Code of Conduct for TPA
- A TPA licensed under these regulations shall as far as possible act in the best professional manner.
- In particular and without prejudice to the generality of the provisions contained above, it shall be the duty of every TPA, its Chief Administrative Officer or Chief Executive Officer and its employees or representatives to
- Establish its or his or their identity to the public and the insured/policyholder and that of the insurance company with which it has entered into an agreement.
- Disclose its licence to the insured/policyholder/prospect.
- Disclose the details of the services it is authorised to render in respect of health insurance products under an agreement with an insurance company;
- Bring to the notice of the insurance company with whom it has an agreement, any adverse report or inconsistencies or any material fact that is relevant for the insurance company's business.
Maintenance and Confidentiality of information
- A TPA shall maintain proper records, documents, evidence and books of all transactions carried out by it on behalf of an insurance company in terms of its agreement. Such records, documents, evidence, books, etc., and the information contained therein shall be available to the insurance company and the Authority and access to them shall not be denied by the TPA on any ground
- Every TPA shall, in maintaining the records, follow strictly the professional confidentiality between the parties as required, but this does not prevent the TPA from parting with the relevant information to any Court of Law/Tribunal, the Government, or the Authority in the case of any investigation carried out or proposed to be carried out by the Authority against the insurance company, TPA or any other person or for any other reason
- If the licence granted to the TPA is either revoked or cancelled, the data collected by the TPA and all the books, records or documents, etc., relating to the business carried on by it with regard to an insurance company, shall be handed over to that insurance company by the TPA forthwith, complete in all respects
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