with cogent reasons for such denial of renewal. iii. A insurer shall not deny the renewal o f a health insurance policy on the ground that the insured had made a claim or claims in the previous or earlier years, except for benefit based policies where the policy terminates following payment o f the benefit covered under the policy like critical illness policy following payment o f the critical illness benefit, the policy terminates. iv. The insurer shall provide for a mechanism to condone a delay in renewal up to 30 days from the due date o f renewal without deeming such condonation as a break in policy. However coverage need not be available for such period. v. The promotion material and the policy document shall explicitly state the conditions under which a policy terminates, such as on the payment o f the benefit in case o f critical illness benefits policies. g. Free Look Period i. All Health insurance Policies shall have a free look period. The free look period shall be applicable at the inception of the policy and: 1. The insured will be allowed a period o f at least 15 days from the date o f receipt o f the policy to review the terms and conditions o f the policy and to return the same if not acceptable 2. If the insured has not made any claim during the free look period, the insured shall be entitled to- a. A refund o f the premium paid less any expenses incurred by the insurer on medical examination o f the insured persons and the stamp duty charges or; b. where the risk has already commenced and the option o f return of the policy is exercised by the policyholder, a deduction towards the proportionate risk premium for period on cover or; c. Where only a part o f the risk has commenced, such proportionate risk premium commensurate with the risk covered during such period. d. In respect o f unit linked policy, in addition to the above deductions, the insurer shall also be entitled to repurchase the unit at the price o f the units as on the date o f the return o f the policy. /" h. Cost of pre-insurance health check up i. The cost o f any pre-insurance medical examination shall generally form part o f the expenses allowed in arriving at the premium. However in case o f products with term o f one year and less, if such cost is to be incurred by the insured, not less than 50% o f such cost shall be borne by the insurer once the proposal is accepted, except in travel insurance policies where such costs need not be reimbursed. ii. Except travel insurance products and for products in accordance with Regulation j and 4 (d) herein, once a proposal is accepted and a policy is issued which is thereafter renewed periodically without any break, further renewal shall not be denied on grounds (>fthe age of the insured. f. Renewal of Policies i. A health insurance policy shall ordinarily be renewable except on grounds of fraud, moral hazard or misrepresentation or non-cooperation by the insured. ii. The re!1~wal of a health insurance policy sought by the insured shall not be denied arbitrarily. If denied, the insurer shall provide the policyholder with cogent reasons for such denial of renewal. 111. A insurer shall not deny the renewal of a health insurance policy on the ground that the insured had made a claim or claims in the previous or earlier years, except for benefit based policies where the policy terminates following payment of the benefit covered under the policy like critical illness policy following payment of the critical illness benefit, the policy terminates. 1v. The insurer shall provide for a mechanism to condone a delay in renewal up to 30 days from the due date of renewal without deeming such condonation as a break in policy. However coverage need not be available for such period. v. The promotion material and the policy document shall explicitly state the conditions under which a policy terminates, such as on the payment of the benefit in case of critical illness benefits policies. g. Free Look Period i. All Health insurance Policies shall have a free look period. The free look period shall be applicable at the inception of the policy and: I. The insured will be allowed a period of at least 15 days from the date of receipt of the policy to review the terms and conditions of the policy and to return the same if not acceptable 2. If the insured has not made any claim during the free look period, the insured shall be entitled to- a. A refund of the premium paid less any expenses incurred by the insurer on medical examination of the insured persons and the stamp duty charges or; b. where the risk has already commenced and the option of return of the policy is exercised by the policyholder, a deduction towards the proportionate risk premium for period on cover or; c. Where only a part of the risk has commenced, such proportionate risk premium commensurate with the risk covered during such period. d. In respect of unit linked policy, in addition to the above deductions, the insurer shall also be entitled to repurchase the unit at the price of the units as on the date of the return of the policy. ( h. Cost of pre-insurance health check up i. The cost of any pre-insurance medical examination shall generally form part of the expenses allowed in arriving at the premium. However in case of products with term of one year and less, if such cost is to be incurred by the insured, not less than 50% of such cost shall be borne by the insurer once the proposal is accepted, except in travel insurance policies where such costs need not be reimbursed. 79 80 THE GAZETTE OF INDIA : EXTRAORDINARY [Part III— S e c. 4] ------i,------------------------- ii. Insurers shall maintain a list of, and the fees chargeable by, institutions where such pre­ insurance medical examination may be conducted, the reports from which will be accepted by them. Such list shall be furnished to the prospective policyholder at the time o f pre-insurance medical examination. i. Cumulative bonus i. Insurers may offer cumulative bonuses on indemnity based health insurance policies, which shall be stated explicitly in the prospectus and the policy document. ii. If a claim is made in any particular year, the cumulative bonus accrued may be reduced at the same rate at which it is accrued; f iii. Cumulative bonus shall not be allowed on benefit based policies, j. Option to migrate to suitable health insurance policy i. Insurers offering health covers specific to age groups such as maternity covers, children under family floater policies, students etc, shall offer an option to migrate to a suitable health insurance policy at the end o f the specified exit age or at the renewal of the policy by providing suitable credits for all the previous policy years, provided the policy has been maintained without a break. f k. All health insurance policies shall allow the portability o f any policy in accordance with Schedule: 1 1 1. AYUSH Coverage: i. Insurers may provide coverage to non-allopafhic treatments provided the treatment has been undergone in a government hospital or in any institute recognized by government and/or accredited by Quality Council of India/National Accreditation Board on Health or any other suitable institutions. ii. For benefit based products, (i) shall not be applicable, ni. Disclosures/Declarations: i. Subject to the' provisions of these regulations, prospectus o f health insurance policy shall mandatorily contain all the information regarding: * 1. disclosures about the terms o f its renewal. 2. coverage and premium applicable as per the 'age progression 3. disclosure o f the maximum age up to when the renewal would be available, if product is offered to specified age groups and the option available to migrate to other policies in all such cases. 4. any changes in the scope o f the cover after certain duration o f the policy or after a certain age- such as including but not limited to coverage for pre-existing diseases; 5. whether renewal premium would be guaranteed or subject to revision; 6. details o f specific circumstances, if any. where premium could be loaded (or discount withdrawn) by the insurer and also to the extent to which it could be done; 7. procedure and terms for enhancing the sum insured or scope of cover, if any; 8. all the exclusions, cancellation conditions and 9. other aspects in accordance with the extant regulations, guidelines, circulars etc on advertisements and disclosure requirements. 80 THE GAZETTE OF INDIA : EXTRAORDINARY [PP,RT III- SEC. 4] ii. Insurers shall maintain a list of, and the fees chargeable by, institutions where such pre- insurance medical examination may be conducted, the reports from which will be accepted by them. Such list shall be furnished to the prospective policyholder at the time of pre:insurance medical examination. i. Cumulative bonus 1. Insurers may offer cumulative bonuses on indemnity based health insurance policies, which shall be stated explicitly in the prospectus and the policy document. ii. If a claim is made in any particular year, the cumulative bonus accrued may be reduced at the same rate at which it is accrued; iii. Cumulative bonus shall not be allowed on benefit based policies. j. Option to migrate to suitable health insurance policy 1. Insurers offering health covers specific to age groups such as maternity covers, children under family floater policies, students etc, shall offer an option to migrate to a suitable health insurance policy at the end of the specified exit age or at the renewal of the policy by providing suitable credits for all the previous policy years, provided the policy has been maintained without a break. r k. All health insurance policies shall allow the portability of any policy in accordance with Schedule: 1 I. A YUSH Coverage: 1. Insurers may provide coverage to non-allopafhic treatments provided the treatment has been undergone in a government hospital or in any institute recognized by government and/or accredited by Quality Council of India/National Accreditation Board on Health or any other suitable institutions. 11. For benefit based products, (i) sh al I not be applicable. m. Disclosures/Declarations: 1. Subject to the provisions of these regulations, prospectus of health insurance policy shall mandatorily contain all the information regarding: ' 1. disclosures about the terms of its renewal. 2. coverage and premium applicable a'i per the •age progression 3. disclosure of the maximum age up to when the renewal would be available, if product is offered to specified age groups and the option available to migrate to other policies in all such cases. 4. any changes in the scope of the cover after certain duration of the policy or alter a ce1tain age- such as including but not limited to coverage for pre-existing diseases; 5. whether renewal premium would be guaranteed or subject to revision; 6. details of specific circumstances, if any. where premium could be loaded (or discount withdrawn) by the insurer and also to the extent to which it could be done; 7. procedure and terms for enhancing the sum insured or scope of cover, if any; 8. all the exclusions. cancellation conditions and 9. other aspects in accordance with the extant regulations, guidelines, circulars etc on advertisements and disclosure requirements. • .. [ * F T III— ' 4 ] W T R T ? : 3TO TW T 8! ii. Declarations shall only form part o f the proposal form and shall not be included in the policy document. The standard declarations in the proposal form shall be: I “I/We hereby declare, on my behalf and on behalf o f all persons proposed to be insured, that the above statements, answers and/or particulars given by me are true and complete in all respects to the best o f my knowledge and that I/We am/are authorized to propose on behalf o f these other persons. 2. I understand that the information provided by me will form the basis o f the insurance policy, is subject to the Board approved underwriting policy o f the insurance company and that the policy will come into force only after full receipt o f the premium chargeable. 3. I/We further declare that I/we will notify in writing any change occurring in the occupation or general health o f the life to be insured/proposer after the proposal has been submitted but before communication o f the risk acceptance by the company. 4. I/We declare and consent to the company seeking medical information from any doctor or from a hospital who at anytime has attended on the life to be insured/proposer or from any past or present employer concerning anything which affects the physical or mental health o f the life to be assured/proposer and seeking information from any insurance company to which an application for insurance on the life to be assured/proposer has been made for the purpose o f underwriting the proposal and/or claim settlement. 5. I/We authorize the company to share information pertaining to my proposal including the medical records for the sole purpose o f proposal underwriting and/or claims settlement and with any Governmental and/or Regulatory authority.” n. Standard Definition of terms in health insurance policies i. Phrases and terms used in all health insurance policies shall carry the meaning attached to them as set out in ‘Standard Definitions’, if any, issued by the Authority from time to time. o. Standard Nomenclature and Procedures for Critical Illnesses i. The nomenclature and procedures incorporated into policies offering ‘critical illness cover’ shall be as defined by the Authority from time to time. p. Standard List of Excluded Expenses in Hospitalization Indemnity policies i. Hospitalization indemnity policies shall generally exclude from cover the Standard list o f excluded items as may be stipulated by the Authority from time to time. ii. However insurers may offer to cover as part o f hospitalization expenses, items in the Standard excluded list or exclude items not in the list, provided that such modification is shall clearly stated and such modified list is annexed to the policy document. q. Special Provisions for Insured Persons who are Senior Citizens i. The premium charged for health insurance products offered to senior citizens shall be fair, justified, transparent and duly disclosed upfront. The insured shall be informed in writing o f any underwriting loading charged over and above the premium and the specific consent o f the policyholder for such loadings shall be obtained before issuance o f a policy. ii. All health insurers and TPAs, as the case may be, shall establish a separate channel to address the health insurance related claims and grievances o f senior citizens. r. Multiple Policies i. If two or more policies are taken by an insured during a period from one or more insurers, the contribution clause shall not be applicable where the cover/benefit offered: 6 6 ° • [ ~WT III- (9U.S 4] ii. Declarations shall only form part of the proposal form and shall not be included in the pol icy document. The standard declarations in the proposal form shall be: ,., "I/We hereby declare, on my behalf and on behalf of all persons proposed to be insured. that the above statements, answers and/or particulars given by me are true and complete in all respects to the best of my knowledge and that I/We am/are authorized to propose on behalf of these other persons. I understand that the information provided by me will form the basis of the insurance policy, is subject to the Board approved underwriting policy of the insurance company and that the policy will come into force only after full receipt of the premium chargeable. 3. I/We further declare that I/we will notify in writing any change occurring in the occupation or general health of the life to be insured/proposer after the proposal has been submitted but before communication of the risk acceptance by the company. 4. I/We declare and consent to the company seeking medical information from any doctor or from a hospital who at anytime has attended on the life to be insured/proposer or from any past or present employer concerning anything which affects the physical or mental health of the life to be assured/proposer and seeking information from any insurance company to which an application for insurance on the life to be assured/proposer has been made for the purpose of underwriting the proposal and/or claim settlement. 5. I/We authorize the company to share information pertaining to my proposal including the medical records for the sole purpose of proposal underwriting and/or claims settlement and with any Governmental and/or Regulatory authority." 81 n. Standard Definition of terms in health insurance policies 1. Phrases and terms used in all health insurance policies shall carry the meaning attached to them as set out in 'Standard Definitions', if any, issued by the Authority from time to time. o. Standard Nomenclature and Procedures for Critical Illnesses i. The nomenclature and procedures incorporated into policies offering 'critical illness cover' shall be as defined by the Authority from time to time. p. Standard List of Excluded Expenses in Hospitalization Indemnity policies i. Hospitalization indemnity policies shall generally exclude from cover the Standard list of excluded items as may be stipulated by the Authority from time to time. 11. However insurers may offer to cover as part of hospitalization expenses, items in the Standard excluded list or exclude items not in the list, provided that such modification is shall clearly stated and such modified list is annexed to the policy document. q. Special Provisions for Insured Persons who are Senior Citizens i. The premium charged for health insurance products offered to senior citizens shall be fair, justified, transparent and duly disclosed upfront. The insured shall be informed in writing of any unden"riting loading charged over and above the premium and the specific consent of the policyholder for such loadings shall be obtained before issuance ofa policy. ii. All health insurers and TPAs, as the case may be, shall establish a separate channel to address the health insurance related claims and grievances of senior citizens. r. Multiple Policies i. lftwo or more policies are taken by an insured during a period from one or more insurers, the contribution clause shall not be applicable where the cover/benefit offered: f6° Gt/ ri - ..21 82 THE GAZETTE OF INDIA : EXTRAORDINARY [P art III— S ec. 4] 1. is fixed in nature; 2. does not have any relation to the treatment costs; ii. In case o f multiple policies which provide fixed benefits, on the occurrence o f the insured event in accordance with the terms and conditions o f the policies, the insurer shall make the claim payments independent o f payments received under other similar polices. iii. If two or more policies are taken by an insured during a period from one or more insurers to indemnify treatment costs, the insurer shall not apply the contribution clause, but the policyholder shall have the right to require a settlement o f his claim in terms of any o f his policies. 1. In all such cases the insurer who has issued the chosen policy shall be obliged to settle the claim without insisting on the contribution clause as long as the claim is within the limits o f and according to the terms o f the chosen policy. 2. If the amount to be claimed exceeds the sum insured under a single policy after considering the deductibles or co-pay, the policy holder shall have the right to choose insurers by whom the claim to be settled. In such cases, the insurer may settle the claim with contribution clause. 3. Except in benefit policies, in cases where an insured has policies from more than one insurer to cover the same risk on indemnity basis, the insured shall only be indemnified the hospitalization costs in accordance with the terms and conditions of the policy. 6. Underwriting a. All Insurance Company’s shall evolve a Health Insurance Underwriting Policy which shall be approved by the Board o f the Company. The policy should among other matters prescribe the proposal form in which prospects may apply for purchasing a Health Policy. Such form should capture all the information necessary to underwrite a proposal in accordance with the stated Policy of the Company. b. The Underwriting Policy shall be filed with the Authority. The Company retains the right to modify the Policy as it deems necessary, but every modification shall also be filed with the Authority. c. Any proposal for health insurance may be accepted or denied wholly based on the Board approved underwriting policy. A denial o f a proposal shall be communicated to the prospect in writing, recording the reasons for denial. d. The insured shall be informed o f any underwriting loading charged over and above the premium and the specific consent o f the policyholder for such loadings shall be obtained before issuance of a policy. e. If an insurance company requires any further information, such as change o f occupation, at any subsequent stage o f a policy or at the time of its renewal, it shall i. prescribe standard forms to be filled up by the insured and shall make these forms part o f the policy document ii. Clearly state the events which will require the submission o f such information. iii. Clearly state the conditions applicable in such event. f. Insurers may devise mechanisms or incentives to reward policyholders for early entry, continued renewals, favourable claims experience etc with the same insurer and disclose upfront such mechanism or incentives in the prospectus and the policy document, as approved under File and Use. 7. Principles of Pricing of Health Insurance Products a. The premium for a health insurance policy shall be based on, i. for individual policies, the completed age of the prospect on the date o f inception of the policy or on the date o f its renewal.. THE GAZETTE OF INDIA : EXTRAORDINARY [PART Ill- -SEC. 4] I . is fixed in nature; 2. does not have any relation to the treatment costs; 11. In case of multiple policies which provide fixed benefits, on the occurrence of the insured event in accordance with the terms and conditions of the policies, the insurer shall make the claim payments independent of payments received under other similar polices. 111. If two or more policies are taken by an insured during a period from one or more insurers to indemnify treatment costs, the insurer shall not apply the contribution clause, but the policyholder shall have the right to require a settlement of his claim in terms of any of his policies. 6. Underwriting I. In all such cases the insurer who has issued the chosen policy shall be obliged to settle the claim without insisting on the contribution clause as long as the claim is within the limits of and according to the terms of the chosen policy. 2. If the amount to be claimed exceeds the sum insured under a single policy after considering the deductibles or co-pay, the policy holder shall have the right to choose insurers by whom the claim to be settled. In such cases, the insurer may settle the claim with contribution clause. 3. Except in benefit policies, in cases where an insured has policies from more than one insurer to cover the same risk on indemnity basis, the insured shall only be indemnified the hospitalization costs in accordance with the terms and conditions of the policy. a. All Insurance Company's shall evolve a Health Insurance Underwriting Policy which shall be approved by the Board of the Company. The policy should among other matters prescribe the proposal form in which prospects may apply for purchasing a Health Policy. Such form should capture all the information necessary to underwrite a proposal in accordance with the stated Policy of the Company. b. The Underwriting Policy shall be filed with the Authority. The Company retains the right to modify the Policy as it deems necessary, but every modification shall also be filed with the Authority. c. Any proposal for health insurance may be accepted or denied wholly based on the Board approved underwriting policy. A denial of a proposal shall be communicated to the prospect in writing, recording the reasons for denial. ct. The insured shall be informed of any underwriting loading charged over and above the premium and the specific consent of the policyholder for such loadings shall be obtained before issuance of a policy. e. If an insurance company requires any further information, such as change of occupation, at any subsequent stage of a policy or at the time of its renewal, it shall 1. prescribe standard forms to be filled up by the insured and shall make these forms part of the policy document ii. Clearly state the events which will require the submission of such information. 