Section 2 in Insurance Regulatory and Development Authority of India (Health Insurance) Regulations, 2016
2. Definitions.
- (i) In these Regulations, unless the context otherwise requires,a. "Act" means the Insurance Act 1938.b. "Health Services Agreement" means an agreement as defined in IRDAI (Third Party Administrators - Health Services) Regulations, 2016.c. "Authority" means the Insurance Regulatory and Development Authority of India established under sub section 1 of section 3 of the IRDA Act 1999.d. "AYUSH Treatment" refers to the medical and / or hospitalization treatments given under 'Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems.e. "Break in policy" means the period of gap that occurs at the end of the existing policy term, when the premium due for renewal on a given policy is not paid on or before the premium renewal date or within 30 days thereof.f. "Cashless facility" means a facility extended by the insurer or TPA on behalf of the insurer to the insured, where the payments for the costs of treatment undergone by the insured in accordance with the policy terms and conditions, are directly made to the network provider by the insurer to the extent pre-authorization is approved.g. "Product Filing Guidelines" mean the Guidelines specified by the Authority on the procedure to be followed by insurers before marketing or offering a product falling under Health Insurance Business.h. "Health insurance business" means Health insurance business as defined under Section 2(6C) of the Act.i. "Health Services by TPA" means the services specified in Regulation (3) of IRDAI (Third Party Administrators - Health Services) Regulations, 2016.j. "Health plus Life Combi Products" mean products which offer the combination of a Life Insurance cover offered by a life insurer and a Health Insurance cover offered by General Insurer or Health Insurer.k. "Network Provider" means network provider as defined in IRDAI (Third Party Administrators - Health Services) Regulations, 2016.l. "Pilot product" means a close-ended product with a policy term of one year that may be offered for sale by General Insurers or Health Insurers for a period not exceeding five years from the date of launch of the product with a view to giving scope to innovation for covering risks that have not been offered hitherto or stand excluded in the extant products.[***] [Omitted 'm. Portability means the right accorded to an individual health insurance policyholder (including family cover), to transfer the credit gained for pre-existing conditions and time bound exclusions, from one insurer to another or from one plan to another plan of the same insurer.' by Notification No. F.No. IRDAI/Reg/14/165/2019, dated 19.11.2019 (w.e.f 12.7.2016).]n. "Senior citizen" means any person who has completed sixty or more years of age as on the date of commencement or renewal of a health insurance policy.o. "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 - III or any other matter which is required to be specified by the Authority under these Regulations.[***] [Omitted 'p. Third Party Administrators or TPA means any person who is registered under the IRDAI (Third Party Administrators - Health Services) Regulations,2016 notified by the Authority, and is engaged, for a fee or remuneration by an insurance company, for the purposes of providing health services as defined in those Regulations.' by Notification No. F.No. IRDAI/Reg/14/165/2019, dated 19.11.2019 (w.e.f 12.7.2016).](ii). All words or expressions not defined in these Regulations but defined in the Insurance Act 1938 or Insurance Regulatory and Development Authority Act 1999 or Rules or Regulations made thereunder shall have the same meanings respectively assigned to them in those Acts, rules or regulations as amended from time to time.
