IRDA Notification No: IRDAI/TPA/Misc./ORD/087/04/2015 (28-Apr-15) In the matter of Good Health Plan (TPA) Limited, Hyderabad


Based on the reply to Show Cause Notice dated 23.09.2014 and submissions made during Personal Hearing Chaired by Mr. M. Ramaprasad, Member (Non-Life), IRDA, on 17.11.2014 at 11.00 AM at the office of Insurance Regulatory and Development Authority, 3rd Floor, Parishrama Bhavan, Basheerbagh, Hyderabad, 500004.

The Insurance Regulatory and Development Authority of India (hereafter, referred to as ''the Authority'') carried out an onsite inspection of M/s Good Health Plan (TPA) Limited having registered office at Plot number 49, Nagarjuna Hills, Punjagutta, Hyderabad- 500082, hereinafter, referred to as TPA, from 07.11.2012 to 09.11.2012.

The Authority forwarded the inspection report to the TPA vide letter dated 10.10.2012 seeking their comments on the same. The TPA responded to the observations as contained in the inspection report vide their communication dated 24.12.2012. On examining the submissions made by TPA it was observed that the TPA has not complied with the provisions of the IRDA regulations and the guidelines framed there under. On the observed deficiencies, in the functioning of the TPA a Show Cause Notice was issued on 23.09.2014 which was replied by the TPA vide their communication dated 13.10.2014 with a request for personal hearing.

Accordingly a personal hearing was held on 17.11.2014 under the Chairmanship of the Member (Non-Life), Sh. M. Ramaprasad. The personal hearing was attended by Sh. R.K.T. Krishnan, Director and CEO and Mr. P. S. Murthy, Director of Good Health TPA. On behalf of the Authority, Ms. Mamta Suri, the then Sr. Joint Director (I&C), Ms. Yegna Priya Bharath, Joint Director (Health), Mr. N.M. Behera, Deputy Director (Health) and Ms. Jyoti Vaidya, Deputy Director (I&C) were present in the personal hearing.

The submissions made by the TPA in their written replies to the Show Cause Notice and also those made during the course of personal hearing along with written submissions made thereafter (dated 19.11.2014) were taken into account. The explanation offered by the TPA to various charges as regards violations/non-compliance as indicated in the Show Cause Notice and the decisions thereon are as follows-

1. Charge No. 1:

Concern/ Violation: Ms. V Usha Rani, the main shareholder of the TPA, was singly allowed to operate all the 28 bank accounts maintained by TPA. Ms. V. Usha Rani was neither a director of TPA nor employed with the TPA.

It is a violation of Reg. 8 (1) of IRDA (TPA -- Health Services) Regulations 2001 which stipulates that the TPA shall appoint with due intimation to the Authority, from among the directors or senior employees, a CAO or CEO who shall be responsible for the proper day to day administration of the activities of the TPA.

Submissions made by the TPA: Ms.V.Usha Rani was authorized by the board through a resolution for signing cheques to avoid delay in payments due to the absence of any of the signatories. She is the beneficial owner of the company and she signed only in one rare occasion. TPA further clarified that the cheque books used to be in the possession of accounts department and a cheque will be prepared against the approved claim and signed by the authorized signatories after the settlement department head authorizes the same. Cheque will be signed only after the voucher is prepared with due authorizations. Ms. V.Usha Rani was not a regular signatory and in emergency only after a request is made from the CEO or the director she will sign if she needs to sign.

TPA further submitted that with the changes in regulation and under the directive of Ministry of Finance, all payments happen through on-line transfer of funds utilizing electronic authorization from the Director/Senior Employees. They have also submitted a letter from the banker HDFC Bank, giving list of authorized signatories...

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