111. Clearly state the conditions applicable in such event. f. Insurers may devise mechanisms or incentives to reward policyholders for early entry, continued renewals, favourable claims experience etc with the same insurer and disclose upfront such mechanism or incentives in the prospectus and the policy document, as approved under File and Use. 7. Principles of Pricing of Health Insurance Products a. The premium for a health insurance policy shall be based on, i. for individual policies, the completed age of the prospect on the date of inception of the policy or on the date of its renewal.. • [ ’TFT III—'0 ^ 4] *tKcT TTJTClf : 3TOTWJT 83 ii. for provision o f cover under family floater, the impact o f the multiple incidence rates o f all family members proposed to be covered. b. . The policy premiums shall be unchanged i. for all group products and travel insurance products, for the entire period o f cover. ii. for all individual and family floater products, other than travel insurance products, for at least: 1. a period o f one year in case of one year renewable policies and 2. for the period o f the tenure as stipulated in Regulations 3 (b) and 3(c) herein in the case o f multi-year policies.. c. For a period o f three years after a product has been cleared under File and Use Procedure the premiums filed shall ordinarily not be changed. Thereafter the insurer may vary the premium rates depending on the experience, such rate shall not be changed for a period of at least one year from the date o f clearance from the Authority. d. Changes in rates will be applicable from the date of approval by the Authority and shall be applied only prospectively thereafter for new policies and at the date o f renewal for renewals. e. The reasonableness of the pricing as arrived at by the insurer will be assessed having regard to the financial sustainability and viability o f the product with respect to the rates, loadings, guarantees and discounts, and the accuracy o f the assumptions underlying the pricing model adopted. f. At the time o f filing the product under the File and Use procedure, the insurer shall provide: i. complete pricing details including the methodology adopted to arrive at the premiums, together with the data sources utilized; ii. assumptions made shall include the expected claim frequency and claim severities across age bands, expected expenses, lapse rates etc; iii. specific loadings, if any, allowed; iv. the profit margin at various model points or the expected loss ratios and the expected combined ratios across various model points across the entire portfolio; v. the underwriting capacity required for the product and the actual capacity available with the insurer; vi. the retention capacity to manage the business vii. internal capacity building measures, if any, required to offer the proposed product and viii. any other relevant metric for the product proposed. g. Applications for revision o f premium rates shall be filed before the Authority for approval under the File and Use Procedure and shall encompass i. the justification for the revision in price; ii. the claims experience of the three immediately preceding years compared to the expected experience duly explaining the variations, and the experience o f any similar product. iii. the expected claims experience, the assumptions underlying the proposed pricing along with an analysis o f how the proposed pricing would address the adversities experienced sustainably. h. Loadings on Renewals: i. The loadings on renewals shall be in terms of increase or decrease in premiums offered for the entire portfolio and shall not be based on any individual policy claim experience. ['IWT Ifl- ~ 4] ii. for provision of cover under family floater, the impact of the multiple incidence rates of all family members proposed to be covered. b. . The policy premiums shall be unchanged i. for all group products and travel insurance products, for the entire period of cover. 11. for all individual and family floater products, other than travel insurance products, for at least: I. a period of one year in case of one year renewable policies and 2. for the period of the tenure as stipulated in Regulations 3 (b) and 3(c) herein in the case of multi-year policies .. c. For a period of three years after a product has been cleared under File and Use Procedure the premiums filed shall ordinarily not be changed. Thereafter the insurer may vary the premium rates depending on the experience, such rate shall not be changed for a period of at least one year from the date of clearance from the Authority. d. Changes in rates will be applicable from the date of approval by the Authority and shall be applied only prospectively thereafter for new policies and at the date of renewal for renewals. e. The reasonableness of the pricing as arrived at by the insurer will be assessed having regard to the financial sustainability and viability of the product with respect to the rates, loadings, guarantees and discounts, and the accuracy of the assumptions underlying the pricing model adopted. f. At the time of filing the product under the File and Use procedure, the insurer shall provide: i. complete pricing details including the methodology adopted to arrive at the premiums, together with the data sources utilized; ii. assumptions made shall include the expected claim frequency and claim severities across age bands, expected expenses, lapse rates etc; 111. specific loadings, if any, allowed; iv. the profit margin at various model points or the expected loss ratios and the expected combined ratios across various model points across the entire portfolio; v. the underwriting capacity required for the product and the actual capacity available with the insurer; vi. the retention capacity to manage the business vii. internal capacity building measures. if any, required to offer the proposed product and v111. any other relevant metric for the product proposed. g. Applications for revision of premium rates shall be filed before the Authority for approval under the File and Use Procedure and shall encompass i. the justification for the revision in price; 11. the claims experience of the three immediately preceding years compared to the expected experience duly explaining the variations, and the experience of any similar product. 111. the expected claims experience, the assumptions underlying the proposed pricing along with an analysis of how the proposed pricing would address the adversities experienced sustainably. h. Loadings on Renewals: 1. The loadings on renewals shall be in terms of increase or decrease in premiums offered for the entire portfolio and shall not be based on any individual policy claim experience. 83 84 THE GAZETTE OF INDIA : EXTRAORDINARY [P art III— S e c . 4 ] ii. The discounts and loadings offered shall: 1. not be at the discretion of the insurer; 2. be based on an objective criteria; 3. be disclosed upfront in the prospectus and policy document along with the objective criteria, and shall be as approved under the File and Use. i. Upper Limit/Maximum Cover offered under a contract: i. If in a benefit based health insurance policy the insurer has prescribed any upper limit for any specified benefit or cover, the insurer shall not accept any proposal for a cover beyond such upper limit, unless the premium for such cover is separately charged. ii. Complete pricing details on how such inbuilt limits are considered in arriving at the total premium shall be provided under the File and Use. iii. If any proposal is accepted beyond such upper limit, the insurer shall not deny a claim on the ground that the policy exceeds the upper limit prescribed for that policy. iv. However, the insurer may cancel the cover beyond such upper limit and shall return the proportionate premium, provided that 1. the policyholder, at the time o f proposal, has not disclosed the existing and simultaneous policy details in the proposal form and 2. the existence o f such policy is revealed only subsequently resulting in the cover accepted beyond the upper limit, and 3. Such other policy has been underwritten by another insurance company. 8. Protection of Policyholders’ Interest a. Unless otherwise provided, the IRDA (Policyholder Protection o f Interest) Regulation, 2002 is applicable to all health insurance policies. b. Every insured shall be provided with a Key Information Sheet setting out in simple language briefly but clearly all the important features of the policy, its claim limits, disallowances. The authority may prescribe such document. c. The insurer shall establish necessary systems, procedures, offices and infrastructure to enable efficient issuance o f pre-authorisations on a 24 hour basis and the prompt settlement of claims and grievances. d. Settlement/Rejection of claim by insurer: i. An insurer shall settle claims, including its rejection, within thirty days o f the receipt of the last ‘necessary’ document. ii. Except in cases where a fraud is suspected, ordinarily no document not listed in the policy terms and conditions shall be deemed ‘necessary’. The insurer shall ensure that all the documents required for claims processing are called for at one time and shall not call for the documents in a piece meal manner. iii. The information that the insurer has captured in the proposal form at the time of accepting the proposal, the terms & conditions offered under the policy, the medical history as revealed by earlier claims, if any, and the prior claims experience shall all be maintained by the insurer as an electronic record and shall not be called for again from the policyholder/insured at the time o f subsequent claim settlements. If called, for such information will not be deemed ‘necessary.’ iv. If the claim event falls within two policy periods, the claims shall be paid taking into 84 THE GAZETTE OF INDIA : EXTRAORDINARY [PART lll-SEc. 4) 11. The discounts and loadings offered shall: I. not be at the discretion of the insurer; 2. be based on an objective criteria; 3. be disclosed upfront in the prospectus and policy document along with the objective criteria, and shall be as approved under the File and Use. i. Upper Limit/Maximum Cover offered under a contract: i. If in a benefit based health insurance policy the insurer has prescribed any upper limit for any specified benefit or cover, the insurer shall not accept any proposal for a cover beyond such upper limit, unless the premium for such cover is separately charged. 11. Complete pricing details on how such inbuilt limits are considered in arriving at the total premium shall be provided under the File and Use. 111. If any proposal is accepted beyond such upper limit, the insurer shall not deny a claim on the ground that the policy exceeds the upper limit prescribed for that policy. 1v. However, the insurer may cancel the cover beyond such upper limit and shall return the proportionate premium, provided that I. the policyholder, at the time of proposal, has not disclosed the existing and simultaneous policy details in the proposal form and 2. the existence of such policy is revealed only subsequently resulting in the cover accepted beyond the upper limit, and 3. Such other policy has been underwritten by another insurance company. 8. Protection of Policyholders' Interest a. Unless otherwise provided, the IRDA (Policyholder Protection of Interest) Regulation, 2002 is applicable to all health insurance policies. b. Every insured shall be provided with a Key Information Sheet setting out in simple language briefly but clearly all the important features of the policy, its claim limits, disallowances. The authority may prescribe such document. c. The insurer shall establish necessary systems, procedures, offices and infrastructure to enable efficient issuance of pre-authorisations on a 24 hour basis and the prompt settlement of claims and grievances. d. Settlement/Rejection of claim by insurer: 1. An insurer shall settle claims, including its rejection, within thirty days of the receipt of the last 'necessary' document. ii. Except in cases where a fraud is suspected, ordinarily no document not listed in the policy terms and conditions shall be deemed 'necessary'. The insurer shall ensure that all the documents required for claims processing are called for at one time and shall not call for the documents in a piece meal manner. 111. The infonnation that the insurer has captured in the proposal form at the time of accepting the proposal, the terms & conditions offered under the policy, the medical history as revealed by earlier claims, if any, and the prior claims experience shall all be maintained by the insurer as an electronic record and shall not be called for again from the policyholder/insured at the time of subsequent claim settlements. If called, for such infomrntion will not be deemed 'necessary.' 1v. If the claim event falls within two policy periods, the claims shall be paid taking into • [ ’TFT III— T s F 5 4 ] ’ TKfl ^fST W T S f : 3rarsrRDT 85 consideration the available sum insured in the two policy periods, including the deductibles for each policy period. Such eligible claim amount to be payable to the insured shall be reduced to the extent o f premium to be received for the renewal/due date o f premium o f health insurance policy, if not received earlier. v. Insurer may stipulate a period within which all necessary claim documents should be furnished by the policyholder/insured to make a claim. However, claims filed even beyond such period should be considered if there are valid reasons for any delay. e. Minimum Disclosures in Policy Document: In addition to the requirements stipulated in IRDA (Protection o f Policyholders’ Interest) Regulations, 2000 the policy document shall contain: i. List of disclosures required as per this regulation. ii. Procedure for claims submission, time lines and possible course of action, if time lines for claim submission are not adhered to along with all the claims documents required for claim processing. iii. Sub-limits applicable on any o f the covers offered in the health insurance product and the impact of such sub-limits on other covers provided in the product, if any, shall be clearly spelt out. iv. Penal interest provision shall invariably be incorporated in the policy document as per Regulation 9(6) o f (Protection o f Policyholders’ Interests) Regulations, 2002. v. The TPA(s) details, if any along with complete address and contact numbers shall be attached 1 to the policy document and shall be updated as and when there is a change in the TPA (s). 9. Administration of Health Policies a. Subject to the terms of a policy, insurers shall extend to all policy holders a cashless facility for treatment at specified establishments or the reimbursement o f the costs o f medical and health treatments or services availed at any medical establishment. b. Cashless facility shall be offered only at establishments which have entered into an Agreement with the insurer to extend such services. Such establishments will be termed as Network Providers. Reimbursement shall be allowed at any medical establishment. All such establishments must be licensed or registered as may be required by any Local, State or National Law as applicable. c. The administration o f all health plus life-combi products shall be in accordance with the provisions of Schedule II to this Regulation as may be amended from time to time by the Authority. d. Except in emergencies a cashless facility may require a Pre-Authorisation to be issued by the Insurer or an appointed TPA to the Network Provider where the treatment is to be undergone. The Authority may prescribe a Standard Pre-Authorisation form and standard reimbursement claims forms which shall be used for this purpose, as applicable. e. To avail the benefit o f cashless facility, insurers shall issue an Identification Card to the insured within 15 days from the date o f issue of a policy, either through a TPA or directly. f. The identification card shall, at the minimum, carry details o f the policyholder and the logo o f the insurer. The validity o f card shall coincide with the term of the policy and mayas renewed from time to time. Insures may issue a Smart Card instead o f an Identity Card. g. Where a policyholder has been issued a pre-authorisation for the conduct o f a given procedure in a given hospital or if the policyholder is already undergoing such treatment at a hospital, and such hospital is proposed to be removed from the list o f Network Provider, then insurers shall provide the benefits o f cashless facility to such policy holder as if such hospital continues to be on the Network Provider list. 85 consideration the available sum insured in the two policy periods, including the deductibles for each policy period. Such eligible claim amount to be payable to the insured shall be reduced to the extent of premium to be received for the renewal/due date of premium of health insurance policy, if not received earlier. v. Insurer may stipulate a period within which all necessary claim documents should be furnished by the policyholder/insured to make a claim. However, claims filed even beyond such period should be considered ifthere are valid reasons for any delay. e. Minimum Disclosures in Policy Document: In addition to the requirements stipulated in IRDA (Protection of Policyholders' Interest) Regulations, 2000 the policy document shall contain: 1. List of disclo~ures required as per this regulation. 11. Procedure for claims submission, time lines and possible course of action, if time lines for claim submission are not adhered to along with all the claims documents required for claim processing. iii. Sub-limits applicable on any of the covers offered in the health insurance product and the impact of such sub-limits on other covers provided in the product, if any, shall be clearly spelt out. 1v. Penal interest prov1s1on shall invariably be incorporated in the policy document as per Regulation 9(6) of(Protection of Policyholders' Interests) Regulations, 2002. v. The TPA(s) details, if any along with complete address and contact numbers shall be attached to the policy document and shall be updated as and when there is a change in the TPA (s). 9. Administration of Health Policies a. Subject to the terms of a policy, insurers shall extend to all policy holders a cashless facility for treatment at specified establishments or the reimbursement of the costs of medical and health treatments or services availed at any medical establishment. b. Cashless facility shall be offered only at establishments which have entered into an Agreement with the insurer to extend such services. Such establishments will be termed as Network Providers. Reimbursement shall be allowed at any medical establishment. All such establishments must be licensed or registered as may be required by any Local, State or National Law as applicable. c. The administration of all health plus life-combi products shall be in accordance with the provisions of Schedule II to this Regulation as may be amended from time to time by the Authority. d. Except in emergencies a cashless facility may require a Pre-Authorisation to be issued by the Insurer or an appointed TPA to the Network Provider where the treatment is to be undergone. The Authority may prescribe a Standard Pre-Authorisation form and standard reimbursement claims forms which shall be used for this purpose, as applicable. e. To avail the benefit of cashless facility, insurers shall issue an Identification Card to the insured within 15 days from the date of issue ofa policy, either through a TPA or directly. f. The identification card shall, at the minimum, carry details of the policyholder and the logo of the insurer. The validity of card shall coincide with the term of the policy and mayas renewed from time to time. Insures may issue a Smart Card instead of an Identity Card. g. Where a policyholder has been issued a pre-authorisation for the conduct of a given procedure in a given hospital or if the policyholder is already undergoing such treatment at a hospital, and such hospital is proposed to be removed from the list of Network Provider, then insurers shall provide the benefits of cashless facility to such policy holder as if such hospital continues to be on the Network Provider list. ,660 G:1./13-:),1 86 THE GAZETTE OF INDIA : EXTRAORDINARY [ P a r t T I I — S e c. 4 ] h. Insurer shall keep the insured informed o f the list o f Network Providers and display the same on their website and the appointed TPA ’s office. Such list shall be updated as and when there is any change in the Network providers. i. The insured shall have access to all the Network Providers o f an insurer to avail cashless facility as long as the insurer has a valid service agreement with the Network Provider and such Network Providers shall remain unchanged irrespective o f change in TP As. j. An insurance company may enter into arrangement with other insurance companies for sharing o f Network Providers, transfer o f claim & transaction data arising in areas beyond their service areas. '/ t 10: Agreement between Insurers, Network Providers and TP As a. Insurance companies may offer policies providing cashless services to the policyholders provided: i. The services are offered in network providers who have been enlisted to provide medical services either directly under an agreement with the insurer or by an agreement between health services provider, the TPA and the insurer. ii. The Authority may, from time to time, prescribe clauses to be included in such agreements as stipulated in (b). j iii. the Agreements which shall be entered into between insurers, network providers/TP As shall cover the following amongst others: 1. the tariff applicable with respect to various kinds o f healthcare services being provided by the network provider. 2. a clause empowering the insurer to cancel or otherwise modify the agreement in case o f any fraud, misrepresentation, inadequacy o f service or other non-compliance or default on the part of TPA or network provider; provided no such cancellation or modification shall be done by the insurer unless the concerned TPA/ network provider is given an opportunity of being heard. 3. a standard clause providing for continuance of services by a network provider to the insurance company if the TPA is changed or the agreement with TPA is terminated. 4. a clause providing for opting out o f network provider from a given TPA for reasons of inadequacy o f service rendered by the TPA to the network provider. 5. a clause specifying the fees and other charges leviable by an insurance company to the TPA for services rendered. 6. a clause specifically requiring only the insurance company the power to deny a claim. 7. a clause enabling insurer to inspect the premises of the network provider at any time without prior intimation. b. The Authority may from time to time prescribe standard clauses to be included in such agreements. c. The insurance company shall endeavour to enter into Agreements with adequate number of both public and private sector providers with adequate geographical spread. 