Book traversal links for Article 15
Article 15
IA-BOD-RES 9/2011 Effective from 4/12/2011The Health Insurance Third Party Administrator shall comply with the following:
- Have its registration number affixed on all forms, correspondence and documents related to the business thereof with the Insurance Company and the Medical Service Providers.
- Provide the Insurance Company with the forms of agreements to be concluded with the Medical Service Providers for the approval before signing such agreements.
- Pay the amounts of claims to the entitled Beneficiaries once received from the Insurance Company within the agreed period under the agreement.
- Keep books of accounts for each insurance company to record the amounts collected from the same for claim payments.
- Not to underwrite any insurance business and not transact any such business with reinsurers.
- Not to charge or collect any additional amounts from the insured or the Beneficiary to whom it provides services other than those agreed upon with the Insurance Company under the agreement concluded therewith.
- Inform the IA of the Insurance Company that delays payment of claims if the period of delay is longer than (15) days as of the period set out in the relevant agreement.
- Provide the contracted Insurance Company with any reports required by the same to show the results of the business between them at any time.
- Not to retain any balance amounts as a result of settlement of claims for amounts lesser than the sums insured covered by the policies. Such amounts shall be returned to the Insurance Company.
- Not to collect any commission or interest on any funds available in the bank for the account of insurance companies, unless agreed otherwise. In case the Health Insurance Third Party Administrator obtains any proceeds, commission or interest other than those stipulated in the agreement, such proceeds shall be due to the Insurance Company.