irda

1. Role of Regulators
Insurance
Regulatory Development
Authority

2. IRDA
• IRDA was setup in 2000 as an autonomous
body.
• The object was to regulate and develop the
business of insurance and reinsurance in the
country as per the Insurance Regulatory and
Development Authority Act,1999.
• The main objective of setting up IRDA was to
promote market efficiency and ensure
consumer protection.
27-09-2022 16:38:06 Dr. Amit Gupta

3. MISSION
a)To protect the interests of the
policy holders
b)To promote ,regulate and ensure orderly growth of
the insurance industry and four matters connected
there with or incidental there to
c)Conduction of insurance
businesses across India in an
ethical manner
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4. IRDA
• IRDA is the controlling and regulatory apex
body in the country for Insurance sector.
• Its Chairman and Members are appointed by
Government of India.
• IRDA’s HQ is located at Hyderabad.
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5. IRDA
The Authority is a ten member team of
I. A Chairman and every other whole-time
member – 5YRS (Maximum age is 60yrs)
II. Five whole-time members (Maximum age is
62yrs)
III. Four part-time members (not more than
5yrs)
(all appointed by the Government of India)
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6. Regulatory Framework
IRDA
Insurance
Companies
Agents
Insurance
Advisory
committee
Insurance
ombudsman
Tariff
Advisory
committee
Insurance
associations/
insurance
councils
Insurance
brokers
Surveyors and
loss assessors
Third party
administrators

7. Duties & Responsibilities
• According to the Section 14 of IRDA Act ,1999
there are certain duties:
• To regulate, promote and ensure orderly
growth of the insurance business and re-
insurance business.
• To issue a certificate of registration and
powers to renew, modify, withdraw, suspend
or cancel the registration.
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8. Duties & Responsibilities
• Protection of the interests of the policy
holders.
• To specify qualifications, code of conduct and
practical training for intermediaries.
• To specify the code of conduct for surveyors
and loss assessors.
• Exercising such other powers as may be
prescribed.
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9. Duties & Responsibilities
• To promote the efficiency in the conduct of
insurance business.
• To promote and regulate the organizations
connected with the insurance and re-
insurance business.
• Levying fees and other charges for carrying
out the purposes of this Act.
27-09-2022 16:38:06 Dr. Amit Gupta

10. Duties & Responsibilities
• To conduct enquiries and investigations for
insurers, intermediaries, insurance
intermediaries and other organizations
connected with the insurance business
• To control and regulate the rates, advantages,
terms and conditions that may be offered by
insurers.
27-09-2022 16:38:06 Dr. Amit Gupta

11. Duties & Responsibilities
• To specify the form and manner in which
books of account shall be maintained.
• To regulate the investment of funds by
insurance companies.
• To regulate the maintenance of margin of
solvency.
• Adjudication of disputes between insurers and
intermediaries.
27-09-2022 16:38:06 Dr. Amit Gupta

12. Duties & Responsibilities
• Supervising the functioning of the Tariff
Advisory Committee.
• To specify the percentage of premium income
of the insurer to finance schemes.
• To specify the percentage of life insurance
business and general insurance business to be
undertaken by the insurer in the rural or social
sector.
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13. Removal from the office
1. The Central Government may remove from
office any member who-
– is act as an insolvent.
–has become physically or mentally
incapable of acting as a member.
–has been convicted of any offence which, in
the opinion of the Central Government,
involves moral turpitude.
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14. Removal
2. Has acquired such financial or other interest as
is likely to affect prejudicially his functions as a
member.
3. Has so abused his position as to render his
continuation in office detrimental to the public
interest.
4. No such member shall be removed under clause
(d) or clause (e) of sub-section (1) unless he has
been given a reasonable opportunity of being
heard in the matter.
27-09-2022 16:38:06 Dr. Amit Gupta

15. Functions of IRDA
1. Ensure orderly growth of Insurance industry.
2. Protection of interest of policy holders.
3. Issue consumer protection guidelines to
insurance companies.
4. Grant, modify, and suspend license for
insurance companies.
5. Lay down procedure for accounting policies
to be adopted by the Insurance companies.
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16. Functions of IRDA
6. Inspect and audit of Insurance companies
and other related agencies.
7. Regulation of capital adequacy, solvency, and
prudential requirements of Insurance
business.
8. Regulation of product development and their
pricing including free pricing of products.
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17. Functions of IRDA
9. Promote and regular self regulating
organizations in the insurance industry.
10.Re-insurance limit monitoring.
11.Monitor investments.
12.Vetting of accounting standards,
transparency requirements, in reporting.
13.Ensure the health of the industry by
preventing sickness through appropriate
action.
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18. Functions of IRDA
16.Publish information about the industry.
17.Prescribe qualification and training needs of
agent.
18.Monitor the charges for various services by
Insurance companies.
19.Regulating intermediaries like;
–Agents, Brokers ,Surveyors , TPA Health
services, Web aggregators
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19. OMBUDSMAN
• The institution of Insurance Ombudsman was
created by Government of India Notification
dated 11th November, 1998.
• Purpose is to quick disposal of the grievances
of the insured.
• The institution helps to generate and sustain
the faith and confidence amongst the
consumers and insurers.
27-09-2022 16:38:06 Dr. Amit Gupta

20. APPOINTMENT OF OMBUDSMAN
• The appointment has to be done with the
recommendations of the committee
comprising of Chairman, IRDA, Chairman, LIC,
Chairman, GIC and a representative of the
Central Government.
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21. COMPLAINTS MAY RELATE TO
• Any partial or total repudiation of claims by
the insurance companies.
• Dispute with regard to premium paid or
payable in terms of the policy.
• Delay in settlement of claims.
• Non- issuance of any insurance document to
customers after receipt of premium.
27-09-2022 16:38:06 Dr. Amit Gupta

22. IRDA’S NEW HEALTH INSURANCE
REGULATIONS – A REVIEW
• Insurers have a freedom to specify max. renewal age.
• Insurer has to now give a min. 30 days grace period for renewal.
• All health policies will now give policyholder a free-look period of
15 days.
• Every proposal for health insurance product shall provide for
“nomination”. Though as per Section 39 of Insurance Act,
“nomination” is optional – however, it is highly advisable.
• Insurers may provide coverage for non-allopathic treatments
provided they are taken at recognized hospitals.
• Insurer has to settle claim within 30 days, cannot asked for
document in one go.
• Identification card within 30days.
• products with a term of 1 year of less, at least 50% of the cost of
proposal will be borne by Insurer
27-09-2022 16:38:06 Dr. Amit Gupta