Settlement of Claims under Group Insurance Policies

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- '1-lf{(Hl:l <l 11=11 lefR !flllefi ~m ]c:'(cnTff 5111'1.(cfi{Ol ! " INSURANCE REGULATORY AND hdal DEVELOPMENT AUTHORITY OF INDIA IRDA/Life/2014/129 8th April, 2015 To the CEOs of all the Life Insurers Re: Settlement of Claims under Group Insurance Policies Authority vide its Circular ref IRDA/LIFE/CIR/GDL/285/12/2014 dated December 29, 2014 has issued modified Guidelines in respect of Group Insurance Policies/Schemes administered by certain category of Master Policy Holders. In order to monitor the execution of the modified guidelines dated 29th December, 201 4 in the matter of the settlement of the claims under Group Insurance Policies all the insurers are directed to submit the half yearly compliance certificate from their respective statutory auditors for the Financial Year 2015-16 in the prescribed proforma attached as Annexure - 1. The certification in the prescribed proforma shall be submitted in respect of the entire group insurance portfolio of the life insurers and be filed with the Authority within 45 days of the expiry of the respective half year. The first such half year ends 30/9/2015 for which certificate as above is required to be submitted. ~ C>. - 9 ~ii:vl ' .=77 ~C7 c.---i 7,.Lj r_. (V Jayanth Kumar) <__ Joint Director (Life) Parisrama Bhavanam,5 -9-58/B, 3rd Floor, Basheer Bagh, Hyderabad 500 004 Phone: 040-23381263, Facsimile: 040 66823334 www.irdaindia.org ,1- ~T{ol<l ~n:n lcfR"l.lTrrcn ;;s{T< rcrcnr<-4 511l~c&or b INSURANC E REGULATORY AND Wal DEVELOPMENT AUTHORITY OF INDIA ANNEXURE - 1 Name of Life Insurer: Information for the Half Year ending ______ __ _ I Total Number of Non Employer-Employee Group Life Insurance Schemes / Policies II Total Number of Group Life Insurance Schemes / Policies under Lender Borrower Schemes SI Where Number Number Where claims Where claims Where claims No. Master of of settled in full settled in full settled in full Policy Schemes Members drawing drawing drawing Holder Insured cheques in cheques in cheques in (MPH) is favour of MPH favour of MPH favour of Nominee I Beneficiary No. of Benefit No. of Benefit No. of Benefit Claims Amount Claims Amount Claims Amount 1 RBI regulated Scheduled Commercial Banks 2 NBFCs having Certificate of Registration from RBI 3 NHB Regulated Housing Finance Companies (1) It is certified that; In respect of all the group insurance schemes where claim cheques (whether for full claim amount or partial claim amount) are issued in favour of the master policy holder the life insurer has (a) obtained specific authorization from the individual members of the group life insurance scheme / policy in compliance to Clause (2) (I) (a) of the Guidelines dated 29th December, 2014 (Guidelines) (b) enabling clause was there in the terms and conditions in compliance to Clause (2) (I) (b) of the Guidelines (c) obtained a Credit Account Statement from the Master Policy Holder in compliance to Clause (3) {I) of the Guidelines. Parisrama Bhavanam,S -9-58/B, 3rd Floor, Basheer Bagh, Hyderabad 500 004 Phone: 040-23381263, Facsimile: 040 66823334 www.irdaindia.org jl-~ 1f~nl<-I <!1141 lqH~l4<t> ,jff{ leltfi"Tff IDIU<t>\Ul £:!. INSURANCE REGULATORY AND Wal DEVELOPMENT AUTHORITY OF INDIA (2) In respect of the following group schemes where claim cheques (whether in part or in full) are issued in favour of Master Policy Holders non compliance is observed as mentioned hereunder. Number of Number of Amount of Details of Non Compliance to the Schemes I Claims Benefits Guidelines dated 29th December, Group 2014 Insurance Policies (3) In respect of the Certification furnished for the half year ending 31 st March, 2016 in addition to the above, the statutory auditors shall also certify the following: (i) In respect of the following cases the life insurer complied with Clause (3) (VII) of the Guidelines. (a) Number of Group Insurance Schemes where complied with Clause 3 (VII) of the Guidelines (ii) In respect of the following cases the life insurer does not complied with Clause (3) (VII} of the Guidelines. (a) Number of Group Insurance Schemes where non compliance to Clause 3 (VII) of the Guidelines is observed It is certified that the above information is furnished after examining the relevant records of the life insurer. The information furnished is correct. Place: #Signature of the Statutory Auditor Date: Seal # in case of engaging more than one statutory auditor, the life insurers may submit the above certification from at least one of the auditors. Parisrama Bhavanam,5 -9-58/8, 3rd Floor, Basheer Bagh, Hyderabad 500 004 Phone: 040-23381263, Facsimile: 040 66823334 www.irdaindia.org