| S.No. |
ENTITY |
PERSONS |
REGULATORY CHARGES |
REGULATORY ACTION(S) / DATE OF ORDER |
FURTHER DEVELOPMENTS |
| 1 |
|
ALANKIT HEALTH CARE TPA LTD.
|
|
|
PUBLISHED WRONG/MISLEADING INFORMATION TO GENERAL PUBLIC THROUGH ITS WEBSITE
|
CENSURED/WARNED & DIRECTED/ADVISED TO BE DILIGENT IN COMPLYING WITH ALL THE ACTS, REGULATIONS ETC.
01-JUL-2016
|
|
| 2 |
|
|
ALANKIT INSURANCE TPA LTD.
|
|
|
DID NOT ADHERE TO MINIMUM BUSINESS REQUIREMENTS VIOLATING REGULATION 14 OF IRDAI (TPA-HEALTH SERVICES) REGULATIONS, 2016
DID NOT FULFIL CRITERIA ON AVERAGE BASIS FOR NUMBER OF POLICIES SERVICED VIOLATING REGULATION 15 (C) (6)(C) OF IRDAI (TPA-HEALTH SERVICES) REGULATIONS, 2016
|
REJECTED APPLICATION FILED FOR RENEWAL OF LICENCE (TPA)
ADVISED TO REMOVE WORD TPA FROM NAME OF THE COMPANY
DIRECTED ALL INSURER HAVING TPA AGREEMENT WITH ALANKIT TPA TO IMMEDIATELY TAKE SUCH ALTERNATIVE STEPS INCLUDING APPOINTMENT OF ANOTHER TPA
DIRECTED TO SUBMIT DATA COLLECTION AND BOOKS, RECORDS OR DOCUMENTS ETC. RELATING TO TPA BUSINESS
DIRECTED TO CO-OPERATE WITH INSURANCE COMPANIES IN MAKING SUITABLE ALTERNATE ARRANGEMENTS TO SERVICE POLICY HOLDERS IN RESPECT OF WHOM POLICIES ARE IN FORCE
DIRECTED TO RECONCILE AND CLOSE THE ACCOUNTS WITH CONCERNED INSURANCE COMPANIES AND NETWORK PROVIDERS
30-JUN-2021
|
|
| 3 |
|
|
ANMOL MEDICARE INSURANCE TPA LTD.
|
|
|
DID NOT GET APPROVAL AND DID NOT INFORM IRDA ABOUT CHANGES IN SHAREHOLDING PATTERN BY WAY OF TRANSFER OF EXISTING SHARES TO EXISTING AS WELL AS NEW SHAREHOLDERS
SUBMITTED WRONG/MISLEADING UNDERTAKING WHILE PROVIDING INFORMATION ABOUT ENGAGEMENT IN ANY OTHER BUSINESS
DELAY IN SUBMISSION OF ANNUAL REPORT
|
IMPOSED PENALTY RS.5,00,000
11-JAN-2016
|
|
| 4 |
|
|
ANMOL MEDICARE INSURANCE TPA LTD.
|
|
|
GRANTED LOAN TO INDIVIDUALS OTHER THAN THE EMPLOYEES
|
IMPOSED PENALTY RS.1,00,000
09-JAN-2024
|
|
| 5 |
|
|
ANMOL MEDICARE INSURANCE TPA LTD.
|
|
|
DID NOT ADHERE TO MINIMUM BUSINESS REQUIREMENTS VIOLATING REGULATION 14 OF IRDAI (TPA-HEALTH SERVICES) REGULATIONS, 2016
|
ADVISED TO REMOVE WORD TPA FROM NAME OF THE COMPANY
DIRECTED ALL INSURER HAVING TPA AGREEMENT WITH ANMOL TPA TO IMMEDIATELY TAKE SUCH ALTERNATIVE STEPS INCLUDING APPOINTMENT OF ANOTHER TPA
DIRECTED TO SUBMIT DATA COLLECTION AND BOOKS, RECORDS OR DOCUMENTS ETC. RELATING TO TPA BUSINESS
DIRECTED TO CO-OPERATE WITH INSURANCE COMPANIES IN MAKING SUITABLE ALTERNATE ARRANGEMENTS TO SERVICE POLICY HOLDERS IN RESPECT OF WHOM POLICIES ARE IN FORCE
DIRECTED TO RECONCILE AND CLOSE THE ACCOUNTS WITH CONCERNED INSURANCE COMPANIES AND NETWORK PROVIDERS
REJECTED APPLICATION FILED FOR RENEWAL OF LICENCE (TPA)
04-JUL-2024
|
|
| 6 |
|
|
ANYUTA INSURANCE TPA IN HEALTH CARE PVT.LTD.