11. Payments to Network Providers and Settlement of Claims of Policyholders: a. For the purpose o f claim settlement, insurer shall make direct payments to the Network provider and to the policyholders by integrating their banking system platform with the network provider or the insured, 86 THE GAZETTE OF INDIA: EXTRAORDINARY [PAKr'lll-SEC. 4] h. insurer shall keep the insured informed of the list of Network Providers and display the same on their website and the appointed TPA's office. Such list shall be updated as and when there is any change in the Network providers. i. The insured shall have access to all the Network Providers of an insurer to avail cashless facility as long as the insurer has a valid service agreement with the Network Provider and such Network Providers shall remain unchanged irrespective of change in TP As. j. An insurance company may enter into arrangement with other insurance companies for sharing of Network Providers, transfer of claim & transaction data arising in areas beyond their service areas. IO: Agreement between Insurers, Network Providers and TPAs a. Insurance companies may offer policies providing cashless services to the policyholders provided: 1. The services are offered in network providers who have been enlisted to provide medical services either directly under an agreement with the insurer or by an agreement between health services provider, the TPA and the insurer. ii. The Authority may, from time to time, prescribe clauses to be included in such agreements as f stipulated in (b). iii. the Agreements which shall be entered into between insurers, network providers/TPAs shall cover the following amongst others: 1. the tariff applicable with respect to various kinds of healthcare services being provided by the network provider. 2. a clause empowering the insurer to cancel or otherwise modify the agreement in case of any fraud, misrepresentation, inadequacy of service or other non-compliance or default on the part of TP A or network provider; provided no such cancellation or modifi~ation shall be done by the insurer unless the concerned TP A/ network provider is given an opportunity of being heard. 3. a standard clause providing for continuance of services by a network provider to the insurance company if the TPA is changed or the agreement with TPA is terminated. 4. a clause providing for opting out of network provider from a given TP A for reasons of inadequacy of service rendered by the TP A to the network provider. 5. a clause specifying the fees and other charges leviable by an insurance company to the TPA for services rendered. 6. a clause specifically requiring only the insurance company the power to deny a claim. 7. a clause enabling insurer to inspect the premises of the network provider at any time without prior intimation. b. The Authority may from time to time prescribe standard clauses to be included in such agreements. c. The insurance company shall endeavour to enter into Agreements with adequate number of both public and private sector providers with adequate geographical spread. 11. Payments to Network Providers and Settlement of Claims of Policyholders: a. For the purpose of claim settlement, insurer shall make direct payments to the Network provider and to the policyholders by integrating their banking system platform with the network provider or the insured, [*TFT III— 4 ] ’TITcT T R q jJ : 87 as the case may be. Provided that, if a claimant opts for payment through a cheque or Demand Draft, the insurer shall not deny such request. 12. Services offered by TPA in relation to Health Insurance Policies ' a. The insurer may enter into an Agreement for the provision o f defined services with a TPA holding a valid license issued in accordance with the IRDA (Third Party Administrators) Regulations, 2001 as may be amended from time to time. b. The services offered by a TPA shall not include i. Claim settlements and rejections with respect to the health insurance policies; However, TPA may handle claims admissions and recommend to the insurer for the payment o f the claim settlement, provided a detailed guideline is prescribed by the insurer to the TPA for claims assessments & admissions in terms o f capacity requirements, internal control requirements, claim assessment & admissions procedure requirements etc under the agreement. ii. Any services directly to the policyholder or insured or to any other person unless such service is in accordance with the terms and conditions of the Agreement entered into with the insurer. c. The TPA shall have in place the infrastructure necessary to extend the health services as required to the policyholders at all times. d. Settlement and Denial of Claims: i. All documents submitted to TPA shall be electronically collected and shall be forwarded to the Insurers for taking a decision on the claim settlements or claim rejections. ii. TPA shall, in the correspondence to the policyholder with respect to settlement/denial o f the claims, state clearly the following: “As per the instructions of the insurer <Name o f the Insurer>. the claim is being settled/denied for Rs. <amount> on account o f <specifics o f treatment/grounds o f denial>. For any further clarifications, you may directly contact the insurer.” iii. The above statement shall form the mandatory part o f the communication to be sent to the policyholder in every case o f settlement or denial o f the claims. iv. The insurer and the TPA shall be responsible for the proper and prompt service to the policyholders at all times. e. Bar on Non-insurance healthcare schemes i. The TPA shall offer health services only in accordance with the IRDA (Third Party Administrators) Regulations, 2001 and shall not provide any services: 1. directly or indirectly to non-insurance healthcare schemes or 2. directly to health insurance schemes promoted, sponsored or approved by entities not being insurance companies, such as Governments, PSU ’s etc. 3. directly or indirectly to the policyholder or insured, except the health services as per the agreement with the insurer. 1 3 . Agreement between a TPA and an Insurance company a. The insurer and the TPA shall themselves define the scope o f the Agreement, the health and related services that may be provided by the TPA and the remuneration therefor. Provided that there shall be a clause in the Agreement for its termination by either party on grounds o f mutual consent or any fraud, misrepresentation, inadequacy o f service or other non-compliance or default fraud. Provided further that, there shall be no element in the Agreement which dilutes, restricts or otherwise modifies the [ 'IWI III-~ 4] as the case may be. Provided that, if a claimant opts for payment through a cheque or Demand Draft, the insurer shall not deny such request. 12. Services offered bv TPA in relation to Health Insurance Policies a. The insurer may enter into an Agreement for the provision of defined services with a TP A holding a valid license issued in accordance with the lRDA (Third Party Administrators) Regulations, 2001 as may be amended from time to time. b. The services offered by a TPA shall not include i. Claim settlements and rejections with respect to the health insurance policies; However, TPA may handle claims admissions and recommend to the insurer for the payment of the claim settlement, provided a detailed guideline is prescribed by the insurer to the TPA for claims assessments & admissions in terms of capacity requirements, internal control requirements, claim assessment & admissions procedure requirements etc under the agreement. ii. Any services directly to the policyholder or insured or to any other person unless such service is in accordance with the terms and conditions of the Agreement entered into with the insurer. c. The TP A shall have in place the infrastructure necessary to extend the health services as required to the policyholders at all times. d. Settlement and Denial of Claims: i. All documents submitted to TPA shall be electronically collected and shall be forwarded to the lnsurers for taking a decision on the claim settlements or claim rejections. ii. TPA shall, in the correspondence to the policyholder with respect to settlement/denial of the claims, state clearly the following: "As oer the instructions of the insurer <Name of the Insurer>. the claim is being settled/denied for Rs. <amount> on account of <specifics of treatment/Rrounds of denial>. For any further clarifications. you may directly contact the insurer." 111. The above statement shall form the mandatory part of the communication to be sent to the policyholder in every case of settlement or denial of the claims. 1v. The insurer and the TPA shall be responsible for the proper and prompt service to the policyholders at all times. e. Bar on Non-insurance healthcare schemes i. The TPA shall offer health services only in accordance with the IRDA (Third Party Administrators) Regulations, 2001 and shall not provide any services: 1. directly or indirectly to non-insurance healthcare schemes or 2. directly to health insurance schemes promoted, sponsored or approved by entities not being insurance companies, such as Governments, PSU's etc. 3. directly or indirectly to the policyholder or insured, except the health services as per the agreement with the insurer. 13. Agreement between a TPA and an Insurance company a. The insurer and the TP A shall themselves define the scope of the Agreement, the health and related services that may be provided by the TP A and the remuneration therefor. Provided that there shall be a clause in the Agreement for its termination by either party on grounds of mutual consent or any fraud, misrepresentation, inadequacy of service or other non-compliance or default fraud. Provided further that, there shall be no element in the Agreement which dilutes, restricts or otherwise modifies the 88 THE GAZETTE OF INDIA : EXTRAORDINARY [Part til— Sec. 4] stipulations o f the IRDA in respect o f Policy Holder welfare, protection, service standards and turn­ around-time parameters. b. The remuneration to the TPA shall be based on the services rendered to the insurer and shall not be related to the product/policy experience or the reduction o f claim costs or loss ratios o f the insurer. c. A copy o f the Agreement entered into between the TPA and the Insurance Company or any modification thereof, shall be filed, within 15 days o f its execution or modification, as the case may be, with the Authority. d. More than one TPA may be engaged by an insurance company and, similarly, a TPA can serve more than one insurance company. e. The Authority from time to time may prescribe minimum standard clauses to be included in the agreement between insurer and TPA. 14. Change of TP As for servicing of Health Insurance Policies a. A change in the TPA by the insurer shall be communicated to the policyholders 30 days before giving effect to the change. b. The contact details like helpline numbers, addresses, etc. of the new TPA shall be made immediately available to all the policyholders in case of change o f TPA. c. The insurers shall take over all the data in respect o f the policies serviced by the earlier TPA and make sure that the same is transferred seamlessly to the newly assigned TPA, if any. It shall be ensured that no inconvenience or hardship is caused to the policyholders as a result o f the change. In this regard, the following aspects shall receive special attention: i. Status o f cases where pre-authorization has already been issued by existing TPA. ii. Status o f cases where claim documents have been submitted to the existing TPA for processing. iii. Status of claims where processing has been completed by the TPA and payment is pending with the insurer/ TPA. 15. Data and related issues: a. The TPA and the insurer shall establish a seamless flow of data transfer for all the claims. b. The respective files shall be handed over to the insurer within 15 days o f the claim settlement or rejection. 16. Submission of Returns to the Authority a. All insurance companies carrying on health insurance business shall furnish the Returns to the Authority in accordance with Schedule-Ill. 17. Transitory Provisions a. Withdrawal o f Products i. The Appointed Actuary shall examine every Health product, Group and Individual, in the Company’s portfolio and list out those products which are not in compliance with the provisions in every particular o f these Regulations. Such list shall be certified by the Appointed Actuary, counter signed by the CEO and submitted to the Authority on or before 30.06.2013. ii. Products not in compliance with this Regulation shall all stand withdrawn and shall not be sold 1. In the case o f Group Products, from Is' July 2013 2. In the case o f Individual Products, from 1st October 2013 iii. No new members shall be enrolled into the existing group policies once the product stands withdrawn. iv. Products which have been filed and are awaiting the approval o f the Authority shall all be returned to the applicant to be refilled afresh after due examination for compliance b. Remedial Measures 88 THE GAZETTE OF INDIA : EXTRAORDINARY [PART lII- SEC. 4] stipulations of the IRDA in respect of Policy Holder welfare, protection, service standards and turn- around-time parameters. · b. The remuneration to the TPA shall be based on the services rendered to the insurer and shall not be related to the product/policy experience or the reduction of claim costs or loss ratios of the insurer. c. A copy of the Agreement entered into between the TPA and the Insurance Company or any modification thereof, shall be filed, within 15 days of its execution or modification, as the case may be, with the Authority. d. More than one TPA may be engaged by an insurance company and, similarly, a TPA can serve more than one insurance company. e. T-he Authority from time to time may prescribe minimum standard clauses to be included in the agreement between insurer and TP A. 14. Change of TPAs for servicing of Health Insurance Policies a. A change in the TPA by the insurer shall be communicated to the policyholders 30 days before giving effect to the change. b. The contact details like helpline numbers, addresses, etc. of the new TPA shall be made immediate~ available to all the policyholders in case of change of TPA. c. The insurers shall take over all the data in respect of the policies serviced by the earlier TPA and make sure that the same is transferred seamlessly to the newly assigned TPA, if any. It shall be ensured that no inconvenience or hardship is caused to the policyholders as a result of the change. In this regard, the following aspects shall receive special attention: i. Status of cases where pre-authorization has already been issued by existing TPA. ii. Status of cases where claim documents have been submitted to the existing TPA for processing. iii. Status of claims where processing has been completed by the TPA and payment is pending with the insurer/ TP A. 15. Data and related issues: a. The TP A and the insurer shall establish a seamless flow of data transfer for al I the claims. b. The respective files shall be handed over to the insurer within 15 days of the claim settlement or rejection. 16. Submission of Returns to the Authority a. All insurance companies carrying on health insurance business shall furnish the Returns to the Authority in accordance with Schedule-Ill. 17. Transitory Provisions a. Withdrawal of Products 1. The Appointed Actuary shall examine every Health product, Group and Individual, in the Company's portfolio and list out those products which are not in compliance with the provisions in every particular of these Regulations. Such list shall be certified by the Appointed Actuary, counter signed by the CEO and submitted to the Authority on or before 30.06.2013. 11. Products not in compliance with this Regulation shall all stand withdrawn and shall not be sold I. In the case of Group Products, from I" July 2013 2. In the case of Individual Products, from I st October 2013 iii. No new members shall be enrolled into the existing group policies once the product stands withdrawn. 1v. Products which have been filed and are awaiting the approval of the Authority shall all be returned to the applicant to be refilled afresh after due examination for compliance b. Remedial Measures [W T III— ' 4 ] 'HKcl : STfnm T11! 89 i. Insurers may on their own modify product features other than those relating to any benefits offered, premium bases, loading levied or discounts offered in the products. If such modifications suffice to render the product compliant in every particular o f this Regulation, then on the basis o f a certificate to that effect by the Appointed Actuary and the CEO, the Authority will record such change and allot the unique identification number where after such product may be introduced. The Authority reserves the right, in such cases to take appropriate action if it is established that this assertion o f the Company was not well founded. ii. Products which cannot be covered under the provisions o f (i) above shall be appropriately modified and filed for a fresh approval under the File and Use. Such application shall be in a tabular format setting out the current provision and the revised provisions to render the product in compliance with this Regulation together with an analysis o f the implications on pricing, reserving, profit margin and other relevant metrics. iii. At renewal, all Group Policies shall be given an option 1. to switch over to a modified approved version o f the group product, or 2. to continue to be renewed under the extant policy, provided that in such case no new members shall be enrolled after 1st June 2013 and the specific written consent is obtained by the group policyholder to continue in the old policy. c. All the insurers shall inform the prospective policyholders about the possible changes in the products being sold during the transition period and give an option to the existing policyholders including prospective policyholders to switch over to the modified version if any, once introduced. 18. Repeal and Savings: a. All the guidelines/clarifications/circulars/letters issued earlier in respect o f the health insurance products shall abate from the date this regulation comes into force. b. Unless otherwise provided by these regulations, nothing in these regulations shall deem to invalidate the health insurance contracts entered prior to these regulations coming into force. Schedule: I Portability of Health Insurance Policies offered by Life and General Insurers: 1. A policyholder desirous o f porting his policy to another insurance company shall apply to such insurance company, to port the entire policy along with all the members o f the family, if any, at least 45 days before the premium renewal date o f his/her existing policy. 2. Insurer may not be liable to offer portability if policyholder fails to approach the new insurer at least 45 days before the premium renewal date. 3. Portability shall be opted by the policyholder only as stated in (1) above and not during the currency o f the policy. 4. In case insurer is willing to consider the proposal for portability even if the policyholder fails to approach insurer at least 45 days before the renewal date, it may be free to do so. 5. Where the outcome o f acceptance o f portability is still waiting from the new insurer on the date o f renewal a. the existing policy shall be allowed to extend, if requested by the policyholder, for the short period by accepting a pro- rate premium for such short period, which shall be o f at least one month and b. shall not cancel existing policy until such time a confirmed policy from new insurer is received or at the specific written request of the insured c. the new insurer, in all such cases, shall reckon the date o f the commencement o f risk to match with date o f expiry o f the short period, wherever relevant. £ 6 0 [ '!WT IIl~l9U.S 4] 'GT«! ~ (I y;j : 3!BT~ i. Insurers may on their own modify product features other than those relating to any benefits offered, premium bases, loading levied or discolflts offered in the products. If such modifications suffice to render the product compliant in every particular of this Regulation, then on the basis of a certificate to that effect by the Appointed Actuary and the CEO, the Authority will record such change and allot the unique identification number where after such product may be introduced. The Authority reserves the right, in such cases to take appropriate action if it is established that this assertion of the Company was not well founded. ii. Products which cannot be covered under the provisions of (i) above shall be appropriately modified and filed for a fresh approval under the File and Use. Such application shall be in a tabular format setting out the current provision and the revised provisions to render the product in compliance with this Regulation together with an analysis of the implications on pricing, reserving, profit margin and other relevant metrics. 111. At renewal, all Group Policies shall be given an option 1. to switch over to a modified approved version of the group product, or 2. to continue to be renewed under the extant policy, provided that in such case no new members shall be enrolled after 1st June 2013 and the specific written consent is obtained by the group policyholder to continue in the old policy. c. All the insurers shall inform the prospective policyholders about the possible changes in the products being sold during the transition period and give an option to the existing policyholders including prospective policyholders to switch over to the modified version if any, once introduced. 18. Repeal and Savings: a. All the guidelines/clarifications/circulars/letters issued earlier in respect of the health insurance products shall abate from the date this regulation comes into force. b. Unless otherwise provided by these regulations, nothing in these regulations shall deem to invalidate the health insurance contracts entered prior to these regulations coming into force. Schedule: I Portability of Health Insurance Policies offered by Life and General Insurers: I. A policyholder desirous of porting his policy to another insurance company shall apply to such insurance company, to port the entire policy along with all the members of the family, if any, at least 45 days before the premium renewal date of his/her existing policy. 2. Insurer may not be liable to offer portability if policyholder fails to approach the new insurer at least 45 days before the premium renewal date. 3. Portability shall be opted by the policyholder only as stated in (I) above and not during the currency of the policy. 4. In case insurer is willing to consider the proposal for portability even if the policyholder fails to approach insurer at least 45 days before the renewal date, it may be free to do so. 5. Where the outcome of acceptance of portability is still waiting from the new insurer on the date of renewal a. the existing policy shall be allowed to extend, if requested by the policyholder, for the short period by accepting a pro- rate premium for such short period, which shall be of at least one month and b. shall not cancel existing policy until such time a confirmed policy from new insurer is received or at the specific written request of the insured c. the new insurer, in all such cases, shall reckon the date of the commencement of risk to match with date of expiry of the short period, wherever relevant. 66~ GJ-Z-/ J 3-:13 89 90 THE GAZETTE OF INDIA : EXTRAORDINARY [P art III— S e c . 4] d. if for any reason the insured intends to continue the policy further with the existing insurer, it shall be allowed to continue by charging a regular premium and without imposing any new condition. 6. In case the policyholder has opted as in 5 (a), and there is a claim, then existing insurer may charge the balance premium for remaining part o f the policy year provided the claims is accepted by the existing insurer. In such cases, policyholder shall be liable to pay the premium for the balance period and continue with existing insurer for that policy year. 7. On receipt o f such intimation, the insurance company shall furnish the applicant, the Portability Form as set out in Annexure T to these guidelines together with a proposal form and relevant product literature on the various health insurance products which could be offered. 8. The policyholder shall fill in the portability form along with proposal form and submit the same to the insurance company. 