THIRD PARTY ADMINISTRATOR

1) Introduction The IRDA (Third Party Administrators Health Services)

Regulations, 2001.
2) Health Services Means all the services to be rendered by a TPA under an
agreement with an insurance company in connection with Health Insurance
business or health cover as defined in regulation 2(f) of the IRDA (Registration
of Indian Insurance Companies) Regulation, 2000, but does not include the
business of an insurance company or the soliciting, directly or through an
insurance intermediary including an insurance agent, of insurance business.
3) Condition of and procedure for Licensing of TPA
4) Minimum Paid up Capital Rs. 1 crore
5) Qualification Atleast one of the director of the TPA shall be qualified as
Medical Doctor registered with Medical Council of India.
6) Foreign participation The aggregate holding of equity shares by a foreign
company shall not be at any time exceed 26% of the paid up equity capital of
TPA.
7) Transfer of shares Any transfer of shares exceeding 5% of the paid up share
capital shall be intimated by the TPA to the authority within 15 days of the
transfer indicating the names and particulars of the Transferor and Transferee.
8) Licensing
9) Fees Rs. 2000010) Additional fees Additional payment of Rs.30,0000 is to be deposited in case the
license is granted.
11) Rejection If rejected can not apply before 2 years.
12) Appointment of CAO or CEO Every TPA shall appoint a CAO or CEO for
proper day to day administration.
13) Qualification of CAO or CEO
14) (a) A degree in arts, science or commerce or management or health or hospital
admn. or medicines etc.
15) (b) A pass of Associateship Examination
16) (c) Completion of practical training.
17) Validity of license 3 years
COMPILED BY NARENDER WADHAWAN, ASSTT. MANAGER, LEGAL DEPTT. DRO-II, NEW
DELHI