|
|
|
DID NOT ADHERE TO MINIMUM BUSINESS REQUIREMENTS VIOLATING REGULATION 14 OF IRDAI (TPA-HEALTH SERVICES) REGULATIONS, 2016
|
REJECTED APPLICATION FILED FOR RENEWAL OF LICENCE (TPA)
25-JUN-2020
|
|
| 7 |
|
|
DAWN SERVICES PVT.LTD.
|
|
|
OPTED TO EXIT FROM BUSINESS OF THIRD-PARTY ADMINISTRATOR (TPA)
|
DID NOT RENEW LICENCE OF THIRD PARTY ADMINISTRATOR (TPA)
06-FEB-2009
|
TERMINATED VIDE NOTICE DATED 08/06/2009
|
| 8 |
|
|
EAST WEST ASSIST TPA PVT.LTD.
|
|
|
SUBMITTED WRONG/MISLEADING UNDERTAKING IN THE MATTER OF ENGAGEMENT BY CEO AND DIRECTOR IN INSURANCE OR INSURANCE RELATED ACTIVITY
|
IMPOSED PENALTY RS.1,00,000
17-NOV-2015
|
|
| 9 |
|
|
E-MEDITEK (TPA) SERVICES LTD.
|
|
|
DID NOT PROVIDE INFORMATION ABOUT INVOLVEMENT OF ITS PROMOTERS AND/OR DIRECTORS IN INSURANCE & INSURANCE RELATED ACTIVITIES TO IRDA
DID NOT SUBMIT TRUE AND CORRECT STATEMENT TO IRDA
PROVIDED WRONG/MISLEADING INFORMATION THROUGH WEBSITE ABOUT SELF-FUNDED SCHEMES OF STATE GOVERNMENT AND/OR CGHS CLAIMS AUDIT
|
IMPOSED PENALTY RS.5,00,000
25-AUG-2014
|
|
| 10 |
|
|
E-MEDITEK (TPA) SERVICES LTD.
|
|
|
DELAY IN SUBMISSION OF ANNUAL REPORT
|
ADVISED INSURANCE COMPANIES TO STRICTLY ADHERE TO IRDA GUIDELINES
01-SEP-2014
|
|
| 11 |
|
|
E-MEDITEK INSURANCE TPA LTD.
|
|
|
INDULGED IN IRREGULARITIES IN RESPECT OF POLICY/CLAIM SERVICING, ACCOUNTING PRACTICES ETC VIOLATING PROVISIONS OF IRDAI (TPA-HEALTH SERVICES) REGULATIONS, 2016
|
SUSPENDED CERTIFICATE OF REGISTRATION AS THIRD PARTY ADMINISTRATOR (TPA)
20-MAR-2018
|
|
| 12 |
|
|
FAMILY HEALTH PLAN (TPA) LTD.
|
|
|
RENDERED SERVICES IN THE FORM OF IT SUPPORT FOR PORTING THE MEMBER DETAILS COVERED UNDER HEALTH INSURANCE POLICIES
ENTERED INTO AGREEMENT WITH ALLIED INSURANCE CO. FOR PROVIDING SERVICES TO THEIR CLIENTS VISITING INDIA FOR MEDICAL TREATMENT
PROVIDED EMERGENCY ASSISTANCE AND OTHER ALLIED SERVIES TO CLIENTS OF FOREIGN INSURERS IN INDIA
ENGAGED IN PRINTING AND DISPATCH OF HEALTH INSURANCE POLICY KITS TO ITS CUSTOMERS AND SEPARATE CHARGES RECEIVED FOR THE SAME FROM INSURER
DID NOT MAKE DISCLOSURE OF CLAIMS OUTSTANDING FOR MORE THAN 6 MONTHS AT THE YEAR-END IN RETURN TPA 4(7) OF ANNUAL REPORT
|
IMPOSED PENALTY RS.25,00,000
CENSURED/WARNED & DIRECTED/ADVISED TO BE DILIGENT IN COMPLYING WITH ALL THE ACTS, REGULATIONS ETC.