9. On receipt o f the Portability Form, the insurance company shall address the existing insurance company seeking necessary details o f medical history and claim history of the concerned policyholder. This shall be done through the web portal o f the IRDA. 10. The insurance company receiving such a request on portability shall furnish the requisite data in the data format for porting insurance policies prescribed in the web portal of IRDA within 7 working days of the receipt o f the request. 11. In case the existing insurer fails to provide the requisite data in the data format to the new insurance company within the specified time frame, it shall be viewed as violation of directions issued by the IRDA and the insurer shall be subject to penal provisions under the Insurance Act, 1938. 12. On receipt o f the data from the existing insurance company, the new insurance company may underwrite the proposal and convey its decision to the policyholder in accordance with the Regulation 4 (6) o f the IRDA (Protection o f Policyholders’ interest) Regulations, 2002. 13. If on receipt o f data within the above time frame, the insurance company does not communicate its decision to the requesting policyholder within 15 days in accordance with its underwriting policy as filed by the company with the Authority, then the insurance company shall not retain the right to reject such proposal and shall have to accept the proposal. 14. In order to accept a policy which is porting-in, insurer shall not levy any additional loading or charges exclusively for the purpose o f porting. 15. No commission shall be payable to any intermediary on the acceptance o f a ported policy. 16. Portability shall be allowed in the following cases: a. All individual health insurance policies issued by non-life insurance companies including family floater policies THE GAZETTE OF INDlA : EXTRAORDINARY [PART Ill- SEC. 4) d. if for any reason the insured intends to continue the policy further with the existing insurer, it shall be allowed to continue by charging a regular premium and without imposing any new condition. 6. In case the policyholder has opted as in 5 (a), and there is a claim, then existing insurer may charge the balance premium for remaining part of the policy year provided the claims is accepted by the existing insurer. In such cases, policyholder shall be liable to pay the premium for the balance period and continue with existing insurer for that policy year. 7. On receipt of such intimation, the insurance company shall furnish the applicant, the Portability Form as set out in Annexure 'I' to these guidelines together with a proposal form and relevant product literature on the various health insurance products which could be offered. 8. The policyholder shall fill in the portability form along with proposal form and submit the same to the insurance company. 9. On receipt of the Portability Form, the insurance company shall address the existing insurance company seeking necessary details of medical history and claim history of the concerned policyholder. This shall be done through the web portal of the IRDA. 10. The insurance company receiving such a request on portability shall furnish the reQuisite data in the data format for porting insurance policies prescribed in the web portal of IRDA within 7 working days of the receipt of the request. 11. In case the existing insurer fails to provide the requisite data in the data format to the new insurance company within the specified time frame, it shall be viewed as violation of directions issued by the IRDA and the insurer shall be subject to penal provisions under the Insurance Act, 1938. 12. On receipt of the data from the existing insurance company, the new insurance company may underwrite the proposal and convey its decision to the policyholder in accordance with the Regulation 4 (6) of the IRDA (Protection of Policyholders' interest) Regulations, 2002. 13. If on receipt of data within the above time frame, the insurance company does not communicate its decision to the requesting policyholder within 15 days in accordance with its underwriting policy as filed by the company with the Authority, then the insurance company shall not retain the right to reject such proposal and shall have to accept the proposal. 14. In order to accept a policy which is porting-in, insurer shall not levy any additional loading or charges exclusively for the purpose of porting. 15. No commission shall be payable to any intermediary on the acceptance ofa ported policy. 16. Portability shall be allowed in the following cases: a. All individual health insurance policies issued by non-life insurance companies including family floater policies [■RFT III— 4 ] ’TTOT TT3PT=T : 3TCTr*ITCirr 91 b. Individual members, including the family members covered under any group health insurance policy o f a non-life insurance company shall have the right to migrate from such a group policy to an individual health insurance policy or a family floater policy with the same insurer. Thereafter, he/she shall be accorded the right mentioned in 1 above. 17. For any health insurance policy, waiting period with respect to pre-existing diseases and time bound exclusions shall be taken into account as follows:- S. No No of years of continuous insurance cover with previous insurer (s) Waiting period to be served with new insurer in number of days/years Y Y Days 1 Year 2 years 3 years 4 years I. X X Days at inception (XX-no of days as per the policy document) (Y Y -X X ) Days N/A N/A N/A N/A II. For 1 year period exclusion: 1 year N/A Nil 1 Year 2 Years 3 Years III. For 2 year period exclusion: 1 year N/A Nil 1 Year 2 Years 3 Years 2 years N/A Nil Nil 1 Year 2 Years IV. For 3 year period exclusion: 1 year N/A Nil 1 Year 2 Years 3 Years 2 years N/A Nil Nil 1 Year 2 Years 3 years N/A Nil Nil Nil 1 Year V. For 4 year period exclusion: 1 year N/A Nil 1 Year 2 Years 3 Years 2 years N/A Nil Nil 1 Year 2 Years 3 years N/A Nil Nil Nil 1 Year 4 years N/A Nil Nil Nil Nil Note 1: In case the waiting period for a certain disease or treatment in the new policy is longer than that in the earlier policy for the same disease or treatment, the additional waiting period should be clearly explained to the incoming policy holder in the portability form to be submitted by the porting policyholder. Note 2 : For group health insurance policies, the individual member’s shall be given credit as per the table above based on the number o f years o f continuous insurance cover, irrespective of, whether the previous policy had any pre-existing disease exclusion/time bound exclusions. [ 'IWT III- ~ 4] 91 b. Individual members, including the family members covered under any group health insurance policy of a non-life insurance company shall have the right to migrate from such a group policy to an individual health insurance policy or a family floater policy with the same insurer. Thereafter, he/she shall be accorded the right mentioned in I above. 17. For any health insurance policy, waiting period with respect to pre-existing diseases and time bound exclusions shall be taken into account as follows:- s. No I. II. Ill. IV. V. No of years of continuous Waiting period to be served with new insurer in number of insurance cover with previous days/years insurer (s) YY Days I Year 2 years 3 years 4 years XX Days at inception (XX-no of (YY-XX) NIA NIA NIA NIA days as per the policy document) Days For I year period exclusion: I year NIA Nil I Year 2 Years 3 Years For 2 year period exclusion: I year NIA Nil I Year 2 Years 3Years 2 years NIA Nil Nil I Year 2 Years For 3 year period exclusion: I year NIA Nil I Year 2 Years 3 Years 2 years NIA Nil Nil I Year 2 Years 3 years NIA Nil Nil Nil I Year For 4 year period exclusion: I year NIA Nil I Year 2 Years 3 Years 2 years NIA Nil Nil I Year 2 Years 3 years NIA Nil Nil Nil I Year 4 years NIA Nil Nil Nil Nil Note 1: In case the waiting period for a certain disease or treatment in the new policy is longer than that in the earlier policy for the same disease or treatment, the additional waiting period should be clearly explained to the incoming policy holder in the portability form to be submitted by the porting policyholder. Note 2: For group health insurance policies, the individual member's shall be given credit as per the table above based on the number of years of continuous insurance cover, irrespective of, whether the previous policy had any pre-existing disease exclusion/time bound exclusions. 92 THE GAZETTE OF INDIA : EXTRAORDINARY [P art III— S e c . 4] 18. The portability shall be applicable to the sum insured under the previous policy and also to an enhanced sum insured, if requested by the insured, to the extent of cumulative bonus acquired from the previous insurer(s) under the previous policies. For e.g. - If a person had a SI o f RS 2lakhs and accrued bonus o f Rs 50, 000 with insurer A; when he shifts to insurer B and the proposal is accepted, insurer B has to offer him SI o f Rs 2.501akhs by charging the premium applicable for Rs 2.501akhs. If insurer B has no product for Rs 2.501akhs, insurer B would offer the nearest higher slab say Rs 3lakhs to insured by charging premium applicable for Rs 3lakhs SI .However, portability would be available only up to Rs 2.50!akhs. 19. Insurers shall clearly draw the attention of the policyholder in the policy contract and the promotional material like prospectus, sales literature or any other documents in any form whatsoever, that: a. all health insurance policies are portable; b. policyholder should initiate action to approach another insurer, to take advantage o f portability, well before the renewal date to avoid any break in the policy coverage due to delays in acceptance of the proposal by the other insurer. Annexure-I Portability Form PART-I 1) Name o f the Policyholder / insured (s) 2) Date o f Birth/Age 3) Address o f the policyholder/insured 4) Details o f existing insurer i. Name o f the product ii. Sum Insured iii. Cumulative Bonus iv. Add-ons/riders taken V. Policy number 5) Details o f the proposed insurance i. Name o f the product proposed/intend to take ii. Sum Insured Proposed iii. Whether Cumulative Bonus to be converted to an enhanced sum insured 6) Reason(s) for portability 6) 92 THE GAZETTE OF INDIA : EXTRAORDINARY [PART HI- SEC. 4] 18. The portability shall be applicable to the sum insured under the previous policy and also to an enhanced sum insured, if requested by the insured, to the extent of cumulative bonus acquired from the previous insurer(s) under the previous policies. For e.g. - If a person had a SI of RS 21akhs and accrued bonus of Rs 50, 000 with insurer A; when he shifts to insurer B and the proposal is accepted, insurer B has to offer him SI of Rs 2.50lakhs by charging the premium applicable for Rs 2.501akhs. If insurer B has no product for Rs 2.50lakhs, insurer B would offer the nearest higher slab say Rs 3lakhs to insured by charging premium applicable for Rs 3lakhs SI .However, portability would be available only up to Rs 2.501akhs. 19. Insurers shall clearly draw the attention of the policyholder in the policy contract and the promotional material like prospectus, sales I iterature or any other documents in any form whatsoever, that: I) 2) 3) 4) 5) a. all health insurance policies are po1table; b. policyholder should initiate action to approach another insurer, to take advantage of portability, well before the renewal date to avoid any break in the policy coverage due to delays in acceptance of the proposal by the other insurer. Annexure-1 Portability Form PART-I Name of the Policyholder / insured (s) Date of Birth/Age Address of the policyholder/insured Details of existing insurer I. Name of the product ii. Sum Insured Ill. Cumulative Bonus IV. Add-ons/riders taken V. Policy number Details of the proposed insurance I. Name of the product proposed/intend to take II. Sum Insured Proposed iii. Whether Cumulative Bonus to be converted to an enhanced sum insured Reason(s) for portability [ ’TFT III— *sF§- 4 ] *riTcr 93 7) No. o f family member to be included I the policy to be ported. Enclosure: Photocopy o f the existing policy documents Date: Signature o f the policyholder PA RT-II 1. Whether the PED exclusions / time bound exclusion have longer exclusion period than the existing policy: (Please indicate Yes / NO): 2. If yes, please give written consent to the declaration below: “I am aware that the waiting period for the following disease(s)/treatment(s) is ......days/years more than the previous policy terms. I hereby agree to observe the additional waiting period for the following disease(s)/treatment(s) Signature o f the policyholder Schedule: II Administration of Health Plus Life Combi Products 1. The product o f this class shall be named as ‘Health plus Life Combi Products’ referred as ‘Combi Products’ hereinafter in this schedule. 2. This schedule does not apply to Micro Insurance Products which are governed by IRDA (Micro Insurance) Regulations, 2005. 3. All insurance companies that promote ‘Health plus Life Combi products’ shall adhere to the following: a. Scope of Combi Product Class: i) The ‘Combi Products’ may be promoted by all Life Insurance and Non-Life Insurance Companies. ii) The ‘Combi Product’ shall be the combination o f Pure Term Life Insurance cover offered by life insurance companies and Health Insurance cover offered by non life insurance companies/stand alone health insurance companies. iii) The Products offered under the combi products shall be individually cleared under the File and Use procedure. iv) Riders / Add-on covers may be offered subject to File and Use clearance. v) The premium components of both risks are to be separately identifiable and disclosed to the policyholders at both pre-sale stage and post-sale stage and in all documents like policy document, sales literature. vi) The product may be offered both as individual insurance policy and on group insurance basis. However in respect o f health insurance floater policies, the pure term life insurance coverage is allowed on the life o f one of the earning members o f the family who is also the proposer on health insurance policy subject to insurable interest and other applicable underwriting norms of respective insurers. 93 7) I No. of family member to be included I the policy to be ported. I Enclosure: Photocopy of the.existing policy documents Date: Signature of the policyholder PART-II I. Whether the PED exclusions / time bound exclusion have longer exclusion period than the existing policy: (Please indicate Yes / NO): 2. Jfyes, please give written consent to the declaration below: F m aware that the waiting period for the following disease(s)/treatment(s) is ..... days/years more than the previous cy tenns. I hereby agree to observe the additional waiting period for the following disease(s)/treatment(s) Signature of the policyholder Schedule: I I Administration of Health Plus Life Corn bi Products I. The product of this class shall be named as 'Health plus Life Combi Products' referred as 'Combi Products' hereinafter in this schedule. 2. This schedule does not apply to Micro Insurance Products which are governed by IRDA (Micro Insurance) Regulations, 2005. 3. All insurance companies that promote 'Health plus Life Cambi products' shall adhere to the following: a. Scooe of Combi Product Class: i) The 'Combi Products' may be promoted by all Life Insurance and Non-Life Insurance Companies. ii) The 'Combi Product' shall be the combination of Pure Tenn Life Insurance cover offered by life insurance companies and Health Insurance cover offered by non life insurance companies/stand alone health insurance companies. iii) The Products offered under the combi products shall be individually cleared under the File and Use procedure. iv) Riders / Add-on covers may be offered subject to File and Use clearance. v) The premium components of both risks are to be separately identifiable and disclosed to the policyholders at both pre-sale stage and post-sale stage and in all documents like policy document, sales literature. vi) The product may be offered both as individual insurance policy and on group insurance basis. However in respect of health insurance floater policies, the pure term life insurance coverage is allowed on the life of one of the earning members of the family who is also the proposer on health insurance policy subject to insurable interest and other applicable underwriting norms of respective insurers. vii) The integrated premium amount of the ‘Combi Product’ shall be basis for reckoning the threshold limit / applicability o f extant Regulations, guidelines and circulars etc. issued by the Authority or any other statutory body. viii) Commission and Claim payouts in respect o f ‘Combi Products’ shall be by respective insurers only. ix) ‘Combi product’ shall have a free look option as outlined in IRDA (Health Insurance Regulations) 2010. Free Look option is to be applied to the ‘Combi Product’ as a whole. x) The Health portion o f the ‘Combi Product’ shall entitle its renewability at the option of policy holder from the respective Non-Life / standalone health Insurance Company b. Tie up between insurers: i) It is mandatory that insurance companies offering the ‘Combi Product’ shall have in place a Memorandum o f Understanding covering the modus operandi of marketing, policy service and sharing o f common expenses. ii) Insurers forming the tie-up shall obtain prior approval o f IRDA by duly filing the copy o f the agreement entered in this regard. Approval may be obtained by any one o f insurers. ' iii) A tie up is permitted between one life insurer and one non-life insurer only. Thus a life insurer is permitted to tie up with only one non-life insurer and vice-versa. iv) Between these two Insurers any number o f ‘Combi Products’ may be promoted. v) Insurance companies shall carry out an appropriate due diligence before establishing the business relationship for the purpose of promoting ‘Combi Products’. Insurers are also expected to have a long-term understanding for effective policy service of the proposed ‘Combi Products’. vi) Withdrawal from the tie-up is generally not desirable. However, in exceptional cases where insurers desire to withdraw from MOU they shall obtain prior permission o f the Authority. vii) There shall be specific time frames / Turn around Times (TA T) to be agreed between the insurance companies as part o f MOU for effective policy service, transmission o f premiums received etc. at various stages o f policy i.e., at pre-sale stage and post-sale stage. viii)Filing the advertisements in accordance with IRDA (Insurance Advertisements and Disclosures) Regulations, 2000 within 30 days from the date of issuing the advertisement with Authority. ix) Proposed procedures for obtaining the prior approval of IRDA for issuing Joint Sale Advertisements along with the common corporate agents. x) The modus operandi o f proposed policy service at various stages o f the policy viz., proposal stage, policy servicing, premium collection arrangements and claims service etc. xi) The Information Technology systems put in place for supporting the sale and policy service of the ‘Combi Products’. xii) Agreement on reimbursement o f expenses in consideration o f common services rendered by each other of insurance companies. xiii) Distribution Channel wise maximum commission allowed under the ‘Combi Products’. xiv)The manner in which premium is proposed to be collected subject to provisions o f Section 64 VB of Insurance Act, 1938. xv) The procedures put in place for expeditious transfer o f the portion o f premium that pertains to the other insurer o f the product. xvi) Operational procedures put in place for updating premium on policy data base on a real time basis. 94 . THE GAZETTE OF INDIA : EXTRAORDINARY [P art III—Sf.c. 4] ()4 THE GAZETTE OF INDIA : EXTR1\.ORDINARY vii) The integrated premium amount of the 'Combi Product' shall be basis for reckoning the thr~shold limit / applicability of extant Regulations, guidelines and circulars etc. issued by the Authority or any other statutory body. viii)Commission and Claim payouts in respect of 'Combi Products' shall be by respective insurers only. ix) 'Combi product' shall have a free look option as outlined in IRDA (Health Insurance Regulations) 2010. Free Look option is to be applied to the 'Combi Product' as a whole. x) The Health portion of the 'Combi Product' shall entitle its renewability at the option of policy holder from the respective Non-Life / standalone health Insurance Company b. Tie uo between insurers: i) It is mandatory that insurance companies offering the 'Cambi Product' shall have in place a Memorandum of Understanding covering the modus operandi of marketing, policy service and sharing of common expenses. ii) Insurers forming the tie-up shall obtain prior approval of IRDA by duly filing the copy of the agreement entered in this regard. Approval may be obtained by any one of insurers. iii) A tie up is permitted between one life insurer and one non-life insurer only. Thus a life insurer is permitted to tie up with only one non-life insurer and vice-versa. iv) Between these two Insurers any number of 'Combi Products' may be promoted. I v) Insurance companies shall carry out an appropriate due diligence before establishing the business relationship for the purpose of promoting 'Cambi Products'. Insurers are also expected to have a long-term understanding for effective policy service of the proposed 'Com bi Products'. vi) Withdrawal from the tie-up is generally not desirable. However, in exceptional cases where insurers desire to withdraw from MOU they shall obtain prior permission of the Authority. vii) There shall be specific !ime frames / Turn around Times (TAT} to be agreed between the insurance companies as part of MOU for effective policy service, transmission of premiums received etc. at various stages of policy i.e., at pre-sale stage and post-sale stage. viii) Filing the advertisements in accordance with IRDA (Insurance Advertisements and Disclosures) Regulations, I 2000 within 30 days from the date of issuing the advertisement with Authority. ix) Proposed procedures for obtaining the prior approval of I RDA for issuing Joint Sale Advertisements along with the common corporate agents. x) The modus operandi of proposed policy service at various stages of the policy viz., proposal stage, policy servicing, premium collection arrangements and claims service etc. xi) The Information Technology systems put in place for supporting the sale and policy service of the 'Combi Products'. xii) Agreement on reimbursement of expenses in consideration of common services rendered by each other of insurance companies. xiii) Distribution Channel wise maximum commission allowed under the 'Combi Products'. xiv) The manner in which premium is proposed to be collected subject to provisions of Section 64 VB of Insurance Act, 1938. xv) The procedures put in place for expeditious transfer of the portion of premium that pertains to the other insurer of the product. xvi) Operational procedures put in place for updating premium on policy data base on a real time basis. L’ TFT III— 4 ] 'RRcT =R : 3T?TT^liul 95 xvii) Options available to policyholders o f ‘Combi Products’ to discontinue either portion of risk coverage while continuing with the other portion, subject to the extant law, regulations, guidelines etc. xviii) Copy o f proposed common Sales Literature / Sales Illustrations, proposal form to be issued by both the insurers in respect o f ‘Combi Products’, subject to the conditions that these documents cleared under File and Use procedure are not modified. xix) Common Advertisements o f ‘Combi Products’, subject to the condition that this shall be restricted to the features, terms and conditions o f the ‘Combi Product’. c. Lead Insurer: i) As two insurance companies are involved in offering the ‘Combi Product’ one o f the insurance companies may be mutually agreed to act as a lead insurer in respect o f each ‘Combi Product’ marketed with agreed terms, conditions and considerations. ii) The Lead Insurer for this purpose is the insurance company mutually agreed by both the insurers to play a critical role in facilitating the policy service as a contact point for rendering various services as required for combi products. The lead insurer may play a major role in facilitating underwriting and policy service. iii) The role o f lead insurer shall not deter in relying upon the existing operational infrastructure of the partner- insurance company for effective policy servicing o f ‘Combi Products’. iv) Either o f the insurers shall not be absolved o f their responsibility o f proactive settlement o f claims and other obligations in accordance with the terms and conditions o f their respective policies. 