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Article 22

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

I. In the event of breach by the Health Insurance TPA Company of the provisions of the Law or regulations, instructions, resolutions or circulars issued thereunder, the Director General may impose any of the following sanctions:

  1. Address a warning to the Health Insurance TPA Company and bind it to rectify the breach and take the necessary actions to prevent the breach recurrence in the future;
     
  2. Suspend the Health Insurance TPA Company from practicing the activity for a period no longer than one year and notify the insurance companies accordingly;
     
  3. Cancel the license of the Health Insurance TPA Company in any of the following cases:
     
    1. The Company ceased to satisfy any of the licensing conditions set forth in these Instructions;
    2. Material breach of any duties or obligations;
    3. The Company has failed to renew the license or to pay the annual license renewal fees or the prescribed delay fines;
    4. A final court decision is held to declare the Health Insurance TPA Company bankrupt;
    5. Wind-up and liquidation of the Health Insurance TPA Company;
    6. The Company has failed to practice the activity within six months from the date of granting the license thereto or renewal thereof;
    7. The Company has failed to practice the activity after the end of a temporary suspension;
    8. If it is found that the license was granted on basis of incorrect information, data or documents, or on basis of an undertaking that was not honored as decided by the IA.

II. Cancellation of the license shall result the following:

  1. Publication of the decision to cancel the license of the Health Insurance TPA Company and its deregistration from the Register for Health Insurance Third Party Administrators as soon as such decision is issued, in two widely circulated local daily newspapers published in the State, one in Arabic language, at the expense of the Health Insurance TPA Company. The IA may settle such expenses from the letter of guaranty of the Health Insurance TPA Company;
     
  2. Recover the letter of guaranty and terminate the Professional Indemnity Insurance Policy after the elapse of (3) months from the date of publication subject to the IA approval thereon and after settling all transactions of the Health Insurance TPA Company and ensuring that there are no obligations towards the IA, medical service providers, insurance companies, or any of the beneficiaries arising from practicing the profession;
     
  3. Suspend any new contracts of the Company relating to health insurance claim business;
     
  4. The Company may not submit a new application for license before the elapse of (3) years from the date of issuing the license cancelation decision. In the event of cancelling its license, the Health Insurance TPA Company shall provide the insurance company with all the records provided for in these Instructions in order maintain them in accordance with these Instructions;
     
  5. The Director General shall notify all medical entities and insurance companies of all decisions to suspend or cancel the licenses of TPA Companies.