29-JAN-2015
|
|
| 13 |
|
|
GOOD HEALTH PLAN (TPA) LTD.
|
|
|
ALLOWED TO OPERATE SINGLY ALL BANK ACCOUNTS AND ALSO INSTRUCTIONS TO BANK WHO WAS NEITHER EMPLOYEE NOR A DIRECTOR OF COMPANY AS PER BOARD APPROVED RESOLUTION
|
IMPOSED PENALTY RS.5,00,000
28-APR-2015
|
|
| 14 |
|
|
GRAND INSURANCE TPA PVT.LTD.
|
|
|
DELAY IN SUBMISSION OF ANNUAL REPORT
|
IMPOSED PENALTY RS.1,00,000
19-SEP-2017
|
|
| 15 |
|
|
GRAND INSURANCE TPA PVT.LTD.
|
|
|
DID NOT FILE APPLICATION TO RENEW CERTIFICATE OF REGISTRATION VIOLATING REGULATION 19 (9) OF IRDAI (TPA-HEALTH SERVICES) REGULATIONS, 2016
DID NOT FILE ANNUAL RETURNS
|
CERTIFICATE OF REGISTRATION REVOKED
DIRECTED ALL INSURER HAVING TPA AGREEMENT WITH GRAND TPA TO IMMEDIATELY TAKE SUCH ALTERNATIVE STEPS INCLUDING APPOINTMENT OF ANOTHER TPA
DIRECTED TO CO-OPERATE WITH INSURANCE COMPANIES IN MAKING SUITABLE ALTERNATE ARRANGEMENTS TO SERVICE POLICY HOLDERS IN RESPECT OF WHOM POLICIES ARE IN FORCE
DIRECTED TO RECONCILE AND CLOSE THE ACCOUNTS WITH CONCERNED INSURANCE COMPANIES AND NETWORK PROVIDERS
DIRECTED TO SUBMIT DATA COLLECTION AND BOOKS, RECORDS OR DOCUMENTS ETC. RELATING TO TPA BUSINESS
ADVISED TO REMOVE WORD TPA FROM NAME OF THE COMPANY
23-JUN-2021
|
|
| 16 |
|
|
HAPPY INSURANCE TPA SERVICES PVT.LTD.
|
|
|
DID NOT MAINTAIN VALID REGISTRATION PERTAINING TO ITS DIRECTOR HAVING MEDICAL QUALIFICATION
SUBMITTED TPA-6 FORMS AFTER EXPIRY OF THREE YEARS FROM THE DATE OF APPOINTMENT OF NEW DIRECTORS ON THE BOARD OF COMPANY
DID NOT TAKE PRIOR APPROVAL FROM IRDA FOR CHANGE IN SHAREHOLDING PATTERN
DID NOT ADHERE TO WORKING CAPITAL REQUIREMENTS
|
REJECTED APPLICATION FILED FOR RENEWAL OF LICENCE (TPA)
ADVISED TO REMOVE WORD TPA FROM NAME OF THE COMPANY
DIRECTED ALL INSURER HAVING TPA AGREEMENT WITH HAPPY TPA TO IMMEDIATELY TAKE SUCH ALTERNATIVE STEPS INCLUDING APPOINTMENT OF ANOTHER TPA
DIRECTED TO SUBMIT DATA COLLECTION AND BOOKS, RECORDS OR DOCUMENTS ETC. RELATING TO TPA BUSINESS
DIRECTED TO CO-OPERATE WITH INSURANCE COMPANIES IN MAKING SUITABLE ALTERNATE ARRANGEMENTS TO SERVICE POLICY HOLDERS IN RESPECT OF WHOM POLICIES ARE IN FORCE
DIRECTED TO RECONCILE AND CLOSE THE ACCOUNTS WITH CONCERNED INSURANCE COMPANIES AND NETWORK PROVIDERS
19-JUL-2016
|