4. Underwriting: Under the ‘Combi Product’, underwriting o f respective portion o f risk shall be carried out by respective insurance companies, that is; Life Insurance risk shall be underwritten by Life Insurance Company and the Health Insurance portion o f risk shall be underwritten by Non-Life/stand-alone health Insurance Company. 5. File and Use: a. The life insurance product and the health insurance product to be offered as a combi product shall have prior approval under File and Use procedure. b. Both the independent approved products shall be integrated as a single product and shall be filed with a common brand name. c. The single product shall be offered without making any modifications to the cleared products. d. ‘Combi Product’ is to be filed at the stage of integrating for getting File and Use approval irrespective o f the earlier approval to either o f products. e. ‘Combi Product’ filing shall follow the File and Use guidelines in vogue and all such guidelines that would be issued from time to time. f. Combi Product’ is to be filed with Actuarial Department o f Authority in File and Use formats that are in vogue. g. The Combi Product shall be approved by the Authority at File and Use. h. The File and Use application o f the ‘Combi Product’ shall also specify the following:- i) Lead Insurer for the ‘Combi Product’ and demarcation o f functions between insurers for carrying out activities ii) Procedures proposed for issuance o f the premium notices, where applicable and final lapse notices in terms o f Section 5 0 o f the Insurance Act, 1938. iii) Where the servicing is to be necessarily attended by the original insurer, the lead insurer shall facilitate the policy servicing. As far as the policyholder is concerned lead insurer shall be made as the single nodal point for receiving the servicing requests, fulfilling the services and issuing acknowledgements. 95 xvii) Options available to policyholders of 'Combi Products' to discontinue either portion ofrisk coverage while continuing with the other portion, subject to the extant law, regulations, guidelines etc. xviii) Copy of proposed common Sales Literature / Sales Illustrations, proposal form to be issued by both the insurers in respect of 'Combi Products', subject to the conditions that these documents cleared under File and Use procedure are not modified. xix) Common Advertisements of 'Com bi Products', subject to the condition that this sh al I be restricted to the features, terms and conditions of the 'Com bi Product'. c. Lead Insurer: i) As two insurance companies are involved in offering the 'Com bi Product' one of the insurance companies may be mutually agreed to act as a lead insurer in respect of each 'Combi Product' marketed with agreed terms, conditions and considerations. ii) The Lead Insurer for this purpose is the insurance company mutually agreed by both the insurers to play a critical role in facilitating the policy service as a contact point for rendering various services as required for combi products. The lead insurer may play a major role in facilitating underwriting and policy service. iii) The role of lead insurer shall not deter in relying upon the existing operational infrastructure of the partner- insurance company for effective policy servicing of 'Combi Products'. iv) Either of the insurers shall not be absolved of their responsibility of proactive settlement of claims and other pbligations in accordance with the terms and conditions of their respective policies. 4. Underwritinl!:: Under the 'Com bi Product', underwriting of respective portion of risk shall be carried out by respective insurance companies, that is; Life Insurance risk shall be underwritten by Life Insurance Company and the Health Insurance portion of risk shall be underwritten by Non-Life/stand-alone health Insurance Company. 5. File and Use: a. The life insurance product and the health insurance product to be offered as a combi product shall have prior approval under Fi le and Use procedure. b. Both the independent approved products shall be integrated as a single product and shall be filed with a common brand name. c. The single product shall be offered without making any modifications to the cleared products. d. 'Combi Product' is to be filed at the stage of integrating for getting File and Use approval irrespective of the earlier approval to either of products. e. 'Combi Product' filing shall follow the File and Use guidelines in vogue and all such guidelines that would be issued from time to time. f. Combi Product' is to be filed with Actuarial Department of Authority in File and Use formats that are in vogue. g. The Combi Product shall be approved by the Authority at File and Use. h. The File and Use application of the 'Combi Product' shall also specify the following:- i) Lead Insurer for the 'Combi Product' and demarcation of functions between insurers for carrying out activities ii) Procedures proposed for issuance of the premium notices, where applicable and final lapse notices in terms of Section 50 of the Insurance Act, 1938. iii) Where the servicing is to be necessarily attended by the original insurer, the lead insurer shall facilitate the policy servicing. As far as the policyholder is concerned lead insurer shall be made as the single nodal point for receiving the servicing requests, fulfilling the services and issuing acknowledgements. 96 THE GAZETTE OF INDIA : EXTRAORDINARY [P art III— S e c. 4] iv) Results o f feasibility study, if any, in giving a limited access to the policy data base o f policies for effecting over-the-counter policy service requests to the lead insurer. v) The results o f the cost benefit analysis carried out by both the insurers and the possibility o f offering any discounts on the premium in the combi product. vi) 6. Lead insurer in settlement o f claims shall ensure:- a. Based on the type o f claim, the other insurer shall also take proactive measures for settlement o f claims. In no case, the Lead insurer shall guarantee the settlement o f claim on behalf o f the other insurer. ' b. The_ risks accepted by one insurer under‘Combi Product’ shall not affect the business o f other insurance company. c. As far as health portion o f ‘Combi Policies’ are concerned, the extant regulations and guidelines shall apply. d. Where the policies are serviceable directly, the lead insurer shall play a facilitative role. e. The operational procedures proposed to be put in place for timely dispatch o f the policy bond o f ‘Combi Products’. f 7. Distribution Channel: 1 a. The sale o f ‘Combi Product’ shall be solicited through:- i) Direct Marketing channels , ii) Brokers and iii) Composite Individual and Corporate Agents, common to both insurers b. ‘Combi Products’ shall not be marketed through ‘Bank Referral’ arrangements. c. Insurers shall ensure that the ‘Combi Product’ is not marketed by those insurance intermediaries who are not authorized to market either o f the products o f either o f the insurers. Mandatory Minimum Disclosures: ' ■’*% . * a. The mandatory minimum disclosures for a Combi Product shall be: j i) The product is jointly offered by “abc insurance company” (specify non-life/ stand-alone health insurer I name) and “xyz insurance company” (specify life insurer name). , ii) The risks o f this ‘Combi Product’ are distinct and are assumed / accepted by respective insurance companies. iii) The liability to settle the claim vests with respective insurers that is for health insurance benefits “abc insurance company” (specify non-life/ stand-alone health insurer name) and for life insurance benefits “xyz insurance company” (Specify life insurer name). iv) The legal/quasi legal disputes, if any, shall be dealt with the respective insurers for respective benefits. v) The policy holders o f the ‘Combi Product’ under reference shall be eligible to continue with either part o f the policy, discontinuing the other during the policy term. vi) Where guaranteed renewability o f health insurance plan is allowed, the health insurance portion of this ‘Combi Product’ is entitled to that facility. vii) Specific Disclosures on the available premium payment options on these ‘Combi Products’. viii) Specific Disclosures about the available Policy Servicing facilities for these ‘Combi Products’. 96 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III- SEC. 4] iv) Results of feasibility study, if any, in giving a limited access to the policy data base of policjes-for effecting over-the-counter policy service requests to the lead insurer. v) The results of the cost benefit analysis carried out by both the insurers and the possibility of offering any discounts on the premium in the com bi product. vi) 6. Lead insurer in settlement of claims shall ensure:- a. Based on the type of claim, the other insurer shall also take proactive measures for settlement of claims. In no case, the Lead insurer shall guarantee the settlement of claim on behalf of the other insurer. b. The risks accepted by one insurer under 'Combi Product' shall not affect the business of other insurance company. c. As far as health portion of 'Combi Policies' are concerned, Lhe extant regulations and guidelines shall apply. d. Where the policies are serviceable directly, the lead insurer shall play a facilitative role. e. The operational procedures proposed to be put in place for timely dispatch of the policy bond of 'Combi Products'. 7. Distribution Channel: a. The sale of 'Combi Product' shall be solicited through:- i) Direct Marketing channels ii) Brokers and iii) Composite Individual and Corporate Agents, common to both insurers b. 'Combi Products' shall not be marketed through 'Bank Referral' arrangements. c. Insurers shall ensure that the 'Combi Product' is not marketed by those insurance intermediaries who are not authorized to market either of the products of either ofthe insurers. 8. Mandatorv Minimum Disclosures-: a. The mandatory ·.;;inimum disclosures for a Combi Product shall be: i) The product is jointly offered by "abc insurance company" (specify non-life/ stand-alone health insurer name) and "xyz insurance company" (specify life insurer name). , ii) The risks of this 'Combi Product' are distinct and are assumed I accepted by respective insurance companies. iii) The liability to settle the claim vests with respective insurers that is for health insurance benefits "abc insurance company" (specify non-life/ stand-alone health insurer name) and for life insurance benefits "xyz insurance company" (Specify life insurer name). iv) The legal/quasi legal disputes, if any, shall be dealt with the respective insurers for respective benefits. v) The policy holders of the 'Combi Product' under reference shall be eligible to continue with either part of the policy, discontinuing the other during the policy term. vi) Where guaranteed renewability of health insurance plan is allowed, the health insurance portion of this 'Combi Product' is entitled to that facility. vii) Specific Disclosures on the available premium payment options on these 'Combi Products'. viii) Specific Disclosures about the available Policy Servicing facilities for these 'Combi Products'. [■RFT III— Tgrrg- 4 ] mrcT TF5FT3 : 3 ^ * 1 1 ^ 97 ix) Specific Disclosures about the proposed claims service of these policies under both the risks. x) Specific Disclosures on the availability of services of ‘Third Party Administrators (TPAs)’ for health insurance portion of risk, if available. xi) Specific Disclosures on the available Grievances Redressal Options including particulars of Ombudsman under these ‘Combi products’. xii) Policyholders are to be advised to familiarize themselves with the policy benefits and policy service structure of the ‘Combi Product’ before deciding to purchase the policy. b. Policy documents o f ‘Combi Products’ shall contain the above referred points (iii) to, (xi) as minimum disclosures. c. Declaration from the prospect shall be obtained and attached to proposal form that he / she has understood the disclosures mentioned above. 9. In respect of ‘Combi Products’ both the insurers shall comply with the provisions Insurance Act, 1938 and Regulations notified there under and other guidelines, circulars that are applicable to health insurance business and life insurance business respectively. 10. For the purpose of these guidelines non-life insurance company includes standalone health insurance Company also. 11. In order to monitor the progress of the penetration of the product class before enlarging the scope o f the same all insurance companies that are marketing ‘Combi Products’ shall submit the information that is required by the Authority from time to time. 12. The Authority may stipulate such other terms and conditions from time to time for monitoring activities of insurance companies offering ‘Combi Products’. Schedule: III Health Insurance Returns to be submitted by Insurance Companies I. HARI NARAYAN, Chairman [ADVT. 111/4/161/12/Exty.] 6 6 $ 'lfficf qiT ~ : 3rnl'tffi"UT ix) Specific Disclosures about the proposed claims service of these policies under both the risks. x) Specific Disclosures on the availability of services of 'Third Party Administrators (TPAs)' for health insurance portion of risk, if available. xi) Specific Disclosures on the available Grievances Redressal Options including particulars of Ombudsman under these 'Com bi products'. xii) Policyholders are to be advised to familiarize themselves with the policy benefits and policy service structure of the 'Cambi Product' before deciding to purchase the policy. b. Policy documents of'Combi Products' shall contain the above referred points (iii) to, (xi) as minimum disclosures. c. Declaration from the prospect shall be obtained and attached to proposal form that he / she has understood the disclosures mentioned above. 9. In respect of 'Cambi Products' both the insurers shall comply with the provisions Insurance Act, 1938 and Regulations notified there under and other guidelines, circulars that are applicable to health insurance business and life insurance business respectively. 10. For the purpose of these guidelines non-life insurance company includes standalone health insurance Company also. 11. In order to monitor the progress of the penetration of the product class before enlarging the scope of the same all insurance companies that are marketing 'Cambi Products' shall submit the information that is required by the Authority from time to time. 12. The Authority may stipulate such other terms and conditions from time to time for monitoring activities of insurance companies offering 'Cambi Products'. Schedule: III Health Insurance Returns to be submitted by Insurance Companies I. HARi NARAYAN, Chairman [ADVT. Hl/4/ 161/1 2/Exty.] 98 THE GAZETTE OF INDIA : EXTRAORDINARY [P art III— S ec. 4] INPUT_HEAlTH_l INPUT HEALTH l(a) INPUT HEALTH LI INPUT HEAL TH 2 INPUT-HEALTH_3 'NPUT HEALTH_4.l NPUT HEALTH 5 NPUT_HEALTH_6 NPUT-HEALTH_6.l NPUT_HEALTH_6 2 NPUT HEALTH 6.3 NPUT_HEALTH_6.4 NPUT HEALTH 7 NPUT HEALTH 8 NPUT_HEALTH_9 ~PUT_HEALTH_lO ~PUT_HEALTH_INOIAN_OFFICE_l ~PUT_HEALTH_FOREIGN_OFFICE_l EP _HEALTH_OFFICE_l EP _HEALTH_OFFICT_2 EP _HEALTH_OHICf_3 Health To-:Be'forms \ Annual Audiled - 30th or June Annual Audited - 30th or June Annual Audited - 30th of June Annual Audited - 30th or June Annual Audited - 30th or June Annual Audited - 30th or June 10th or the lollowln1 mooth 10th of the followin1 mooth 10th of the following mooth 10th of lhe followina month Annual Audited - 30th of June 15th of the mooth followm1 end or quarter 15th of the moolh following end or quarter 15th of the monlh follow1n1 end of _quarter users end of quarter 2 Days befo,e the due date IOn due Date 2 Days befo,e the due date On due Date 2 Days befo,e the due date On due Date 2 Days befo,e the due date IOn due Dale 2 Days before the due date 2 Days before the due date 2 Days before the due d;ite 2 Days befo,e the du• date 2 Days before the due date 2 Oa~ before the due date Z Days before the due dat• Z Oa~ befo,e the due date 2 Days before the due date 2 Days befo,e the due date 2 Oa~ before the due date 2 Oays before the due date On due Date On due Date On due Date On du• Date On due Date On due Oat• On due Oat, On due Oat• On due Date On due Date On due Date On due Date Quarterly I 15th ol 1he month followt"I end of quarter 12 Days before the due date On du• Date Quarterly j lSth of the month following end or quarter J2 Days before the due date On due Date Quarterty I 15th of the month fotlow1"1 •nd or quarter 12 Oa}! bero,e the due dale On due Oat• lvearly I 12 Oays before the due date On due Date ~ ~ tT1 ~ ~ 0 'Tl ~ ► ~ >-l ~ 0 ES ~ ~ 1 r C/l "' r, ..:: Purpose and Frequency This form collects the information on the foreign offices classified as representative offices, branches, subsidiaries, agency offices This is a new form for capturing the information on foreign offices. The frequency of this return is quarterly. INF^fJ T_HEAL TH_ Foreign^ Office_ 1 Details of foreign offices Filters and Parameters Year Quarter Name of insurer Country # . Particulars Wo. Column Code a whether regulated by focal authority No. of representative branches ^outside India I No. o f branches ** outside India ] j No. of subsidiaries * * * outsidejndia No. of agency Offices * * * * outside India Total No. of offices outside India Note: ** *** * * * * A representative office is an office established by a company to conduct marketing and other non-transactional operations, generally in a foreign country where a branch office or subsidiary is not warranted. A branch of insurance companies is a retail location where an insurer offers a wide array of face to face and automated services to its customers. A subsidiary, in business matters, is an entity that is controlled by a separate higher entity An agency office is an entity where the business is carried out by agents of the insurance companies * [ ’ TFT I II— 4] ’ TRcT T F 5 m tN#pT_HEAL TH_ Foreign_ O/fice_l odtails of foreign offices Purpose and Frequency This form collects the information on the foreign offices classified as representative offices, branches, subsidiaries, agency offices This is a new form for capturing the information on foreign offices. The frequency of this return is quarterly. Filters and Paramete-rs _______ ~ Year j jQuarter # Name of in_s_u_re_r ______ _.J Country whether lp,rt;c,lm No. regulated by local authority Column Code a b No. of representative branches • outside India ! No. of branches •• ~ utside India I 3 t No. of subsidiaries ••• outside India 4-- \No. of agency Offices••-;• outsid~ India • \Total No. of offices outside India Note: • •• ••• •••• A representative office is an office established by a company to conduct marketing and other non-transactional operations, generally in a foreign country where a branch ~ffice or subsidiary is not warranted. A branch of insurance companies is a retail location where an insurer offers a wide array of face to face and automated services to its customers . A subsidiary, in business matters, is an entity that is controlled by a separate higher entity An agency office is an entity where the business is carried out by agents of the insurance companies I 100 THE GAZETTE OF INDIA : EXTRAORDINARY [ P a r t III— S e c. 4 ] INPUT_HEALTH_Office_3 Growth of Offices in Each State - Yearly Purpose and Frequency The purpose of this report is to provide a summary of the distribution of offices across each state. The frequency of this report is yearly. Filters and Parameters________________________ Year Current Year Previous Year Second Previous Year Third Previous Year Fourth Previous Year | ft State Name No. of Rural Offices No, of Urban Offices No. of R ural, Offices No. of Urban Offices No. of Rural Offices No. of Urban Offices No. of Rural Offices No. of Urban Offices No. of Rural Offices No. of Urban Offices Column Code a b c d e f g h i i Source/C alculation IN P U T N ON LIFE INPUT_N ON LIFE INPUr_N ON LIFE !NPUT_N ON LIFE INPUT_N ON LIFE INPUT_N Ort LIFE INPUTJM ON LIFE INPUT_N ON LIFE INPUT_N ON LIFE INPUTJM ON LIFE O ffice_l O ffice_l O ffice_l O ffice_l O ffice_l O ffice_l O ffice_l Office_l O ffice_l O ffice_l 1 Andhra Pradesh 2 Arunachal Pradesh 3 Assam 4 Bihar 5 Chhattisgarh 6 Goa 7 Gujarat 8 Haryana 9 Himachal Pradesh 10 Jammu & Kashmir 11 Jharkhand 12 Karnataka 13 Kerala 14 Madhya Pradesh 15 Maharasthra 16 Manipur j 17 Meghalaya 18 Mizoram 19 Nagaland 20 Orissa 21 Punjab 22 Rajasthan 23 Sikkim 24 Tamil Nadu 25 Tripura 26 Uttar Pradesh 27 Uttrakhand 28 West Bengal 29 [Andaman 8i Nicobar Is. 30 Chandigarh 31 Dadra & Nagra Haveli 32 Daman & Diu 33 Delhi [ 34 Lakshadweep 35 Puducherry # Total 100 THE GAZETTE OF INDIA : EXTRAORDINARY [PART Ill-SEC. 4] INPUT_HEAL TH_ O/fice_3 Growth of Offices in Each State - Yearly Purpose and Frequency The purpose of this report is to provide a summary of the distribution of offices across each state. The frequency of this report is yearly. Filters and Parameters .-------------. Year 1 Current Year Previous Year Second Previous Year Third Previous Year 'Fourth Previous Year II ' ~::: : ::~a~f I ~~~:~ : ::~a~f : ~~~:~ ::;a~f ; ~~~:~ ::;a~f ii ~~~:~ ] ::;:if II ~~~:~ , Of!ic~ I Office_s Offices J Off!ce_s _t()ffices : Offices Offices Offices _ ; <Jff_ic_e_s ______,_O!fices Column I - -j 1 1 Code I a I b c d e I g h I ,- -~ - -•- - ~-- - t--- ~ - ----- _J ___ • -•-- - Source/C 'INPUT_N !1NPUT_N 11NPUT_N :INPUT_N ilNPUT_N :INPUT_N 11NPUT_N i lNPUT_N IINPUT_N :INPUT_N I ON LIFE I ON LIFE I ON LIFE ON UFE ION LIFE I ON LIFE I ON LIFE I ON LIFE I ON LIFE 1· ON LIFE olculotion I Offi~e_l - Offke_l -1 Offke_l - I Offi~e_l - Offke_l - Offke_l - I Offke_l - Offke_l - Offi-ce_l - I Offi~e_l - • I • • .1• 2 ArunachalPradesh 3 Assam l 4 Bihar S Chhattisgarh 6 Goa 7 Gujarat 8 Haryana 9 Himachal Pradesh l----+-------1----+-- ---- - 10 Jammu & Kashmir -----,-~ --- ------ 11 Jharkhand 12 Karnataka 13 Kerala 14 ~ad~ya Pradesh 15 Maharasthra 16 Manipur I 17 _ Meghalaya 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 Mizoram Nagaland Orissa Punjab Rajasth_an Sikkim Tamil Nadu Tripura Uttar Pradesh Uttrakhand West Bengal Andaman & Nicobar Is. Chandigarh Dadra & Nagra H~~i r--- --, Daman & Diu Delhi l 34 Lakshadweep _ 35 _ P~ ducherry # Total __ J ____ _ ---- -----+----+-----+-----+-------l - - - ----"----'--------'------+---- - - -- -----+----1------l -'--------l----------1--- -- [ w r iii— 4] ■htct : aq^rmRwr 101 Purpose and Frequency This form collects the information on the office (Branch) details in each state for each insurer. This form is re-engineered on the basis of the existing Form VII of existing Office Information. The frequency of this return is quarterly. f ... Filters and Parameters_________________________ Year | | Quarter | Insurer Name Business within India l \ No. of branches _______________ ___________ # State No. of branches at the beginning of the quarter No. of branches inprincipl e approved during the quarter Out of approvals of previous quarter Out of approvals of this quarter No. of branches closed during the quarter No of branches at the end of the quarter No. of offices relocated No. of offices m erged No. of existing branches in rural area No. of existing branches in urban area Column Code a b c d e f g h i k 1 Andhra Pradesh 2 Arunachal Pradesh 3 Assam 4 Bihar1 5 Chhattisgarh 6 Goa 7 Gujarat 8 Haryana 9 Himachal Pradesh 10 Jammu & Kashmir 11 Jharkhand 12 Karnataka ................. 13 Kerala 14 Madhya Pradesh .. 15 Maharasthra 16 Manipur ~ 17 Meghalaya 18 Mizoram ■ 4 '■ ;! 