Section 11 in Insurance Regulatory and Development Authority of India (Third Party Administrators - Health Services) Regulations, 2016
11. Requirement of qualification, training and passing of examination.
(1)Every TPA shall appoint, with due intimation to the Authority, from amongst its directors or senior employees, either a Chief Executive Officer (CEO), or a Chief Administrative Officer (CAO) who shall possess the educational qualifications mentioned in regulation 11(5) of these regulations and shall also undergo training as stipulated by the Authority from time to time, with any institution recognized by it. Such a Chief Executive Officer or Chief Administrative Officer shall be responsible for the day-to-day administration of the affairs of the TPA and for ensuring compliance of regulatory requirements.(2)Every TPA shall have a Chief Medical Officer (CMO) who shall be a person having a minimum qualification of MBBS, holding a valid registration from the Medical Council of India or Medical Council of any state of India being thereby entitled to practice medicine within its jurisdiction; and is acting within the scope and jurisdiction of such registration. Such a Chief Medical Officer shall be a full time employee of the TPA.(3)The appointment of any of the officials referred in regulation 11 (1) and (2) and the appointment of any of the Directors to the Board of TPA shall be intimated to the Authority within thirty days of the date of appointment in such form as may be specified by the Authority :Provided that the Authority, for the reasons recorded in writing, may direct the TPA to terminate the services of CEO, CAO, CMO or any of the Directors of the TPA within such time as may be mentioned therein and the TPA shall terminate the services of such persons within such time :Provided further that before issuing such direction, the Authority shall give the TPA an opportunity of being heard.[Provided further that] [Inserted by Notification F. No. IRDAI/Reg/15/166/2019, dated 3.12.2019 (w.e.f. 14.3.2016).] The Chief Executive Officer or Chief Administrative Officer and Chief Medical Officer shall not suffer disqualifications mentioned under Section 42D of the Act.(4)A CEO or CAO shall possess the following qualifications -a. a bachelor's degree from a recognised University; andb. a pass in the Associateship examination conducted by the Insurance Institute of India or such equivalent examination as may be recognised and specified by the Authority; andc. completion of training with an institution recognised by the Authority for these purposes, as may be specified by the Authority.
