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SOURCE OF INFORMATION : INSURANCE REGULATORY & DEVELOPMENT AUTHORITY OF INDIA WEBSITE
PERIOD COVERED : 16-AUG-2002 TO 20-JAN-2026

NAMES IN BROWN COLOUR
Names of entities/persons in brown colour denote that the regulatory order is not against them but their names have been mentioned only for association purposes.

INSURANCE COMPANY: VIOLATED IRDA (TPA-HEALTH SERVICES) REGULATIONS, 2016

S.No. ENTITY  PERSONS  REGULATORY CHARGES REGULATORY ACTION(S) / DATE OF ORDER FURTHER DEVELOPMENTS
1
History of entity/person CARE HEALTH INSURANCE LTD.  
  DID NOT PROVIDE INSURED/ COMPLAINANTS WITH SPECIFIC NAME AND ADDRESS OF COMPETENT JURISDICTION’S INSURANCE OMBUDSMAN

DID NOT ADHERE TO IRDAI INFORMATION & CYBER SECURITY GUIDELINES, 2023

DID NOT SUBMIT RISK MANAGEMENT COMMITTEE CONSTITUTED BY BOARD AND ACTION TAKEN REPORT IN PRESCRIBED TIME PERIOD

DID NOT CAPTURE SIGNATURES OF PATIENT OR ATTENDANT ON SUMMARY BILLS AND DISCHARGE SUMMARY OF HOSPITALS

REDUCED CLAIM AMOUNT BY APPLYING DEDUCTIONS ON ACCOUNT OF DISCOUNT BY HOSPITAL/ NETWORK PROVIDER AND DIFFERENCE IN TARRIF

DID NOT PROVIDE DETAILED BREAKDOWN OF CLAIM AMOUNTS PAID TO CUSTOMERS, INCLUDING CLAIMED AMOUNT, BREAK-UP OF PAID AMOUNT AND DEDUCTIONS INCLUDING HOSPITAL OFFERED DISCOUNTS

SETTLED AMOUNT LESS THAN FINAL BILL SUBMITTED BY HOSPITAL IN RESPECT OF CASHLESS CLAIMS

DID NOT CORRECTLY APPLY RETAIL HEALTH QUOTA SHARE TREATY RATE MENTIONED AS ‘ORIGINAL NET RISK RATES (NET OF COMMISSIONS AND EXPENSES)’ AS PER ARTICLE 8.1 AND ITEM NO.9 OF SCHEDULE TREATY

DID NOT MAINTAIN REASONABLE COMMISSION RATIOS UNDER RETAIL HEALTH QUOTA SHARE TREATY

DID NOT SET OFF/ADJUST PREMIUM RECEIVED IN ADVANCE/DEPOSITS/UNALLOCATED PREMIUM DURING CURRENCY OF THE POLICY NOR REFUNDED WITHIN SIX MONTHS FROM EXPIRY OF THE POLICY

DID NOT ADHERE TO REGULATORY COMPLIANCE AS SPECIFIC INFORMATION REQUIRED FOR MANDATORY DISPLAY ON THE WEBSITE AND AMOUNT WAS TRANSFERRED TO UNCLAIMED AMOUNT OF POLICYHOLDERS   		IMPOSED PENALTY RS.1,00,00,000

CENSURED/WARNED & DIRECTED/ADVISED TO BE DILIGENT IN COMPLYING WITH ALL THE ACTS, REGULATIONS ETC.

15-DEC-2025 		 
The regulatory charges/regulatory actions may be fully or partly applicable to the entities/persons mentioned in the second column.

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