19 Nagaland 20 Orissa 21 Punjab 22 Rajasthan 23 Sikkim 24 iTamil Nadu 25 Tripura r 26 Uttar Pradesh 27 Uttrakhand 28 W est Bengal 29 ,Andaman 8i Nicobar Is. 30 Chandigarh 31 Dadra & Nagra Haveli 32 Daman 8i Diu 33 Delhi 34 Lakshadweep 35 IPuducherry w a fts * -iiCgsgSjjSj5' Note: 1. Branches stand for place of business 6 6 ° [ 'IWT Ill~ 4] Purpose and Frequency Thts form collects the information on the office (Branch) details in each state for each insurer. This form Is re-engineered on the basis of the existing Form VII of existing Office Information. The frequency of this return Is quarterly. . . <" Filters and Paramete ... r_s ___________ ~ Year Quarter Insurer Nam;.;.;.;;e ___________ _, Busin~ss within Ind/a No. of branche, ! No. of No. of I branchPs Out of No. of No of at the inprincipl approvals I branches branchPs ij State branches I Out of I 1 e of I approva s I closed at the end 1 beginning I I of this ' of the I approved previous during thP of the I durinr. the quarter I quartPr I quarter quarter Column Code quarter a Andhra Pradesh Arunachal Pradesh 3 Assam 4 Blhar ' quarter b d 5 Chha_tt_i~sg=a_r~h----+----------1-----,1--- 6 Goa I e No. of offices relocatPd g No. of office s merged h No. of 1 e xisting branches in rurdl area No. of e>cisting branches in urban are:-a 7 Gujarat .. le. - --- 4----- -+----- ----+-----+-=~--- -- ----........ ----+-----+----------tf-------, 8 H~!Jan_a_ J _____ t---- -+-----+-----t-- ----t 9 Hlmachal Pradesh 10 Jamma & Kashmir 11 Jharkhand 12 Karnataka - ------- 13 Kerala 14 Madhya Pradesh 1-_ l_S_---+M_ a_h_ar..cca_st_h~r_a ___ __ ____ ---i----+------t-- --4-----+-------- ---+----t--- 16 Manipur I 17 Meghalaya 18 Mlzoram 19 Na aland 20 Orissa 1-__ 2_1_-+-P_u_n-<-ja_b ________ __ _ 22 RaJasthan 23 Sikklm 24 Tamll Nadu 25 Tripura 26 Uttar Pradesh 27 Uttrakhand t----- -'--------·-·-· ·-··----•---·-- 28 29 30 31 32 Not~: West Bensal Andaman & Nicobar Is. Ch~ndi_,,s_ar_h __ _ Dadra & Nagra Haveli Daman & Dlu 1. Branches stand for place of business 6'60, c;-:c/13-..?6 --+----- - - -- ---- ---- - ---------t----t--------- ----- - _,, ________ _ - ···-- ---~----'-------1 IOI .. \NPUT_HEAiTH_i(a) I Yearly | §#*$" ' Details of product performance - Products with more than 1 year term (To be furnished by All insurers having health products) Purpose and frequency To collect product information for all products having term more than 1 year To replace the existing form 0 to add more data elements on new business and expected business data The frequency of the return is yearly and as and when. Filters and Parameters Year Insurer Nam* * Particular i • | Product 1 Product 2 Product 3 Product 4 [ Product 5 Column Code r a b c d ■ r ...... e..... | Product Details • • -• . ] 1 1 Product Name 2 UIN j— '1 3a Scope of Cover(l) 3b Target Group 4 Insured Type Group Group Individual 4a Basis of Payout — ~ 5 Date of clearance of product j; 5a Minimum Policy Period 5b Maximum Policy period 6 Current Status of Product 6a Add-on covers induded No Yes ;________ ■ . • : 6b No. of add on covers 6c Whether serviced by TPA? Yes lZIIIZZZZIZZIZI 6d _ Total no. of TPA involved ‘ ' -• ’ ■' - ' No. of policies issued : :.................... 8 Gross Premium* Collected 8.1 Total Premium Ceded p ...................... 9 No of persons/members/ lives covered D ata to input D ata to Input 1 1 10 Total Sum Insured 31a Reinsurance Commissions Received ■ - Km—1 O.U ■ .m k - • - : m 7a No. of policies due for renewal \ 8a No. of policies renewed ■ 9a Total Renewal Premium Collected 9a.l Total renewal premium ceded ■ 10a No of persons/members/ lives covered D ata to input D ata to input \ 1 1 1U J Total Sum Insured in renewal ■ ■* ’ lib Reinsurance Commissions Received - .. # - *ta . - ■ 7b No. of policies I i 9b Gross Premium Income i 9b.i Total premium ceded I ? 10b No of persons/members/ lives covered D ata to input D ata to input lib Total Sum Insured ■ 12b Reinsurance Commissions Received — - ■ : Canc^tJonD*. • 7c No. of cancellation In free look period Out of New Business 8ci No. of cancellation*** during the policy term Oct of New Business 8c.ll Out of Renewal Business ■ Expected new bust[*wss flgurel (for next year) . ■: ■ :-r ____ 6e No. of policies 6f . Total Gross Premium ’ “ i Total no. of claims 6h Total amount of claims 6i Claims ratio .(U.___ Combined ratio • H 33 W o fcm m O T l a > m X 7 3> iO 2> "0 % Note: 1. only predominant cover should be mentioned in scope of cover. * Gross premium Is defined as the premium amount before deducting service tax. •• This section is currently optional. • Other than free look cancellation C/5 m O INPUT~HEAL TH_J{o) Yearly - :;i.,, 'lo~ Details of product performance • Products with more than 1 year term (To be furnislied by All insurers having liealth products) PurpoH! ■nd frt!quancy To COiiect product Information for 111 proch.Jcts h•vh'II IIM'ffi more th•n 1 year To repiao the ulst1n1 fOJm D to o1dd more d■t ■ !Nemetits Of'I n~ busJMn and e.pet.1«1 bu1lne11 data Tht! fr~uency of the return 11 yearly o111d as ■nd when. Flltitr1 ■nd Pllraffll!ten ,_, Insurer Nam. • P1rt1cular l'rodui t 1 6'ruduct J, Produ, t J Prcdu<t 4 Product'> Column Code a ti • r d •- Product Nam~ -)~-----+----- ' --------- +----------1-------j 31 SmpeafCov.~•="',i'--------+--'--'-~--,....------+--------------------cl~------ ;,.. 3b T■r1.t:Cif'cUe,Pc___ ________ +'-"-cC..~ I -~ - - 1,.11,11d!rl>e"-----------+--------+~= --1== --r ~"~----,---- ----'----- - '41 IHII of Payout ---+ • ·- Group G,oup i lndlvldu1I I S D ■ta of de ■r ■nc e of product I I ,. Minimum Polio, P■riod ,-_ - I ,. M•lrnllm Polity p■rtod I • Curr:enl SblU"l of Product ~~ .. Add-an coven lftdudNI ,- No ... I .. No. of ■dd on CO\IMI L I .. Whether 1■rvl~ by TP-A7 h es .. Total no. or TPA in'llolwed ,. Ha. af pallcl~ ksued arms Premium• CoUH:t~ ----+----+- : ----; - ---- --,--- ---'-------! I.I Tatll Premium CNl@d I Na cif persom/members/ JN~ CO'lll!red 10 Total S!Jm lnsuril'd U ■ l■•ln n1r-ance Cammlulan, Received ,. l Na. Cfnl'IUdH due far renewal .. .. ~Na. ol pollct.s renewed \ Tabll Renewal Premium Collected ======--------l------+----l--------,-----: - ----------- ·====------j--- ~ --+-----l-------------1------ •- ---'--------j = ====,·===--------+-----+.,.- ,.-,.-,._ - .. --+-.,.,.--,.-,.,..,. --, -------, -: - -----+--------, ... , tl'olll renewal premium ceded Ill■ No cf persons/members/ lives mV'l!l'ed 111 ITatal Sum Insured in renewal I Ub ·a-.1n1uranc• Commissions Receh1ed ., ,. Na.afpolicles •• li&,011 Premium 1ncom• ===-·---------+---- --+-------<-----+'-----+------+--------~ ... , ====--------+-----+----,-----------+------+--------- Total premium cedld ... -.ia of DerJ;Ons/m_rmbt!rs,I H'ltlas covered ,,. Tatal 5um Insured "" Jleim1o1r■oce CDmmlltlDlll ll•c•N•d - ..... 1c N0. 0fcanceU,1tl0n In flH look period --. ... Nlw Bv.ilnl!H I - I le.I I DIii al IIINI lullness r-.:ii7 flla. afcanO!!ll,■Hon••• durln1 !he policy term ~o=0,=_=~=c0c:.u~=,.,., - ,-------+------f-------+--------j --~-11■•-.-• '-~ ~;.,■, fi■ Na.afpollcles I I &f Total Grau P;-emlum ---+------+-- ----j- - ----t-------+------ fi/i Tat:111 amount cf dalms Noee: 1. anly predominant COVH shaukl be mentioned In scape cf cover. • Grass premium Is defined H the premium ■maunl before deducting service t,■x . .. This sect/an Is currently apHana L • other th ■n free lock cancellation - .. .. -l ::r: rr, 0 ~ 9 rr, 0 'Tl ';:a ~ ... T (ll m 0 .._.. T_HEAL7H_1.1 I Yearly ails of product performance in terms of claims development and aging (To be furnished by All insurers having health products) se and frequency To collect claims movement and daims aging data To replace the existing form D to add more detailed level information on claims data rhe frequency of the return is yearly and as and when. and Parameters Year J Channel Type J Particular Product 1 Product 2 Product 3 Product 4 Column Code a b c d 1U B B H Claims Data • . ■ ! [Claims pending at the beginning of the year No. !_! Amount ; | ,; r l New claims registered No. r j Amount — ] Claims repudiated No. Amount _ i Claims closed due to other reasons No. I Amount Claims reopened No. Amount . . . ... .. .... Claims pending at the end of the year No. Amount i_iPenal Interest Paid No. i< .: Amount ........ . . 1_|Incurred Claims Ratio I r Combined Ratio Claims Ratio = (Total Amount of Claims Incurred)/ 6WP datms* ■ . :,i.ii Claims pending for less than 1 month No. Amount l.J.ii Claims pending for greater than 1 month and less than 3 months No. Amount Ii Claims pending for greater than 3 month and less than 6 months No. Amount >.i Claims pending for greater than 6 month and less than 12 months No. . ... . Amount >.ii.ii Claims pending for greater than 1 year and less than 2 years No. Amount 7.iF.ii Claims pending for more than 2 yrs No. Amount koned from date of first intimation - Aging of settled caims-............. 2.1 2.fi Claims settled for less than 1 month No. Amount 3.i Claims settled for greater than 1 month and less than 3 months No. . B.ii Amount Claims settled for greater than 3 month and less than 6 No. 4,11 months Amount 5.1 r-5-n Claims settled for greater than^S month and less than 12 months No. Amount 6.1 Claims settled for greater than 1 year and less than 2 No. ... . 6.ii 1 years Amount 7.f r ia im c caHiaH frtr m n r a lk a n 7 urc No. r . r:__HEAEl'H_U Yearly alls of product performance In terms of claJms development and aging (To be furnished by All insurers having health products) s• and fr11qu1ncy ro collect claims mo.,,ement and daims a1ing data ro replace the existlflll form Oto add more detailed level Information on claims data rhe freQuencv of the return Is yearly and as and when. ■nd P■rametu s Year ~---------~Channel Type Parl1cular Product 1 I P1oduc1 2 Product 3 Product 4 Product ., Column Cade I a t b j c d ClalmlOata jClaims pending Uthe beg"'l-'nn"'l""n1._o::.:f_ctcch•'--Yc•=•'--r ----- +c=-------+--------+-------------;l,--------- ---"------- +---------1 I New claims r•a lsttred-----------t--~-----;- ------ ------·-- No. I Amount I No. I I I I I I i - '-:--11_c_l•-lm_,_,_•p_u_d_l•-te~d~~~~~~ ~~~~~----~~-------------------~~----~~~,::;;;:;;_ou:;;-'n_!_ _____ ___j. ___ +, --=:=j ---,-----===-·-=--=-====-t-+-- i daims closed due t:;co_coccthc:•cc' .cc'•=•.=.soc.cn=•---------'-''-------+ --- - --+----------~! ' -------------+----------< •c..· ---,f--------- ------------sAN __ m 0-'_o~unt _ __ L. 1 __ ---------+--l--------,-- 1 Claims r•opened ! '--+= =-~"-=-- - ---- ------+,---- -+-----;----------- -·--+--------,--- -- I Amount I I Amount I No. I I - I I I I I - I I f I j I I ! _I _ ... c_1a_lms ~ pe ~ nd_ lna~ ••_1_h_• _• _nd_of_ t_h_•_•~•-•_r --- ---+-N_o_. _____ .. __ j_ _____ ~ I ____________ __ t ____________ _ ::_;_1------------ ------+'A-'-m"-o'-"unl _________ _L_ _ -----------+-________ _ :..I -i:.P.=• :::na::.l.:;ln.:;t•::.:'.=es:..:t.;.P.=• ld=-- -------- - ---+-'No. 1 I ii Amount I I I "-.1-1-ln<_u_rr_ed_C_l_a,-·m-,-R-, -tio- ·-----------+-- ~--=--·· I ! ! I -- _, _________ I ----------- . I I i I ___ I I I ____ ___ _J Ii Combined R~tio 1 I c..__--'-'== = =~--- -------,,..,--,-~ ---- -~-- --~------ - - ------- --- - ~ -- Cla1rn~ AatiO = (iotjl AmllUOt of Clalms Incurred)/ GWP C.On,!iWJ RJ tlO • irot •1 A Nllll'l r,f ClwiK 'nnured , fohf Com~•nv hrw-tu"t Amour,t)/GWP ' -- _..,_ ...... ,,.r ·• ,. . - L dalms pef1dln1 for less than 1 month No. .ii [Amount ' ~ daims pendinR for 1reater tha.~J. mo~th and less than 3 ~ - I .ii months 1Amount I u Claim, J)t!ndin1 for 1n~ater than 3 month and less than 6 No. i . :a- months Amount ----· I jJ Claims pending for 1ruter than 6 month and leu than 12 No. I ;:.- months Amount ' I ~ Claims pendina for greater than 1 year and less than 2 No. I i.11 years Amount I 1.i Clalms pendln1 fer more than 2 yrs No. r - - Amount I '·" koned from date of first intimation • . - lllilq .. •tlllil O~I■■ - -· ··· .r, . 6 -·'C. .,;' ....... -_ - r· -·- ~ Claims settled for less than 1 month No. I 2.li Amount I 3.i Claims settled fo r areater than 1 month and less than 3 No. I 3.il months Amount I ~ dalms settled for 1reater than 3 month and less than 6 No. ' 4.11 . months Amount ---- 5 .1 Clalms settled for gr■ater than'5 month and less than 1:2 No. I ~ I months Amount I 6.1 Claims settled for 1reater than 1 year and less than 2 ~ 6Jil years nl ,1.1 1 rt ,.1,...c c•ttl,,rl fA, mt,- theft 1 v n: No. I ---------- dcorted from the dJfe of receipt of last requirement lAmount S u Claims repudiated for less than 1 month ■ No. ii Amount l.i Claims repudiated for greater than 1 month and less thanw J 3 months Amount Li Claims repudiated for greater than 3 month and less than 6 months No. ii Amount ^i_ 3 Claims repudiated for greater than 6 month and less than 12 months No. Amount i.i Claims repudiated for greater than 1 year and less than 2No. J years Amount '.iii Claims repudiated for more than 2 yrs No. Amount •ckoned from date of receipt of last requirement jrred Claims ratio = Total incurred claim/ Total Earned Premium nbined Ratio = (Total claims paid+other operating expense)/total premium earned product will be populated based on the selection of the target group J0% '''"v “V 1 en.bWDI.atii. Form '• Tabto tome |P.D«t«' Type '•j , K, '4 ;," .......- ... Maxtor,? .. FWdTyp.. ■■ • ’ ' » 8® | Buslswss Lock Oescrlpti on i Claims pending at the beginning of the year Closing of last year will be beginninDatabase 1 )No. Enable Numeric 20 Yes Input Database i 2) Amount Enable Numeric 20 Yes Input Database i New claims registered Database 1 )No. Enable Numeric 20 Yes Input Database i 2) Amount Enable Numeric 20 Yes Input Database i Claims settled fully without grievance Database l)No. Enable Numeric 20 Yes Input Database 1 2) Amount Enable Numeric 20 Yes Input Database i Claims settled fully subsequent to grievance Database 1 )No. Enable Numeric 20 Yes Input Database i 2) Amount Enable Numeric 20 Yes Input Database a Claims first rejected and subsequently settled fully Database 1 )No. Enable Numeric 20 Yes Input Database 7) Amount Enable Numeric 20 Yes Input Database b Claims first partially settled and subsequently settled fully Database 1 )No. Enable Numeric 20 Yes Input Database 2) Amount Enable Numeric 20 Yes Input Database Claims partially settled Database 1 )No, Enable Numeric 20 Yes Input Database » 2) Amount Enable Numeric 20 Yes Input Database Claims repudiated , Database lW o . Enable Numeric 20 Yes Input Database i 2) Amount Enable -- Numeric 20 Yes Input Database Claims dosed due to other reasons Database 1 )No. Enable Numeric 20 Yes Input ^ > - Database 2} Amount Enable Numeric 20 ■•s. Yes Input Database Claims reopened Database 1 )No. Enable Numeric 20 Yes Input Database THE GAZETTE OF INDIA : EXTRAORDINARY [ P art III— S e c . 4] d:oned from tlie-ate of receipt of Lut requirement Claim■ rwpudlamd fDr less Uliln 1 ntDl"lth L, daims r1pudlatecl far1reater than 3 month and lus than e::No=-. ----'1-------+------------+------+--------'-----''------f ii 6 months Amount ..i Claims repuillated for 1rnter than Ii month incl lessdan ~No=---------,1-------+------------+------+-------+---------f .ff 12 monlll■'---------4'-'""'°"=::":.:.'---l----+-----------t--------1----------+---------I Claims repudiated for 1realer1hln 1 year and less than 2 fCNo=-. ------,1-------+------------+------+-------+---------f yHrS Amount Claims repudiated for more thin 2 yrs Na. A"""'nt -ctoned from date of rKeipt of last requireml!nt med daims ratio= Total incurred daim/ Total Earned Pn!!mlum nblned Ratio= (Total claims paid+other operatin1 e,:pense}/total premium urned product will bl! populated based on the selection of the ta(let 1roup Enable lstered Enable 2)Amounl Enab6e Claims settN!d ftJUy without grievanc:e 1· No. En.able 2 Amount Enable Oalms settled fuUy sub~uent tc rievance l)No Enable 2)Am0t.1nl Enable Oaims first rejech!d and subsequently sett1ed fully !)No. Enable 2] Amount Enable Claims fJrs1 partially settled and subsequently ~ttled fully 1 No. Enabll! 2)An'IGUnt Enable Cblms partialf\, settled l)No. Enablo 2 Amounl Enable Cllilll! r•pudlatl!d 11No. Enable 21""-nl Enable ClaJms dosed due to atl,er reasons l)Na. Enable 2 Amount Enable Oalnll r11opened 1 )Na. Enable Numeri:: 20 Numeric 20 Null'll!!ric 20 Null'll!!ric 20 Numeric 20 Numeric 20 NumfrlC 20 Numeric 20 Numeric 20 Numeric 20 Numeric 20 Num@ric 20 Numeric 20 Numeric 20 Numeric 20 Numeric 20 Numl!rk 20 Numeric 20 -l ::c tTl a ~ tTl -l -l tTl 0 .,., z c::, ► Input Yes Input Yes Input Yes Input Database tTl X Database -l Database ~ Database Oat..lbase 0 Yes Input Yes Input Database ~ Database Database z Yes Input Oalabase ► Yes lnp.Jt Database ~ Databa5e Yes Input Database Yes Input Database Database Yes Database Yes Database Database Yes Yes D,1tabase ':;, Database ~ Database Yes lnput Yes Input Datatir.ise r Database Database Yes Input - ~ Yes Input Database [./] Database 0 Yes Input Datab.ise .:= DatabaSI!! 8.N 2) Amount Enable Numeric 20 Yes Input Database 9.1 Claims pending at the end of the year Database l)No. Enable Numeric 20 Yes Input Database 9.H 2) Amount Enable Numeric 20 Yes Input Database lO.i Penal Interest Paid Database 1 )No. Enable Numeric 20 Yes Input ' ' Database lO.ii Enable Numeric 20 Yes Input Database ll.i Incurred Claims Ratio Enable Numeric Database 11 ii Enable Numeric Database - Agms erf p«„dlno eUlmt- . Rt r TaWe Name ' Wyp. ’ ' D^V.,U. Mandate*?; ’ Field Type Database 12.1 Claims pending for less than 1 month Database 1 )No. Enable Numeric 20 Yes Input Database 12.11 2) Amount Enable Numeric 20 Yes Input Database 13.1 Claims pending for greater than 1 month and less than 3 months *■ • Database 1 )No. Enable : Numeric 20 Yes Input Database IB.ii 2) Amount Enable Numeric 20 Yes Input -» Database 14.i Claims pending for greater than 3 month and less than 6 months Database 1 )No. Enable Numeric 20 Yes Input Database 14.ii 2) Amount Enable Numeric 20 Yes Input Database 15.1 Claims settled for greater than 6 month and less than 12 months Database l)No. Enable Numeric 20 Yes Input Database i5.n 2) Amount Enable Numeric 20 Yes Input Database 16.1 Claims settled for greater than 1 year and less than 2 years ■ Database 1 )No. Enable Numeric 20 Yes Input Database 16. ii 2) Amount Enable Numeric 20 Yes Input Database 17.i Claims settled for more than 2 yrs Database l)No Enable Numeric 20 Yes Input Database 17.ii 2) Amount Enable Numeric ■ 2° Yes Input Database i — — I — am i IM i ’j.i. -l l l l l l l l l S f ; HE3H 12.1 Claims settled for less than 1 month Both 1 }No. Enable Numeric 20 Yes Input Both 12 J 2) Amount Enable Numeric 20 Yes input Both i3.i Claims settled for greater than 1 month and less than 3 months Both 1 )No. Enable Numeric 20 Yes Input Both 13.ii 2) Amount Enable Numeric 20 Yes Input Both 14 .i Claims settled for greater than 3 month and less than 6 months Both 1 )No. Enable Numeric 20 Yes Input Both 14.H 2) Amount Enable Numeric 20 Yes Input Both 15.i Claims settled for greater than 6 month and less than 12 months Both 1 )No. Enable Numeric 20 Yes Input 3oth 15.il 2) Amount Enable . Numeric 20 Yes Input Both 16.1 daims settled for greater than 1 year and less than 2 years Both 1 )No. Enable Numeric 20 Yes Input Both 16.tf 2) Amount Enable Numeric 20 Yes Input Both 17.i Claims settled for more than 2 yrs Both 1 )No. Enable Numeric 20 Yes Input Both 17.«i 2) Amount Enable . ____ __ Numeric 20 Yes Input Both s.n 21Amounl Enable Numeric 20 Yes 1.,..., Database ,....., CJJ dalrm pl!ndlna at thlP end cf the ','Mr Database 1 111111. EnaW. NlJmeric 20 Yos 1"11111 Database u 2 Amount En ■ble Numeric 20 Yu Input Database lllJ 111ml ln .. ,■st Paid 0atabaH! ~ Enablo Numeric 20 Ye, Input Databa.se 10.li Enable Numeric 20 Yes lni:iut Database 11.1 Enablo - Numerk: O..tabase IIJI Enable NumertC Database ~ ....... 12.D Database Claims pend Ire for 1reater than 1 month and less than 3 UI months Daftbase !INo. Enable Numeric 20 Yos Input Database 13.il 2 Amount Enable Numeric 20 Vos Input Database Claims pendin1 for 1reater than 3 month and less than 6 14.1 months Oatab.is@ l No. Enable Numeric 20 Yes lni:iut Database IU 2 Amount Enable Numerk: 20 Yos Input Database Claims settled for greater than 6 month and less than 12 IS.I months D.atabase 1 No. Enable Numeric 20 Yos Database 1.5.R 2 Amoont Enable Numeric 20 Yes Oatab.ise Cblms settled for 1reater than 1 year and less than 2 16.i '" Database 1 )No. Enable NurnertC 20 Yos Datilbase 16.11 2 Amount Enabll Numeric 20 Yes lni:iut Database 17.i Clalffl:!i settled for more than 2 rs Database !)No. Enablo Numeric 20 Yes lnpu1 Database 17.li 2) Amount Enable Numeric 20 Yes Input Database I 12.1 Claims sattlad for •n th.in 1 month Both !)No. Enablo Numeric 20 Ye• Input Both 12.11 1JArrounl Enable Numertc 20 Yes Input Both Oalms settled for 1reater than 1 mDnttl and IMs than 3 13.I months Both Enable Numeric 20 Yes Input Both 13.11 2 Amount Enable Numeric 20 Yos Input Both Claims sett~ for 1reater thin 3 month and less than 6 IU Both Enable Numeric 20 Vos Input Both IU Enablo Numeric 20 Ye, Input Both Oairns sented for 1reater thiln 6 month and less tlian 12 IS.I months Both llNo. Enable Numerk 20 Yes Input lath 15.il 2 Amount Enable Numerk. 20 Vos Input Both dllms settled far greater than 1 Yl!U and less than 2 16.I Yl!!ars Both !JNo. En.Ohio Numerk: 20 Yu Input Both 16.~ 2) Amount Enable Num&ric 20 Yes lflll(JI Both 11.1 Clalmi setUed for more than 2 yrs Both I No. Enable Numuk: 20 Yes Input Both 11.11 2 Armunt Enable Numeric 20 Vos Input Both s 106 THE GAZETTE OF INDIA : EXTRAORDINARY [P a r t III— Sec. 4] Both Both Both Both JE 1 1 £ om l 1 1 1 £ 1 1 1 ■6 J : ■ -■ - . 1 1 i ■ ac 1_c I ] i 1 t sa.c 1c I tc Ic 1J= l £ $ 1 i 1 I >■ 1 V> i ‘- I 8 s s ? a s o "a s a - f !3 z 11 •S i i£ J V ■ 32 i •C E3 Z 13 Z •c 1 .U ii .u 13 _z * 3 ;, '-r' M - - ! : / ; fV ; V - ■ 1 ■, I ll i * » £ 2 £ 3s UJA a 31UJ ' ■- • . - . ■ . • : . ^ 6 $ 1 1 £ £ I I I 1 1 1 { ! ? I I I ■ i : ez * 1 ! c 1 I I I i U 18 S . Claims repudiated for greater than 6 month and less than 12 months i c c? <N 1 2 1 1 1 1 ,1 I I£ A t i ■l c I fN 1 4) I£ asi 1 | 3 = 3 Pi a <3 5 ! s a in == in := ~ ~~ N•-·- Nur'l'll!rlc I li!'.!.rneri!: - '-~~E I INLll'ftfric I £ .. N...,..lc Enobll! T l 1 INume.ric I - l l l - jNumeroc 1 INu,-nc I lNumerlc l lNumeric I Enable I I ! --~moric j i:-J~~•uo1·~;~~-- ~ ;~!W~f-*~1•111r..t :I IY•• I:~ I I I I 'fe~ :1 ,~: l'"""t I~ I I I 201 Ives hnout I 20j lYu j lnput 201 l vu T,_, 20J Iv•• l 1nout 20! Tv., ltnN•t ~ Jv .. !1rput i - -, Bolh Both Both ~ - Both Both Both Boll, ~ j11 II i tTl Cl ~ tTl ~ 0 'Tl z 0 ► tTl >< ..., ~ 0 ::a:, 0 z ► ~ ? -T CJ) Pl ~ Product 5 I Product Name Scope of Cover(l) Hospital Care Others 3b jTarget Group Individual* group Group Individual 4 : Insured Type 4a I Basis of Payout 5 j Date of clearance of product 5a I Minimum Policy Period 5b j Maximum Policy period^ Launched 6 Current Status of Product 6a ! Add-on covers included 6b No. of add on covers 6c j Whether serviced by TPA? 6d i Total no. of TPA involved 7 • No. of policies issued Gross Premium* Collected .i Total Premium Ceded 9 ; No of persons/members/ lives covered Data toinpul Datatofnpi 10 !Total Sum Insured 11a ! Reinsurance Commissions Received 7a jNo.ofpoTtdes due for renewal 8a No. of policies renewed____ 9a Total Renewal Premium Collected 9a.i [Total Renewal Premium Ceded No of persons/members/lives covered & Data to Input Total Sum Insured in renewal lib Reinsurance Commissions Received : No. of cancellation during the policy term Product 3 -Product 4 c d List of scope of cover given and is mentioned below ■ Hospital Care 2. Critical Illness 3. Surgical Cash 4. Hospital Daily Cash 5. High Deductible 6. Outpatient cover 17. Dental cover Health Savings Domestic Travel 10. International Travel 11. International Comprehensive Cover 12. Spedfied disease / disease management cover {e.g. Cancer, HIV, Diabetes etc) 13. Personal Accident 14. Maternity and Fertility 15. Long term care 16. Disability and rehabilitation 17. Mental Illness 99. Any other fie No. of policies i V . . •• 6f ; Gross Premium J •, ~ ' . 