Section 2 in Insurance Regulatory and Development Authority of India (Third Party Administrators - Health Services) Regulations, 2016
2. Definitions.
(1)In these regulations, unless the context otherwise requires, -a. "Act" means the Insurance Act, 1938 as amended from time to time.b. "Advisory Committee" means the Advisory Committee constituted under Section 25 of the Insurance Regulatory and Development Authority Act, 1999;c. "Applicant" means an applicant seeking registration or renewal as Third Party Administrator under these regulations;d. "Authority" means the Insurance Regulatory and Development Authority of India established under sub-section (1) of section 3 of Insurance Regulatory and Development Authority Act, 1999;e. "Health Services by TPA" means services mentioned in Regulation 3 of these Regulations.[***] [Omitted 'f. 'Cashless facility' means a facility extended by an insurer to an insured where the payment of the costs of treatment undergone by the insured in accordance with the policy terms and conditions is directly made to the network provider by the insurer to the extent of approved pre-authorization' by Notification F. No. IRDAI/Reg/15/166/2019, dated 3.12.2019 (w.e.f. 14.3.2016).].g. "Form" means the relevant form as may be specified by the Authority under these regulations;h. "Health Insurance Business" ; as defined in Section 2 (6C) of the Act.i. "Health Services Agreement" means an agreement prescribing the terms and conditions of services which may be rendered to the holders of health insurance policies of any Insurer and may be entered into between:a. a Third Party Administrator (TPA) and an insurer; orb. a Network provider and an insurer; orc. a Network provider, a TPA and the insurer.j. "Inspecting authority" means one or more officers of the Authority or any other individual, firm, person or persons appointed by the Authority to carry out inspection of TPA.[k. "Network Provider" means hospital enlisted by an insurer, a TPA or jointly by an insurer and a TPA to provide medical services to an insured by a cashless facility.] [Substituted by Notification F. No. IRDAI/Reg/15/166/2019, dated 3.12.2019 (w.e.f. 14.3.2016).]l. "Specified" means specified by the Authority from time to time ,by issue of Circulars, guidelines or instructions for the purpose of these regulations on matters listed in Schedule - I or any other matter which is required to be specified by the Authority under these regulations.[m. "Third Party Administrator (TPA)" means a company registered with the Authority, and engaged by an insurer, for a fee or by whatever name called and as may be mentioned in the health services agreement, for providing health services as mentioned under these regulations.] [Substituted by Notification F. No. IRDAI/Reg/15/166/2019, dated 3.12.2019 (w.e.f. 14.3.2016).](2)Words and expressions used and not defined in these regulations but defined in the Insurance Act, 1938, or the Life Insurance Corporation Act, 1956 (31 of 1956) or the General Insurance Business (Nationalization) Act, 1972 (57 of 1972), or Insurance Regulatory and Development Authority Act, 1999 or rules or regulations made there under shall have the meanings as respectively assigned in those Acts, rules or regulations as amended from time to time.
