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Article 16

IA-BOD-RES 9/2011 Effective from 4/12/2011

The Health Insurance Third Party Administrator must comply with the professional rules and ethics represented in the following:

  1. Conduct its business with professionalism, good faith and fairness.
     
  2. Comply with the agreements concluded with the Insurance Company and the Medical Service Providers.
     
  3. Compel its employees and representatives to identify the TPA, the Insurance Company and the Medical Service Providers when dealing with a third party and explain the nature of services it is permitted to provide.
     
  4. Inform the Insurance Company of the Medical Service Providers contracted on behalf thereof.
     
  5. Maintain all necessary documents pertaining to claim management for a period of five years after the termination of the agreement concluded with the Insurance Company.
     
  6. Refrain from doing any act that would directly or indirectly influence the decision of the insured on dealing with a certain insurance company and not others or on ending the business relation with another.
     
  7. Inform the Insurance Company in case of entering into or terminating contracts with any Medical Service Provider or in the case of amending an existing agreement concluded with a Medical Service Provider prior to affecting such amendment.
     
  8. Maintain the confidentiality of all data and information obtained by virtue of its business; and take all proper actions to maintain the confidentiality of information and documents in its possession.
     
  9. Refrain from advertising or promoting for the business and services provided by it on behalf of the Insurance Company without obtaining a written consent from the latter, provided that the information contained therein is correct, accurate and clear and reflects the nature of business it performs.
     
  10. Observe accuracy, objectivity and impartiality in claim settlement and deal with the contracted insurance companies and medical service providers without bias.
     
  11. Maintaining the level of services offered to the insured or the Beneficiary throughout the policy period of validity in accordance with the provisions of the agreement concluded with the Insurance Company.