1; .... . Purpose and frequency To collect product information for all products having term 1 year or less than 1 year To replace the existing form D to add more data elements on new business and expected business data The frequency of the return is yearly and as and when. Filters and P a r a m e t e r s _____________________________________ Insurer Name [ ’ TFT I I I — Isl^S 4 ] be fumish1!d by. Ali insurers Purpose and frequency To collect product information for all prodocts havi1111 term 1 year or less than I year To replace the existin1 form Oto add more data elements an new busin~ and expected business clata The ln,quency of the return is yearly and IS and when. FIiters and Parameters .,_ lnsuR!r Name 2~ I I 3a , Scope of Cover(l) ~·t--------+-----+--------------r---~--- 7 List of scape of cover given and is mentioned below r - -""'- --r . ,~, Hosp~al care :_3b-[Target Groop I Hospital Care 4 11nsured Type I '•·\Ol"I Others - ·- . lnd"i.,,id~I+ aroup Group 'Individual I - 2. Critical Illness ,__4a_~e_,_s_ls_o_f _P_a~you _ t __ ----- -----,!-------,f----- --+----,-·---+--------+I _____ --13. Sur1ical Cash 5 j Date of clearance of prod_ uct _______ t------+-------f----- ;------,-------,l _____ ---l4. Hospital Daily Cash Sa 'Minimum Policy Period i I 5. Hitlh Deductible ~ 6b- i~:::~~a~~c;tp:~ ~---------t----~-t-- ------- 1Launc-he_d_+------<--------+;---- -~~: ~~::;~:::~r 1---=--~=====~=----------t---,---:,----,,-------f=-c-'-----'----t---- --+------.,---- ----. 6a No Yes I 8. Health Savings :Add-on covers induded c'1 ,~. 6b I I _J9. Domestic Travel No. of add on covers C'. - 6c Yes I I 10. International Travel i Whether serviced by TPA 7 1 6d I 11. International Comprehensive Caver :Total no. ofTPA involved I '·"'"" -'. '"' , . ..,_..,,,_~,..." UW :.;: >'lrl• .-...,-,-~·.,;:,r., ' . ;·;::;- •~'."r'"";; ..t ·' 12. Specified disease/ disease management cover (e.g. Cancer, HIV, Diabetes etc) t·r _•t•~ .•?i,::., --.,.., ~•-7,,.-. 7 f 13. Personal Accident No. of policies issued .,;'!- .. . ---- --<---------------< f-_ a __ G_r_o_ss_P_re_m_ iu_m_'_Co-,-llect 0_ ed _ ______ _ -----~+-------,_ 1 [ ___ --+------+------~------ 14. Maternity and Fertility ~ __ ITc __ ot __ al_Pr_e_m_i_u_m_C,,_ de_d _ _________ ,...... __ ~ ___ '-_,_ ______ -------+----- -~------- _____ _ 15. Long term care I ' t 9 No of persons/members/ lives covered ----t,---,~= •;:;---t-Dal _ __ a lo Input IDato to lnp,' J ~ -'-;T:.;:0;.:ta;:.:l..=Su.::.m ;.c_clnsu .cc.cccred c=.... ___ ~ ______ +-· •-' '"''"'--'~'.'--'--,.._ I-_____ -+----+-----+------+------ - -- 11:a 1Reinc.urance Commissions Received .. I ' I (~~~:.:CD~. '"-'-' -~• .. - 7a 'No. of policies due for r~al • 8a 1No.ofpoliciesrenewed j,. k ' r------1-----,-----+------- 1--=9a:__cTc.o::.:ta-=,'-R"'en"ewa =-:--lc'Pre-=-m-:--iu'--m~Col-oc-lect- e-;d---c- ---+--,..,.,-- _,-....,.-,_~+ 9a.i •Total Ren•wal Premium Ceded __ . • ~: ·~,cJ -~ o-ol ~rsons/members/lives coverod 9,""'~. -'--':\"'7,,-loa, c--a- ,o-ln,-p-ut- -----t-=o.c. --to-,-:-i..i ---t-· ---- --J-+--- ---- I ! i I I 1---'lh =-+!T:.:o:::ta::.:l.::Su.::.m.::.cl""' = r'-'ed"--i'n-'-re= ne.::.w=,a::.:l-,---c ____ + ►·...;, __ <:.,.. .,. __ "..+-------+------+1------+------ llb 'Reinsurance Commissions Received ,._,.. ~f.. ·., I I ! I ~ INo. of cancellation during the policy tffl'n 8b. , ss I l 6e I No. of e9licies ' I '"",;;:.,-_~ ,-.-1 I I 16. Disability and rehabilitation 17. Mental illness 99. Any other 6g Total no. of claims 6h Total amount of claims 6i Claims ratio .... Combined ratio *■. Claims Ratio = (Total Amount of Claims Incurred)/ GWP Combined Ratio = (Total Amount of Claims Incurred + Total Company Expenses Amount)/GWP Claims O/s ratio = Total claims pending /total claims reported \ Claims settlement ratio = Number of claims settied/total claims reported Note: 1. only main cover should be mentioned in scope of cover. * Gross premium is defined as the premium amount before deducting service tax. Iii Tllbl 110. ot.111111, 61, Tatal amaunt al dalms 61 Claim, ratio ~,e will be L---=L-_,_Co=mc:b:;;;in.;;•c:dcc•:c•t;;;io;..... _________ .....,.._ _ _ _ __ ..... _____ ___. ________ ___. ______ ~- ----- np,.t bylnsurrr,. Nole: Claims Ratio= [Total Amount of Claims Incurred)/ GWP Combined Ratio = (Total Amount of Claims Incurred+ Total Company Expenses Amount}/GWP Oaims O/s ratio~ Total claims pending /totiiill claims reported daims settlement ratio= Number of cliiilims settled/total claims reported 1. only main cover should be mentioned In scope of cover. • Gross premium is defined as the premium amount before deducting service tax. £ input_health_2 j j yeorly I ^ Details of product performance in terms of claims management w.r.t TPA (To be furnished by insurers having health insurance business) Purpose and frequency *4^ To capture the performance of the products in terms of daims management w.r.t TPA This form is a replacement of the existing form D to gather more detailed level Information about TPA contribution. The frequency of the return is yearly and as and when. 7 Filters and Parameters M v„r f............ .... ..... ....... 1 2] Claims Handled Through ®i/*house Q pa Note: 1. All the products which have been approved during the period will be covered ir 2. Product Type can be Individual or Group. 3. Current Status of product will be - active, inactive or withdrawn. ~~l_________________________________________________________ | Product I Values to be entered separately for No. of policies serviced=a No. of claims handled=,b, Amount of claims handled=c. No. of claims settled-d, Amount of claims settled =e ft V Particular EnabWDisabte Reference Form Table Name Column Name Data Type Size Default Value Mandatory7 Field Type Ul Validations Business Logic Remark s/Descripti on level C Name of Product Enable VarChar 20 Yes Input Should not be Numeric Need to Validate the Input for Products and policies issued can come from Form n INPUT Health 1 aa) No. of policies serviced Enable Numeric 20 Yes Input Should not be Negative Need to Validate the Input for Products and policies issued can come from Form # INPUT Health 1 Databse C(b) No. of claims handled Enable Numeric 20 Yes Input Databse C(c) Amount of claims handled Enable Numeric 20 Yes Input Databse m No. of claims se Enable Numeric 20 Yes Input Databse qe) Amount of daims settled Enable Numeric Databse 8 - I "'· Cl•J Clbl c, Cid) Cl■J INPUT_HEAW4_a I ! Yearly I Details of prodqct performance in terms of claims management w.r.t TPA (To be furnished by insurers having health insurance business) Purpo1 ■ and frequency To c.aptur@ the PHfOtfflilnct oftl-.e producb In terms ofdaims manaae,nen1 w.r.t TPA This form is ii r1placement of the eidstina fomi D to lilther more dt!Ulled level lnformiltiDn ilboulTPA contribution. TN! fre.:iuenq, of tht! r@turn IS yeiilrly and as ilnd when. Fllbr-5 .and Par■mnt!n v .. , -- ~-------------~Calms Handled Throucti •lnlh>ule 0-,A -- ____ I -- 1 Note· 1. All Im" products which hilve been approved during 1h@ period will be covered ir. tNl Jonn. 2. Product Typt- can be lndi11idui1I or Group 3. Current Status of product will be - i1Cli11e, inilctive or withdrawn ---- ·-~---- [ ___ ,___=:!--I- ----+-~ -+-------t=------j -+------- f-- -------- -1 Values to be E'nt@red s@ .:iriltely for No. of policies serviced:a No. ol cl.ilms hanc:lled=,b, Amount or claims hilndled.:c, No. of cl.iims sl"ttled-d, Amount of claims settled=e ,._ ·- -- ·-- -- -• ... - -- ... _.,. Fllld Nilmeof Product En.ilbi@' va/'Char 20 YflS In UI No. of policies J.erviad En.ilble Numeric 20 '" Input No.of cl.aims handled En.ible Numeric 20 '" Input Amount of claims handled ·-- Numeric 20 "' Input No. of claims SI!! ,...., Numeric 20 '" lnut Amountaf cl1lmsMtded Enilola Numeric ,...., 1 .... _ --· .. .. _, Need to Villidi11@ the Input for Products ,md policies issued un come from Fonn Should not be Numeric IINPUT Health 1 Need lo V<11lidi1tl! the Input for Products ilndpciliciesissul!d can come h-om Form Should not M Ne1.nh,'I!' I INPUT Heillth 1 Databse Databse Diltabse Dat.abse Dat.lbse § 110 THE GAZETTE OF I DlA · EXTRAORDrNARY [PART Ill- EC. 4] J l H J J i l it 1 ... I' 11 I ' INPUT_HEALTH__5 Details of Due payable to TPA Purpose and frequency To measure the effectiveness of functions of TPAs in terms of daim float and TPA Fees This is the recreated form of the proposed format for collecting due information The frequency of the form is monthly. Tha data is submitted by insurers in respect of every TPA enrolled with them. Filters and Parameters Year Insurer Name s Float TPA Fees, ______ Total i ~b c 2 Payment request received during the month 3 Due paid during the month 4 Due outstanding at the end of the month 5 Due outstanding at the end of the month 5.i More than 0- 7 days 5.11 More than 7-15 days S.iii More than 15- 30 days 5.iv More than 2 months 5.v More than 4 months 5.vi More than 6 months Closing balance of previous month will be opening balance of current month INPUT^HEAL TH_6.1 ? | M o n th ly \ Details of Claims Handled directly- To be submitted by the Insurers having health business (Group) Purpose and frequency The purpose of the form is to collect the information of the claims handled directly by insurers having health business for the group business This is a modification of proposed format for capturing the claims data The frequency of the form is monthly Filters and Parameters Year |Group " Claims movement Details Form lnput_Health_6 and Form !npu?_Health_6.1 needs to be merged by giving drop down for Business Reimbursement Cashless No. of claims No. of claims Particulars Column Code Benefit Based Total No. of claims Amount of claims e f No. of claims Amount of claims g h . Amount of claims b Claims pending at the beginning of the month New Claims registered during the month Claims Settled During the Month Claims repudiated____ Claims pending at the end of the month Amount Of claims d '-S' Aging of pending claims ■* Particulars Column Code No. of claims a Cashless Amount of claims b Reimbursement No. of claims 1 1 Amount of claims c | d • Benefit Based - No. of claims Amount of claims e f Total No. of claims Amount of claims g h 1 Claims pending for less than 1 month Claims pending for 1-3 months i 3 Claims pending for 3-6 months 4 Gaims pending for 6-12 months • : i 5 Claims pending for 1-2 years . - • .- 1 .....— -------- . claims pending for more than 2 years .......................... . * Reckoned'frorr. date of first intimation Aging of settled claims** [WT III— 4] *!K?T ll'#'UT_HEAL1H_5 Details of Due Put'J)OS,11 and freQUlfflCY Monthly liletoTPA Ta musur. th• eft«tiiftne111 of functions afTPAI An terffl'l: afdalm flc ■1 and TPA FeM Thl1 k di• r«rHt•d l:Jrm of th• propoted format for coll«ti,il du. lnfcnm■tion Th• tr.quency at the form is monthty. Th~ data is submittRd by lnsuttrs In rmpect of ev«y TPA enrolled with th•m. Fllt•rs and Parameters '-------------------~I- lnlunrflllrne ~-----------------~IT'P4- ,. . ...L..,____ 4• ,, • I .. !IO-'!I • 1~~P~\ lo!al • - • ,~ I b C . ~ (losing bal.anu of pre-..io,a !Tlonth w ill bl! opening balance of cuirent month , Ou, paid durin1 the month t--------,-""-• _ou_,._1,_,_difl1 al lhe end af the mond'I ---~-----+----·------------· - ._ ___ s _____ Due ___ ..,_ _____ ndln,: at ttia .~--;;, thti rMr1th ~ l S.i More thc1n D- 7 davs I ____ 5_.li ________ M_o_,e __ l_h,_,~7:·~---------,------<-·--·------•,-- ----'!"":~;.s'----,,--M ~M~:;~:~::~::~,= 15m~:=~c.:,!~:"~-------, ----~1-------------,·--====-=--.:_-_-_--,_ l----c:"~:~---'- 1 - -':~':':"':":~::"":-=:-":=·"-::7::'--------.-:-,1 -- ~ INftJf .. )ffAL7H_fi.l 7 Monthly I Details of Claims Handled directly- To He submitted by the Insurers having health business (Group) Pu,pme and fre,quency The purpasa of the form Is to collect the Information of the cl.alms handled di~ly by lnsurt!rs ha ... 1rc hNtth business for thit araup buslnus This is a modlfic:~ion at proposed to,mat for capturina th clalms data Thit frequency of the tom, Is monthly Fllten and Panmeters v ... '--------------------''- '-------------------------'-- !G roup Clo/ms movtmtnt Dtrolls !='.arm lnput_Heahh_6 and form lnput_Health_6 1 n~eds to bf' merged by giving drop down for Busine.§s Castiiess "''~I,,..,, I Bene/11 fl.ned . Particulars No al cla1nH, Amount of claims No of claims Amount of claims No al claims Amount of claims Col-umn Code . b ' d . I Claims pending at the bqmnl of the month -- 2 iNt:w Claim~ reaiste,ed during thf' month I i I I 1-¾--l~lms Settled During the Month ·- ~ I • --- I -+-t,Oalms ,.pud~ted i I I I S ,Claims pendln11 at the e~iattht! month I I I I Aging of ptndlno <lo/ms ·• No of claims g Total Cashless Reimbursement Benf'flt Based Total Amount of rla1ms h ,: Particulars No of claims - Amount of claims • No of claims Amount of claims • No of~a1ms Amount of cla,ms • No of claims Amount of da,ms Column Cod~ . a • b • c ' d . e f • II . h 1 Claims pending for less than 1 month _ ----· ~ - --+----- 1 _____1_ }Oaims ptndin1 for 1·3 months _____ 1 1 : _ 3 Claims oendlna tor 3-6 mon .~~th_•--- -----+-----+------------ -·----'- ------+-- - ------------+---------+-------< I--_---.--Jc::. • _ _,;:aa:::l::,m:;;;= .. '"a::d;::.;n&,i.,:;lo<:;..:::ti-..:l;.2"mon = lh=•-------+------+-I-------+---------,--- -----t--------i-------+--------+--•--·- --- S iOalms oendina for 1·2 years I .. I I lclalm1 pendin1 for more than 2 wears I • Aeckonaltfron:. date of first intimatt0n AOl"II a/ uttltd claims .. -.. * 1_________ Particulars ________ Column Code Cashless Reimbursement Benefit Based Amount of claims No. of claims Amount of claims No of claims ^mount of claims No. of claims Amount of claims 1_ Claims settled within less than 1 month Claims settled within 1-3 months I Claims settled within 3-6 months Claims settled wrthin 6-12 months i Claims settled within 1-2 years 6 I claims settled within more than 2 years___ ** Reckoned from the date of receipt of last requirement Aging of repudiated claims*** Benefit Paid No. of daim$ Amount of claims No. of claims 1 j Claims repudiated within less than 1 month 2 [Claims repudiated within 1-3 months ! Claims repudiated within 3-6 months i Claims repudiated within 6-12 months Claims repudiated within 1-2 years 'claims repudiated within more than 2 years Amount of claims h . 1 Cashless Reimbursement . » i Particulars No. of claims Amount of claims No. of claims 1 Amount of claims Column Code a b 1 *** Reckoned from the date of receipt of last requirement INPUT_HfALTH_6.2 I M onthly I u ■ v ; , D e t a i l s o f Claims Handled through TPA-To be submitted by the insurers having health business Purpose and frequency The purpose of the form Is to collect the information of the daims handled through TPA This is a modification of proposed format for capturing the daims data The frequency of the form is monthly. Filters and Parameters _______ J Month Year I _________________________________ Insurer Name I iTPA Name Division O Individual ®Group Total Benefit Based Reimbursement Cashless Amount of claims Amount of claims No. of claims Amount of claims No. of claims Particulars Claims movement Details I Claims pending at the beginning of the month I New Claims registered during the month___ Claims Settled During the Month___ Claims repudiated ________ ;__ I Claims pending at the end of the month___ Aging of pending claims * Cashless Amount of claims Amount of claims No. of claims Particulars Column Code 1 1 Claims pending for less thah 1 month 2 [aaims pending for 1-3 months 3 [claims pending for 3-6 months 4 j Claims pending for^6-12 months 5 [Claims pending for 1-2 years____ 6 [ claims pending for more than 2 years * Reckoned from date of first intimation Aging of settled claims** _________ Reimbursement___________ No. of claims 1 Amount of claims __________ Benefit Based No. of claims Amount of claims e f THE GAZETTE OF INDIA : EXTRAORDINARY [ P art III— S e c . 4] 1n 1-3 months t~ ths--- ----+-----1----------~-- s s.ettled within 6-12 months Cliims settlt'd within 1-2 yean ,1.,1m~d~o~~ars •• Reckoned from the date of reulpt of tast r•quir•ment Aging of r•pudlat•d dalnlJ••• ,, P Cashless . Re1mbursemf'nl Benefit Paid , 1 I art,cul.ars No of cl.aims . Amount of cla1ms No of cla,ms i Amount of cla,m,; · No of cl.11ims Amount of cl.aim\ • No of chums - Amo nl of clam Column Cod~ a b ,1 r I r u h ' ,. __ 2 _ _) _-=.c..c= 4 "+--- ---·-- _,_I --- -,------+- ___:_ S- -- 'claims repudiated within 1-2 yun 6 claims repudiated within more than 2 ean ••• Reckoned from the datll! of rwceipt of last requi~ent INPUT_HEALTH_6.1 Monthly I Details of Claims Handled tfirougfi TPA- To be submitted by the Insurers havinB health business Purpose ■nd treq&.1ency The siurpc:is• c:if the farm 11 tc:i CDllett the lnfarmatlcir, ol tM daims t.andl•d throu&h TPA. This it I modiflutlon of propcis«i format for upturin1 th• cl.aims (tau Tha fn!qU41!ncy of thl! form fs monthty. FIiters and Parameters Vear lnsur•r Name Oivklc:in Oa/ms mowment Details '---------------------'llantll '---------------------'1PANa111e • (.;isnll!'\\ , RPmtJurll!'mrnt • tlenrt ttla1ca lOIJ • P.;ir!cuJrS • No oltl.;im, _ Amauntofcl.;arr• ",j,-, ,-Ir,.,.,, Amountalclim~ •• ' • A,~~~,' ,T • •• ' • Amountolclam1 , - .. r ,,, , t (. , , • , ► Aging o/ prndlng claims • Ln'11eu Rf'1mour,emc-nr Hcr,et11 tla~ca ' • , • P.;ir ,cu .;ir\ : No of cl;i ml • Amou,.,I of clams • ~ m~ 1 Amoun~ c ~ m, • ~f ti;;~ Amount of clam~ : •• • ArrounT ol r•.a rr~ Column Code , ► , d " f • • • Red:oned hotn d.;ate ot finl in11m.aihon Aging o/ settlrd claims .. - -+ - -----~,--------!--------+-----·- ➔ • ! ~=--= - --+---- - --------'------1=+---- Cashless Benef-t Based Amount of claims Particulars Amount of claims No. of claims Amount of claims Column Code I Claims settled within less than 1 month 2 [daims settled within 1-3 months 3 I Claims settled within 3-6 months Claims settled within 6-12 months Claims settled wftWw 1-2 years claims settled within more than 2 ^ Cashless Amount of claims from the date of receipt of last requirement Column Code a i Claims repudiated within less than 1 month 2. ; 1Claims repudiated within 1-3 months __ _J 3 Claims repudiated within 3-6 mortths _ i 4 Oaims repudiated within 6-12 months j 6 ~ Claims repudiated within 1-2 years daims repudiated within more than 2 years _________ Reimbursement ___________ No. of claims________ Amount of claims c d ________ Benefit Paii No. of claims j Amount of claims Do 'O ** Reckoned from the date of receipt of last ret Aging of repudiated daims*** HI— 4] «fTTcT qR 1 a C a - 2 a • (J<l"lr~1 • J- --, _ ! • _ • r I ti , • _ , I PJrtc~ Jr! ..,, • ' '· ,• ~... Amountofcla•m\ -. Arr 1 lei rn~ No c 1 c1a,m\ Arrountofca,.,.- C.01urnn Code • , t ' , 1 • r , • , .., Oanm settled wrthin less than l month 2 i~ims settled within 1-3 month~ u~ §e'ltle<:l Wlthin 3--6 months .C ~Claims ~tt'ed llrithin 6-12 months 5 1cIuns~wi"hin1-2years • • Aeclconed from the date of re.r:e.,t al last r~ Aging of ,qudlated clalms 00 • T I I I I I ( .,~l'llc11 Ae•rn~t. l'Tl('nl 8c,ne1,• ~1 : • , , Arre: n101,~m~ • No~,m~ _Arre~~ NoofclJm1 Amo~r-lo'tJ11'T1\ • • • Colurnt1Cod~ 1 • c d • • , ~ : Claims repudiatN'.I wi'thin 1-3 months I lClaim~ relUdtatfl:I wrthin 3-6 months I leliams repudi.lted '!Within 6-12 months klatrnS repudutNt within 1-2 ~~ I . ' ldalms ,-ppudi~ed within monl! th.an 2 yea-s I ... ...._.. from tha dat11 of ,.utpt of lut requ~nt .._ .. ~ Tho-ol1"'r-lllO<Oks ... -ollfie-lw•-• INlll•--W---- n,.-.11111o-1,-i. ...., ......... - I i I I ., I T ! - I 1 I i l i -~ ~- I I ,_.,_ ·r & w n Particulars Column Code No. of claims a Cashless Amount of claims b Reimbursement No. of claims ! Amount of claims ---------C-------- 1-------T Benefit Based No. of claims Amount of claims e f Total No. of claims Amount ofclaims g h l jClaims pending for less than 1 month .. 2 ^Claims pending for 1-3 months \ 3 j Claims pending for 3-6 months____ __4 Claims pending for 6-12 months ' " 1 ................ 5 Claims pending for 1-2 years — — ^ ! 6 |claims pending for more than 2 years Purpose and frequency The purpose of the form is to collect the information of the dalms handled directly by insurers having health business for the individual business This is a modification of proposed format for capturing the claims data The frequency of the form is monthly Filters and Parameters __________________________________ ____________________ Year | [Month Insurer Name 1 ~1 Claims movement Details __#_ Particulars Column Code No. of claims a Cashless Amount of claims . b Reimbursement No. of claims | Amount of claims c 1 d Benefit Based No. ofclaims j Amount of claims e 1 f Total No. ofclaims Amount of claims g h 1 i Claims pending at the beginning of the month __ . • L. ’_2 |New Claims registered during the month ' ! - ■ ................ • i ■ ■ ■■ __3_ [Claims Settled During the Month _4 ;Qaims repudiated _5_ j Claims pending at the end of the month Aging of pending claims 0 Cashless Reimbursement Benefit Paid Total r r Particulars No. of claims Amount of cjaims No. of claims Amount of claims No. of claims Amount of claims No. of claims Amount of claims Column Code a b c d e ; f ' g h 1 (claims repudiated Within less than ! month ______ .\l _2_ Claims repudiated within 1-3 months . 1 . . . :. •. -1 __3 jciaims repudiated within 3-6 months _...... ■ ■ . ' -. ___ 4 {Claims repudiated within 6-12 months . .., . I __5 iClaims repudiated within 1-2 years .! ■ - •% . 6_ jciaims repudiated within more than 2 years ; . 1 ■ I *** Reckoned from the date of receipt of last requirement F Particulars Column Code No. of claims a Cashless Amount of claims b Reimbursement No. ofclaims i Amount of claims c 1 d Benefit Based No. ofclaims Amount of claims e f Total No. ofclaims ! Amount of claims g 1 h ~ 1 {Claims settled within less than 1 month 1 . 2 I Claims settled within 1-3 months _3 Claims settled within 3-6 months :■ • ,’■■■ . . • 4 jQaims settled within 6-12 months • • 1 __5 1 Claims settled within 1-2 years i r — — 6 jciaims settled within more than 2 years • . 1 ! * Reckoned from date of first intimation Aging of settled claims 00 * * Reckoned from the date of receipt of last requirement Aging of repudiated claims00* THE GAZETTE OF INDIA : EXTRAORDINARY [ P art III— S e c . 4] ..._.,d...,._ TIit purpose of the form isto collect the information olthe ctalrns hand Seel directfy by inS&Jrers havt1,1 heaN:t, business for the individual business TIils Is a fflCJldflcltlorl of pn,po•d format far capt\Jr1"1 the c■lms data Th• frequency of the farm is ,_thly '---------------------'- <Jol,ru _,,, O.IOIIJ Cashless Re mbur~ement henef11 8.ned T~tal it Part CtJlar~ \o of rlarms • Amounl of cla,nl!i . No of claim-; , Amou~t of claims . No of claims Amourt of claims • No of claims A'Tlounl of fla1ms Column (odC' a b c d e f g h Claims ll"L'.'nd1n, at ttM! bl!ginnfrl£ of the month ~ !New Claims ~eig;s1ered=:d:;uc;,;'-"n2"'t"'h=-• c:.m:::0n:::tc:h ___ _ --4 _____ 4--_______ -'------------'----- ----,~------11-1-------,e--- -----le--- _ 3 1Claims Settled Durin& the Month ---------.--------e---------..._l ________ , ______ +--------•------+----- ' !Claims r~pudiated 1 I S k:laims oendin1. at thfo end of the month I I A!llllfl af ~nd/n!J dolms • ' Part1cu1ars Cal1Jmn Codt Cli1ms ndfna fo tns t an 1 o 2 i(latms pendi~ for 1-3 months 3 !ClaffTu pendilll for 3-6 months ------;--7c~-i~s pendini for 6-12 months s IClaim:s pendini for 1-2 'fll!!iUS 6 I claims pendin111: for mol"I! than 2 years • Reckoned from date of first intimation Aging of •~tt~d claims .. - ' P.;,t1CLL,HS -· Column Code 1 :ctaims settled within ~ss than 1 month ~ :Claims w-ttled within 1-3 months 3 !Claims settlN:I withirl 3-6 months 4 'Claims settled within 6-12 months s !Claims sett~ within 1-2yeilrs 6 ·clairm settled within lllOn! than 2 yen •• Reckoned from the date of receipt of tast requirement AlJlng oJ TPpud/al~d claims••· I _J I I Cas,1ess No of tla ms Amount of c1a rrs a b Cashless "--lo ofcla,ms Amount of cla ms . b -- He1mtlursement Benett B.;ised No ol cl;:i m~ Amount of claims No of clams Amount of claims C d e f I I l I I I I I I -- -- I I I ( I I ke mbursemert Benefit Based No of claims Amount of cla,m, No of claims Amount of cla,ms C I d e f -1~---=r I I ! I ! i--·- ----t- I ' i I I --. Tot ill No o' claims Al'l'lount of cra1ms ' h I -·-r-- I ---------- I i i I I I Tota! l\o ofcla,ms Amount of cla,ms 8 h t=- I I I -- ---- I I I I C.1shless Re1moursement Benefit Paid Total -;- P;1rh<u an · fl.a of cla,ms Amount of claims No of claim,; Amount of cl,1,ms ~ l\o ol claims Amount cf cla,ms : No o• <ia,rns Amount of cla,ms (c,lumn Cod~ a b c d e f g h _ _ 1_ 1Cla1ms. repud~ted within I~ than 1. ,:nonth _--j-___ _ 2 fCJaims repudiated within 1-"-3'-'rn=oncclcch•~ ------~-+-----f---------..