IRDA VIDE ITS ORDER DATED 22/01/2018 A) ADVISED TO REMOVE THE WORD TPA FROM THE NAME OT ITS COMPANY AND SHALL NOT DO TPA BUSINESS B) ALL INSURERS HAVING TPA AGREEMENT WITH HAPPY TPA, SHALL IMMEDIATELY TAKE SUCH ALTERNATIVE STEPS INCLUDING APPOINTMENT OF ANOTHER TPA, IF ANY, AS MAY BE NECESSARY TO CONTINUE TO CATER TO THE POLICY HOLDERS SERVED BY HAPPY TPA C) HAPPY TPA SHALL IMMEDIATELY SUBMIT DATA COLLECTION AND THE BOOKS, RECORDS OR DOCUMENTS ETC., RELATING TO TPA BUSINESS CARRIED ON IT TO RESPECTIVE INSURERS D) SHALL COOPERATE WITH INSURANCE COMPANIES IN MAKING SUITABLE ALTERNATE ARRAGEMENTS TO SERVICE THE POLICY HOLDERS IN RESPECT OF WHOM THE POLICIES ARE IN FORCE E) SHALL RECONCILE AND CLOSE THE ACCOUNTS WITH CONCERNED INSURANCE COMPANIES AND NETWORK PROVIDERS, IF ANY
|
| 17 |
|
|
ICAN HEALTH SERVICES PVT.LTD.
|
|
|
COMMITTED BREACH OF CODE OF CONDUCT UNDER IRDA REGULATIONS
DEFAULTED IN MAINTAINING PRESCRIBED WORKING CAPITAL UNDER REGULATION 3(4)
CHANGED THE CHARACTER AND OWNERSHIP OF COMPANY SINCE GRANT OF LICENCE
UNSATISFACTORY AND WEAK FINANCIAL POSITION
CONDUCTED OPERATIONS AGAINST THE INTERESTS OF INSURANCE COMPANY AND POLICYHOLDERS
|
REJECTED APPLICATION FILED FOR RENEWAL OF LICENCE (TPA)
22-MAR-2006
|
|
| 18 |
|
|
MDINDIA HEALTHCARE SERVICES (TPA) PVT.LTD.
|
|
|
DID NOT PROVIDE INFORMATION ABOUT INVOLVEMENT OF ITS PROMOTERS AND/OR DIRECTORS IN INSURANCE & INSURANCE RELATED ACTIVITIES TO IRDA
DID NOT SUBMIT TRUE AND CORRECT STATEMENT TO IRDA
DID NOT MAKE DISCLOSURE RELATED TO PROMOTER TO IRDA
DID NOT SUBMIT RESIGNATION LETTER OF MR.SOUNDARAJAN RAJAN TO IRDA
CHANGED THE STATEMENT SUBMITTED TO IRDA RELATED TO APPOINTMENT OF MR.SOUNDARAJAN RAJAN
DID NOT MAKE DISCLOSURE OF PROMOTER MR.TILAK RAJ SHARMA FOR RENEWAL OF TPA LICENCE TO IRDA
|
IMPOSED PENALTY RS.5,00,000
17-JUN-2014
|
|
| 19 |
|
|
MEDICARE INSURANCE TPA SERVICES (I) PVT.LTD.
|
|
|
SURRENDERED THIRD PARTY ADMINISTRATOR (TPA) LICENSE
|
CANCELLED CERTIFICATE OF REGISTRATION AS THIRD PARTY ADMINISTRATOR (TPA)
19-FEB-2019
|
|
| 20 |
|
|
MEDICARE TPA SERVICES (I) PVT.LTD.
|
|
|
RENDERED HEALTH/TPA SERVICES WITHOUT ENTERING INTO AGREEMENT WITH INSURANCE COMPANY
DID NOT PROVIDE INFORMATION ABOUT INVOLVEMENT OF ITS PROMOTERS AND/OR DIRECTORS IN INSURANCE & INSURANCE RELATED ACTIVITIES TO IRDA
DID NOT MAKE DISCLOSURE ABOUT HOLDING OF POSITION OF DIRECTOR IN ANNUAL RETURN FORM TPA 4(1) TO IRDA
|
IMPOSED PENALTY RS.5,00,000
26-AUG-2014
|
|
| The regulatory charges/regulatory actions may be fully or partly applicable to the entities/persons mentioned in the second column. |
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