--------+---- ----+---- ---+---·-----+--------+---------1 -· 3 1Clakns reDUdlat~ within Hi mcnths --• - j Claims repudiated within 6-12 months -----1- 5 •Claims repudiated within 1-2years • 6 iclaims repudiated within mora than 2 ye.an I ! I ~ i I I I I I - ' . I ' • 0 Reckoned from the date of receipt of last R!QUirement I -l ::r: m C) ~ m ~ 0 'Tl z 0 > £ c 0 \ 4^ State Column Code Direct Business (Internet) No. of Premium j Total Sum policies 1 Amount | Insured a | b } c Direct Bl No. of policies d siness (Other than Internet) Premium Total Sum Amount | Insured -------------------------------------- e { f Individual Agents No. of Premium Total Sum NO. of policies Amount Insured policies g ; h ' j Banks Premium Amount k Total Sum Insured 1 Othe No. of policies m corporate agents Premium Total Sum Amount Insured n o No. of policies . P Brokers Premium Amount P Total Sum Insured r No. of policies s Re'errals Premium Amount f Total Sum Insured No. of policies V Premium Amount V, Tot =il Sum ifsu'ed X 1 Andhra Pradesh 2 Arunachal Pradesh '• ' 3 Assam ' 4 Bihar ■■ ■ ...; .. 5-• ■: Chhattisgarh 6 Goa 7 Gujarat 8 Haryana ■ 9 Himachal Pradesh ■ - ■ 10 Jammu 8i Kashmir 11 Jharkhand , ' •• 12 Karnataka ........ 13 Kerala 14 Madhya Pradesh__ ___ _ ..i1 15 Maharasthra V : 16 Manipur 17 Meghalaya 18 Mizoram !____ • 19 Nagaland ___ 4----- J[--- -—i 20 Orissa 21L_Punjab j' ; •' 22 Rajasthan 23 Sikkim 24 'Tamil Nadu 25 Tripura ,.J ../..j.... _ — ’ . 1 i 26 "Uttar Pradesh .• V 27 Uttrakhand ■■ .' . . . ■ '1 28 West Bengal . '.._4 29 Andaman & Nicobar Is. : . ,1 30 Chandigarh 31 Dadra & Nagra Haveli • • • : '' : ■ 32 Daman & Diu ■__ _ 33 Delhi ____ 34_ Lakshadweep I ...... J 35 Puducherry i ■ a Total ...... - I I ^ .. . purpose and Frequency To collect State wise information on Gross Premium, No. of: Policies and Total Sum Assured across Channels This form is re-engineered on the basis of existing Form 1 and Form II of gross premium. The frequency of the form is Quarterly * Filters and Parameters " Year I J r Name of Insufef l t a 2 2 - Purpose ■nd Frequency Ta mllect $Ute ~lse Information on Gr055 Prffl'llum, Na.. of Policies and Total Sum Assured across Channels This fcrm is n!·@nliliHrN on tlie bni:s af Hbtln1 Forml anc:1 Form II of 1ross premium. The frequency af ttle form Is ~ • Rlten and P1nmet1n , ... Nanll Df lns&nr -o- D•'C'rl 8L 1 , 11, \ r'7 •J ['I,, •(I fl , 1 10lt'lt>• •~ 1~ lf'ft•r~r, 1 ~::l \11duJI A1 f ~ 8Ank<, OthP corpor~IP ~gP~t, P.rt,lit•I', fle'rrr 1, ' . No cf Prt>" H 1 r 1 ,I Sl.m N) ol P,cmn .. m Tc 1 ii '5u-n No of Prp,i,um Tota, Sum No al Prem,um Taul Sum No of Prem um Total Sum No of Prem,1.:m Total 'Sum Ne, of PrPm,.Jm To•al SJm P•p...... ,,.... 1 i! ,, ~ Jr Sf)t~ po•• r, Amc ... nt .,sured po ,IP\ Amount Ir ured polic,es Amo:Jnt l~,;urPd l)olc 1M. Amount lrnurPd pol,c,Ps An-ou,,, lnsJred polic1M Amount lnsurl'.!d po,c,es Amount 1ns1.rPd ~o c'r. [ Pi Ar ~ ~ r::l (oJ.,mnCode· a b c d --,------,--· g • 1"1-------,-- J -• It•-·-;;_-•-,,-• n --c, • Q • r • s-• ,-~---- v w • Andhra Pradesh Arunadlal Pradesh Anam Blhar Chhilttisg111rh Goa 7 Gujarat 8 ,H.aryana g Himilchill Pr.ade-sh 10 Jur.-nu & Kashmir 11 .11.arthilnd 12 lun.at.ab 13 leralil ' -----r- 14 Madhril Prildesh l.5 Matlilrasthra 16 Manlpur 17 .Molf,olaya 18 Mb:aram 19 Nat;.aland 20 Qn,sa 21 Punjib 22 RilJ.anhan 23 Slldcim __ 24_ T•mil N•dlJ __ _j 25 Tr1pura Utt.ar"3d~ 27 Uttralr:hand ---t- 28 WHtBf!ncal 29 ktdam.an & Nicab.ar Is. 30 ICh;anC:liprh 31 Dadra & Na.11ra Haveli 32 Dam.an&Dlu 33 [)elt,j ~-- t.ikshadweep 35 p;;-duct,,,ry -- , Taraf .f:> ......, 116 THE GAZETTE OF INDIA : EXTRAORDINARY [ P a r t III—Sec. 4 ] 116 THE GAZETTE OF INDIA : EXTRAORDINARY I i I ·7-+--f---+-,.--l-7-- , i I r-t-7 --,f-+--t-1----+--H--,-+--i--t-H-t-+-r-+-11--+---+-e-l-~~-1--;--i.. I I I I [PART III-SEC. 4] . .,. c No. of Claims Enable Numeric 20 Yes Input Both d Amount of Claims Enable Float 15 Yes Input Both Individual Agents Disable e No. of Claims Enable Numeric 20 Yes Input Both f Amount of Claims Enable Float 15 Yes Input Both Banks Disable g No. of Claims Enable Numeric 20 Yes Input Both h Amount of Claims Enable Float 15 Yes Input Both Other corporate agents Disable i No. of Claims Enable Numeric 20 Yes Input Both j Amount of Claims Enable Float 15 Yes Input Both Brokers Disable k No. of Claims Enable Numeric 20 Yes Input Both 1 Amount of Claims Enable Float 15 Yes Input Both Referrals Disable m No. of Claims Enable Numeric 20 Yes Input Both n Amount of Claims Enable Float 15 Yes Input Both Microinsurance Agents(MFI, SHG, NGO) Disable 0 No. of Claims Enable Numeric 20 Yes Input Both P Amount of Claims Enable Float 15 Yes Input Both (For Health Insurance - Individual), No. of lives covered Enable Numeric 10 Yes Input Both (For Health Insurance - Group), No. of lives covered Enable Numeric 10 Yes Input Both 1 Andhra Pradesh Disable 2 Arunachal Pradesh Disable 3 Assam Disable 4 Bihar Disable 5 Chhattisgarh Disable 6 Goa Disable 7 Gujarat Disable 8 Haryana Disable 9 Himachal Pradesh Disable 10 Jammu & Kashmir Disable 11 Jharkhand Disable 12 Karnataka Disable 13 Kerala Disable 14 Madhya Pradesh Disable 15 Maharasthra Disable 16 Manipur Disable 17 Meghalaya Disable 18 Mizoram Disable 19 Nagaland Disable 20 Orissa Disable 21 Punjab Disable 22 Rajasthan Disable 23 Sikkim Disable 24 Tamil Nadu Disable 25 Tripura Disable 26 Uttar Pradesh Disable 27 Uttrakhand Disable 28 West Bengal Disable 29 Andaman & Nicobar Is. Disable 30 Chandigarh Disable 31 Dadra & Nagra Haveli Disable 32 Daman & Diu Disable 33 Delhi Disable 34 Lakshadweep Disable 35 Puducherry Disable # Total Disable Float 20 Yes Derived Sum(No. of Claims/ ArBoth tilih \P SnMt— III iilh] C No. of Claims Enable Numeric 20 Yes Input Both d Amount of daims Enable Float 15 Yes Input Both lndivldual Agents Disable e No. of Claims Enable Numeric 20 Yes Input Both f Amount of Claims Enable Float 15 Yes Input Both Banks Disable . No. of Claims Enable Numeric 20 Yes Input Both h Amount of Claims Enable Float 15 Yes Input Both Other corporate a1ents Disable ; No. of Claims Enable Numeric 20 Yes Input Both ; Amount of Claims Enable Float 15 Yes Input Both Brokers Disable k No. of Claims Enable Numeric 20 Yes lnout Both I Amount of Claims Enable Float 15 Yes Input Both Referrals Disable m No. of Claims Enable Numeric 20 Yes Input Both n Amount of Claims Enable Float 15 Yes Input Both Microinsurance A1ents(MFI, SHG, NGO) Disable 0 No. of Claims Enable Numeric 20 Ve, lnout Both D Amount of Claims Enable Float 15 Yes Input Both (For Health Insurance - Individual), No. of lives co11ered Enable Numl!!ric 10 Yes lnout Both (For Health Insurance - Group), No. of lives covered Enable Numeric 10 Yes Input Both 1 Andhra Pradesh Disabll!! 2 Arunathal Pradesh Disable 3 Assam Disable 4 Bihar Disable 5 ChhattisHrh Disable 6 Goa Disable 7 Gujarat Disable 8 Haryana Disable 9 Himachal Pradesh Disable 10 Jammu & Kashmir Disable 11 Jharkhand Disable 12 karnataka Disable 13 Ker.iliil Disable 14 Madhya Pradesh Disable 15 Maharasthra Disable 16 Manipur Disable 17 Meghalaya Disable lB Mizoram Disable 19 Nagaland Disable 20 Orissa Disable 21 Punjab Disable 22 Rajasthan Disable 23 Sikkim Disable 24 Tamil Nadu Disabll!! 25 Tripura Disable 26 Uttar Pradesh Disable 27 Uttrakhand Disable 28 West Benlilal Disable 29 Andaman & Nicobar Is Disable 30 Chandigarh Disable 31 Dadra & Nagra Havl!!li Disable 32 Daman & Dlu Disable 33 Delhi Disable 34 Lakshadweei:, Disable 35 Pu du cherry Disable • Total Disable Float 20 Yes Derived Sum(No. of Claims/ Ar Both -..J INPUT_Health_9 S Large Claim Details - Insurer-wise Purpose and frequency This form captures the claim details of large claims in for all insurers This is a new form The frequency of this form is yearly and as and when Filters and Parameters Year | | Quarter Insurer Name Reported Claims Fully Settled claims Partially settled claims Outstanding Claims State No. of claims Amount of claims No. of claims Amount of claims ,No. of claims Amount ofclaims No. of claims Amount of claims Column Code a b c d e f g h 1 Andhra Pradesh J..... M. It 2 Arunachal Pradesh 3 Assam 4 Bihar 5 Chhattisgarh 6 Goa 7 Gujarat 8 Haryana 9: Himachal Pradesh 10 Jammu & Kashmir 11 Jharkhand 12 Karnataka 13 Kerala 14 Madhya Pradesh 15:Maharasthra 16 Manipur 17 j Meghalaya 18; Mizoram 19 Nagaland 20 Orissa 211 Punjab 22 Rajasthan 23 Sikkim 24 Tamil Nadu 25 Tripura 26 Uttar Pradesh 27 Uttrakhand j 28 West Bengal 29 Andaman & Nicobar Is. 30 Chandigarh 31 Dadra & Nagra Haveli 32 Daman & Diu 33 Delhi Lakshadweep 35 Puducherry 1 * Total THE GAZETTE OF INDIA : EXTRAORDINARY [ P art III— S e c . 4] INPU1=ffealth_S Large Claim Detatr, -Insurer-wise Purpose and frequency This form captures the claim details of lar1e claims in for all insurer, This is a new form The frequency of this form is yearl\, and as and whon Filters and Parameters Year Insurer Name Quarter _ ______________ ~ Reported Claims ____ +--- _ _ ~~ttle~ cla1~s ~- ~-- - ~a~1~lly se~tled ~la1ms Outstanding Claims :s I State No of Amount of claims No of claims Amount of claims No of Amount of claims Na of Amount of rla1ms claims claims claims • Column Cade I a b c d I e ~ f g h 1 IAndhra Pradosh I I I 2 Arunachal Pradosh I 3.Assam • -----------+----+---------------------+----------+----+---------+----+------·•- 4 IBihar I 5 iChhattis1arh I 6 iGoa 7 Gujarat I I -----------t-- --,t----------1-----------+---------+----+--------l------i-------- 8 Haryana 9 , Himachal Pradesh 10 Jammu & Kashmir 11 Jharkhand 12 , Karnataka 13 i Korala 14 i Madhya Pradosh 15 i Maharasthra l I I I I I l I l ---+--------t-----+-----+----i..---------; ! 16 Manipur -----------+-----+---------- - ·----------+----------+----,1------------<1------.. 1·--- ------< I I 17 ; Meahalaya l8 1Mizoram I ! 19 Na1aland I 20 Orissa I --- 21 1 Punjab • I 22 Rajaslhan I 23 Sikkim I 24 Tamil Nadu I 2SiTripura 26i Uttar Pradosh ~------------+----+----·----------·-------+---------+-- -- ~--------t- ----;l _______ -1 I 27 1 Uttrakhand . 28 Wost Ben1al __ .::..:__,.:..:.::.=.:c.::.:.:,::_ ______ +------+---------.:... '· --- -------~- --------1---+---------+-----+i---- ----l I I 29 !Andaman & Nicobar Is. 30 Chandi1arh 31 Dadra & Na1ra Haveli I i ~ ----- --+-----+-------t---------+---------+----+--- ----+--____,l _____ ____, 32 Daman & Diu i I 33 Dolhi i 34 · Lalcshadwoop I I 35 Puducherry I I # !Total I I I .. 00 ~ ► ::j ,_ ,_ T [/J t'I1 0 ..::: Input!HEALTH_10 Quarterly Grievance movement <this form is filled by lnsurer> Purpose and Objective ThisFormt represents the grievance movement through out the period for each insurer against different types of complaints The frequency of this form is quarterly Filters and Parameters Year Complaint Type Complaint Type Delay in Payment Refusal of claim Deduction Policy not received Any Other No. of complaints rejected No. of new complaints registered No. of complaints pending at the beginning No. of complaints pending at the end No. of complaints resolved Name of Insurer Column Code Grievance Management System Grievance Management /• System Grievance Management System Source/ Calculation Grievance Management System Grievance Management System No. of complaints pending fore- 12 months No. of complaints pending for 1- 3 months No. of complaints pending for 3-6 months No. of complaints pending for < 1 month No. of complaints pending for > 1 yr Name of Insurer Column Code Source/Calculation fchfrft P>lk [t? S n g L — III l d h ] <this form is filled by Insurer> Purpose and Objective Thisformt represents the grievance movement through out the period for each insurer against different types of complaints The frequency of this form is quarterly FIiters and Parameters Year Complaint Type --------+··------ ------;-------- Complaint Type Delay in Payment Refusal of claim Deduction Policy not received Any Other INPUT_HEALTH_4.1 | Yearly I ' Details of new business and renewal business - Statewise Purpose and frequency To capture the statewise new business and renewal business activities for each insurer This form is a new format. The frequency of the return is yearly. Filters and Parameters ___________________ ____________________________ Year | | Business j Individual Insurer Name Individual Business Needs to be removed; create the drop down as shown above New Business Renewal Business In-Force Business # State * No. of policies Gross Premium Amount Total Sum Assured No. of policies Gross Premium -Amount Total Sum Assured No. of policies Gross Premium , Amount Total Sum Assured C olum n Code a b d e f h e f h 1 Andhra Pradesh ■ 'V . - 2 Arunachal Pradesh 3 Assam ., ......... , : ' 4 Bihar 5 Chhattisgarh 6 Goa _ 7 Gujarat 8 Haryana 9 Himachal Pradesh 10 Jammu & Kashmir 11 Jharkhand 12 Karnataka 13 Kerala 14 Madhya Pradesh . ................... .J 15 Maharasthra ■ 16 Manipur :■ j 17 Meghalaya . 18 Mizoram : ■ 19_ Nagaland ' '• •' ' i 20 Orissa ......... ..;..... . 21 Punjab 22 Rajasthan ■ ..... , .... 23 Sikkim 24 Tamil Nadu ■ " 25 Tripura 26 Uttar Pradesh 27 Uttrakhand ...... ' 28 West Bengal 29 Andaman & Nlcobar Is. ■ 30 Chandigarh 31 Dadra & Nagra Haveli 32 Daman & Diu 33 Delhi 34 Lakshadweep 35 Puducherry ' 1 / . ; : # ra ta l , ..... ' .;........... Group Business * THE GAZETTE OF INDIA : EXTRAORDINARY [ P art I I I — Sec. 4 ] INPUT_HEALTH_ 4.1 Yearly I · Details of new business and renewal business - Statewise Purpose and frequency To capture the st.iltewise new business and renewal business artMties for each insurer This form is a new format. The frequency of the return is yearly. Alters and Parameters Year Insurer Name lndi\lidual Business Needs to be removed; create the drop down as shown above Nrw Business Gross Premium # State • No. of pohc,es Amount - Column Code a b A h a ' 2 Arunachal Pradesh 3 Assam - - 4 Bihar 5 Chhattis1arh 6 Goa 7 Gujarat - 8 Ha""ana 9 i Himachal Pradesh 10 1Jammu & Kashmir 11 Jharkhand 12 Ka mataka 13 Kera la 14 Madhya Pradesh 15 Maharasthra 16 Manipur 17 M•ahalaya 18 Mizoram 19 Na1aland - 20 Orissa 21 Punjab ! 22 IRajasthan 23 Sikkim ! 24 iTa mil Nadu 25 Tris:iur.1 26 Uttar Pradesh 27 Uttrakhand 28 West B•n1a l 29 Andaman & Nicobar Is. 30 Chandqiarh 31 Oadra & Na1ra Haven ~ · 32 Daman & Diu 33 Dtlhl --- 34 Lallcshadw••P 35 Puducherry " T- - n Group Business • .. Total Sum Assured - - d ·-- • BLJsines.s l1ndividual Renewal Business In Force Business Gross No of policies Gross Premium No. of policies Total Sum Total Sum AssurPd Premium Assured Amount Amo1.1nt e I h e I h i I i I I I I I i I I I I ' i ! I l I ! ·--·- i ! I ' ! ! I I ' ~ i I i i I I I ,·. -. /£- E///0 1 ' New Business Renewal Business In-Force Business Data ■ 8 State No. of policies No. of lives covered Gross Premium Amount Total Sum # , • No. of policies Assured No. of lives covered Gross Premium Amount Total Sum Assured No. of policies Gross Premium Amount Total Premium Amount Total Sum Assured 1 Column Code a b c e f » g h j f g h ........i 1 Andhra Pradesh 2 ArunachalPradesh 3 Assam 4 Bihar 5 Chhattisgarh 6 Goa 7 Gujarat 8 Haryana 9 Himachal Pradesh 10 Jammu & Kashmir 11 Jharkhand - 12 Karnataka 13 Kerala 14 15 Madhya Pradesh Maharasthra -......- ... .................. .. ....... 16 Manipur 17 Meghalaya 18 Mizoram 19 Nagaland "j ‘ 20 Orissa 21 Punjab 22 Rajasthan 23 Sikkim 24 Tamil Nadu 25 Tripura -... . .......- .. ,...... . 26 Uttar Pradesh ___ ____ __ 27 Uttrakhand '' 28 West Bengal j ; ' 29 Andaman & Nicobar Is. | ‘ _30 _ Chandigarh 31 Dadra & Nagra Haveli L _ — _____ , —- - : j 32 Daman & Diu 33_ Delhi r~~ “i 1 ___ - , 34 Lakshadweep [ " T~.."...........1} — ~ 1 35 Puducherry j\ , . ...... [7' v . - j i . # Total L . . .... . ;:V-v - ______ '...■___ _ ...... i Note: * Group include family floaters and any policy with more than one insured person life a ih [fr griis> HI I r i k ] 0\ Q N ~ w , LN --- ... I.. _ --..--- _______________ I___ _ __ NewBusiness ----,.-----~ ___ RenewalBusmess _ t ln-ForceBus1nessData I :J No. of lives Total Premium 1 State No. of polmes covered Amount Total Sum Assured CDlumnCDde ~ h : I 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Andhra Pradesh Arunachal Pradesh Assam Sihar Chhattisgarh Goa Gujarat Harya~a Himachal Pradesh Jam mu & Kashmir Jharkhand Karnataka Kerala Madhya Pradesh Maharasthra Manipur Meghalaya Mizoram Nagaland Orissa Punjab ... Rajasthan Sikkim Tamil Nadu Tripura Uttar Pradesh Uttrakhand West Bengal Andaman & Nicobar ls. Chandigarh 31 Dadra & Nagra Haveli 32 Dam.in & Oiu 33 Delhi 34 35 # Note: lakshadweep Puducherrv Total -t - T ----+-- + - I +- +· I 1 Group include family floaters and any policy with more th.in one iMured person ~ ! + ·--~ + I t + I t ~ I I i f I ---+ -i- i t r r t I I I j I -f I j I r ~ I I I 1 I I .t.i ~ ~ 1 ~ ] I✓ INPUT_HEALTH_6.4 Quarterly Performance of Government sponsored Health Insurance Scheme Purpose and frequency This form is used to capture the details of the Performance of Goverement Health Insurance sponsered Scheme This is a new format The frequency of the form is quarterly Filters and Parameters Year Insurer Name Quarter # Product / Scherrw No. of policies issued No.of BPL families covered No of ot hers covered in BPL Families Total number of beneficiaries covered Gross Premium (In 000s) No.of claims reported Amount of Claims reported No.of claims settled Claim Amount settled No. of claims O/s Amount of ■ Claims O/s. Incurred Claim Ratio (%) Column Code \ a b c d e f g h i j k 1 2 3 4 5_ 6 7 8 9 10 11 12 THE GAZETTE OF INDIA : EXTRAORDINARY [ P art III— S e c . 4] tNPUT_HEALTH_6.4 I Quarterly I Performance of Government sponsored Health Insurance Scheme Purpose and frequency Th is form is used to capture the details of the Performance of Goverement Health Insurance sponsered Scheme This Is a new format The frequency of the form is quarterly Filters and Parameters Year lnsuner Name .__ _________________ __, Quarter I f No.of BPL )__ -_-- I I Amount of I Incurred 1 No. of polic,es I Total number of ' Gross Pnemium No.of claims 1 . No.of claims Claim Amount No. of claims Amount of Cla,m Rat,o , families I C aims 1 ossued , covered beneficlarie OOOs) reported I reported settled settled O/s Claims O/s. (%) n Product/ Schem, , - Colu;,; Code , I c _d___ e f g , h I ;- - ,-. • k - - 1 2 3 4 5 6 7 8 9 10 11 12 ----- - - --- - +--- • 4 5 ---- -- I _j__ .... f-- -,_-=-_- -+ --+ - I _ __j - ---i- -+ __L ---+-- ~ I -~- -~=t -~- ---r·- --t---- I I I -~--·- -·- -- --+------ 1-., -l :c !Tl Cl ~ tTl ~ 0 "T1 z 0 ► ::-:, >< ..., ;;:o ► 0 ;;:o 0 z ► ~ n0\ <3i Cw I W I - I ~ ] .; 7 % jU ,r ’ ■ ~— - - - - - - " r - - TaKI u ; ‘ - HataTiLb ra^ioName | uoiumn Nam e j uara iype _ j--'""1 _—.—-—_ ] database/ c Product/Scheme Enable 20 Yes Input Database C(a) No. of policies issued Enable Numeric 20 Yes Input Should not be Negative Database C(b) No.of BPL families covered Enable Numeric 20 Yes Input Should not be Negative Database C(c) Total number of beneficiaries covered Enable Numeric 20 Yes Input Should not be Negative Database C(d) Gross Premium (In 000s) Enable Numeric 20 Yes Input Should not be Negative Database C(e) No.of claims reported Enable Numeric 20 Yes Input Should not be Negative Database C(f) Amount of Claims reported Enable ( Numeric 20 Yes Input Should not be Negative Database C(g) No.of claims settled Enable Numeric 20 Yes Input Should not be Negative Database C(h) Claim Amount settled Enable Numeric 20 Yes Input Should not be Negative Database C(i) No. of claims O/s Enable Numeric 20 Yes Input Should not be Negative Database CO) Amount of Claims O/s. Enable Numeric 20 Yes Input Should not be Negative Database C[k) Incurred Claim Ratio (%) Enable Numeric 20 Yes Input Should not be Negative Database JSilkJi. life imte [ P s-nis>— ITT If Ik ] C Product/Scheme Enable No. of policies C{a) i5Jued Enable No.of BPL C(b) families covered Enable Total number of beneficiaries C(c) covered Enable Gross Premium C(d) {In OOOs) Enable No.ofdaims C(e) reported Enable Amount of C(f) Claims reported Enable No.ofdaims C{g) settled Enable Claim Amount C{h) settled Enable ((I) No. of daims O/s Enable Amount of C{j) Claims O/s. Enable Incurred Claim Ratio (%) ((k) Enable 20 Yes Input Numeric 20 Yes Input Numeric 20 Yes Input Numeric 20 Yes Input Numeric 20 Yes Input Numeric 20 Yes Input Numeric 20 Yes Input Numeric 20 Yes Input Numeric 20 Yes Input Numeric 20 Yes Input Numeric 20 Yes Input Numeric 20 Yes Input Should not be Negative Should not be Negative Database Should not be Negative Database Should not be Negative Database Should not be Ne alive Database Should not be Negative Database Should not be Negative Database Should not be Negative Database Should not be Negative Database Should not be Negative Database Should not be Negative Database .... - ~ ~ m ~ ; ~ "" w mm of offices - Quarterl Purpose and Frequency The purpose of this report is provide information on the distribution of office locations in each state fo^.each insurer The frequency of this report is quarterly Filters and Parameters Year Quarter State No. of % of ■ ft - . urban Urban branches Branches Column Code a b c d e Source/C alculation INPUT_N ON_LIFE_ Office_l INPUT_N ON_LIFE_ Office_l =100*b/( b+d) INPUT_N ON_LIFE_ Offlce_l =100*d/( b+d) 1 3 4 \ 3 ________ 5 6 . # Total ;:.i% V ' j i - . ■V--1 . H Xm O>N m m O ~n a > m XH i o 73O 2> 3 OO mp Rf P_HEAL TH_ O/fice_2 Statewise Report of clistribution O'f offices .. Qoadea,ly --""--'"''-•=.i.r..•'Qa Purpose and Frequency The purpose of this report is provide information on the distribution of office locations in each state for.each insurer The frequency of this report is quarterly Filters and Parameters ,------------, Year Quarter State Rural Urban Area Area ~No. of f branches No. of % of rural No. of % of Name o I rural urban Urban # ,approved Insurer I branches Branches branches Branches but not I opened Column ! b d Code I a C e j INPUT N INPUT_!'. =l00*b/( I INPUT_N =l00*d/( Source/C , ON LIFE olculation I - - ON_LIFE - b+d) I ON_LIFE_ b+d) Office_l Office_l I Office_l - - 3 ---·--- ---- t---- - - --+-- - - ---! __ ___,__ 4 5 --+----+-----+----+-----+----+-----I 6 ----, I futal - • -l :r: !:Tl C) )> N tT1 =1 !:Tl 0 'Tl z CJ > !:Tl >< -l ~ 0 ;:o CJ z )> ~ r m 0 *nrcr : sm rw i Purpose and Frequency The purpose of this report is to provide the office details o f each insurer in each state and at an overall level The frequency of this report is quarterly v 1 ' , ' Filters and Parameters y Year I | Quarter | State | | No. of offices at N am e of the Insurer beginning of the year Source/C alculation No. of branches opened during the year No. Of branches approved during th e year O ut of approvals o f previous year b c INPUT_N ON_LIFE_ O ffic e _ l INPUT_N ON_LIFE_ O ffic e _ l O ut of approvals o f this year ON_LIFE_ O ffice 1 branches branches closed at th e end during th e o f th e year year INPUT N INPUT N ON_LIFE_ Office 1 ON_LIFE_ Office 1 3 4 .......... 5 6 Total - - ■_ ....... P rin te d by the Manager, Government of India Press, Ring Road, Mayapuri, New Delhi-110064 and Published by the Controller o f Publications, D elhi-110054. RfP_ OF Purpose and Frequency The purpose of this report is to provide the office d!!tails of each Insurer In each state and at an overall level The frequency of this report is quarterly ' Filters and i>arameterr..;;.s _________ __, Year State No. of branches opened during the year No. of No. of Out of offices at Name of the branches approvals n approved of ln5urer beginning of the during the previous year year year --- Coll1mn b ,l C <odP - ~ !I!!!!!!!!!!! - ---- Source/C INPUT N INPUT_N INPUT - N ON _LIH ON _ LIFE ON_LIFE alculation - - Office I Office_l Office_l '2 3 4 5 6 i ·• Total • - Out of approvals of this year d - - INPUT _N ON LIFE - Office 1 Quarter " r lo . of branches losed during the year (' 'lloof branches at the end afthe year INPUT N INPUT_N ON_LIFE ON_LIFE_ Office _ 1 Office 1 Printed by the Manager, Government of India Press, Ring Road, Mayapuri, New Delhi-110064 and Published by the Controller of Publications, Delhi-110054