In exercise of the powers conferred under clause zd of sub section 2 of Section 114A read with sections 42D and 42E of the Insurance Act

REGD. No. D. L.-33004/99 The Gazette of India CG-TL-E-30072026-274995 EXTRAORDINARY PART III—Section 4 PUBLISHED BY AUTHORITY No. 483] NEW DELHI, THURSDAY, JULY 30, 2026/SHRAVAN 8, 1948 INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY OF INDIA NOTIFICATION Hyderabad, the 30th July, 2026 INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY OF INDIA (THIRD PARTY ADMINISTRATORS - HEALTH SERVICES) (AMENDMENT) REGULATIONS 2026 F. No. IRDAI/Reg/12/226/2026.— In exercise of the powers conferred under clause (zd) of sub-section (2) of Section 114A read with sections 42D and 42E of the Insurance Act, 1938 and Section 14 read with Section 26 of the IRDA Act, 1999 and in consultation with the Insurance Advisory Committee, the Authority hereby makes the following Regulations, namely: - 1. Short title and commencement: (i) These Regulations may be called the IRDAI (Third Party Administrators - Health Services) (Amendment) Regulations, 2026 (ii) It shall come into force from the date of its notification in the Official Gazette. 2. Objective: (i) To align the IRDAI (Third Party Administrators - Health Services) Regulations 2016, with the provisions of the Sabka Bima Sabki Raksha (Insurance Laws) Amendment Act, 2025. (ii) To carry out consequential, clarificatory, harmonising and other housekeeping amendments to ensure consistency. 3. Throughout the IRDAI (Third Party Administrators-Health Services) Regulations, 2016, (hereinafter referred to as the “Principal Regulations") - (i) for the words "Medical Council of India", the words "National Medical Commission" shall be substituted. 4. Clause (b) of sub-regulation (1) of Regulation 2, shall be substituted with the following - "Advisory Committee" means the Insurance Advisory Committee constituted under Section 25 of the Insurance Regulatory and Development Authority Act, 1999; 5. Regulation 6A shall be substituted with the following - Every Applicant and TPA, being a company incorporated under the Companies Act, 2013 and having majority foreign shareholding, shall ensure that either the Chairperson of its Board of Directors or its Chief Executive Officer, Principal Officer, or Managing Director is a resident Indian citizen at all times. 6. In Regulation 7, the following shall be inserted after sub-regulation 6 - (7) Procedure for renewal of Certificate of Registration to existing TPAs: (i) A Third Party Administrator (TPA) holding a Certificate of Registration issued prior to the coming into force of the Sabka Bima Sabki Raksha (Amendment of Insurance Laws) Act, 2025, with a validity period of three years, may apply to the Authority, in such form and manner as may be specified by it, for renewal of registration and issuance of a Certificate of Registration in accordance with sub-section 4 of section 42D of the Act, within ninety (90) days prior to the expiry of its existing Certificate of Registration upon payment of the annual fee specified under Regulation 9. Provided that where a TPA fails to submit such application within the period specified above, it may, within ninety (90) days from the date of expiry of the existing Certificate of Registration, submit the application along with the reasons for such delay, under the proviso to sub-section 4 of section 42D of the Act on payment of the applicable annual fee and an additional fee of seven hundred and fifty rupees. Provided also that where the application is not submitted within ninety (90) days from the date of expiry of the existing Certificate of Registration, the TPA shall be required to apply afresh for registration in accordance with Regulation 7. (ii) The Authority, upon being satisfied that the applicant complies with the requirements of the principal regulations, as amended, may issue a Certificate of Registration in such form as may be specified by it. Provided that the Certificate of Registration issued under these Regulations shall take effect from the date of expiry of the existing Certificate of Registration. 7. In Regulation 9 - (i) In sub-regulation (2), - a) for the words “and other taxes", the words "plus applicable taxes” shall be substituted (ii) sub-regulation (4) shall be substituted with the following; Validity of Certificate of Registration: A Certificate of Registration granted by the Authority to a Third Party Administrator (TPA) under these Regulations shall remain in force, subject to payment of such annual fee as may be specified by Regulation 9(6), unless it is revoked, suspended, cancelled, or otherwise ceases to be in force in accordance with these Regulations, the procedure specified by the Authority, and the conditions stipulated under sub-section (6) of Section 42D of the Insurance Act, 1938, as amended from time to time. (iii) In sub-regulation (5), - a) for the words "validity period", the words "validity status" shall be substituted (iv) After sub-regulation (5), the following shall be inserted as sub-regulation (6) - (6) Annual fee: (i) Every Third Party Administrator (TPA) holding a valid Certificate of Registration shall, on or before 31st day of January of each year, pay an annual fee of ₹50,000 (Rupees Fifty Thousand only), plus applicable taxes, for the ensuing financial year, and submit all regulatory returns specified under principal regulations and circular/guidelines issued thereunder. Provided that where a TPA fails to pay the annual fee on or before the 31st day of January, it may remit the same on or before the 31st day of March of that year together with interest at the rate of two per cent of the annual fee payable. Provided further that failure to pay the annual fee together with the applicable interest on or before the 31st day of March shall constitute a breach of the conditions of registration and such certificate of registration may be suspended or cancelled in accordance with sub-section (6) of section 42D of the Insurance Act, 1938. (ii) Where a Certificate of Registration is granted during the course of a financial year, the annual fee for that financial year shall be payable on a pro-rata basis, calculated from the date of grant of the Certificate of Registration up to the end of that financial year, and shall be paid within fifteen days from the date of grant of such Certificate of Registration. (iii) A Third Party Administrator whose Certificate of Registration is under suspension shall continue to be liable to pay the annual fee when it falls due during the period of suspension. Provided that, where such suspension subsequently results in cancellation of the Certificate of Registration, any annual fee paid during the period of suspension shall stand forfeited and shall not be refundable. (iv) Where a Third Party Administrator voluntarily surrenders its Certificate of Registration in accordance with Regulation 17, any annual fee already paid shall stand forfeited and shall not be refundable. 8. In sub-regulation (2) of Regulation 12- (i) for the words "service tax", the word "taxes" shall be substituted. 9. Regulation 15 shall be omitted; 10. In sub-regulation (1) of Regulation 16, the following shall be inserted after clause (q) as clause (r) - "The TPA commits any contravention/default as provided under sub-section 6 of section 42D of the Insurance Act, 1938". 11. In Regulation 19, the following shall be inserted after sub-regulation 11 - 12. Every TPA shall ensure that all related party transactions are supported by appropriate agreements, requisite approvals of the Board and/or relevant committee(s), and other necessary documentation, and are undertaken in compliance with the provisions of the Companies Act, 2013, and other applicable laws, rules, regulations, guidelines, and directions, as amended from time to time. (i) Every TPA shall furnish to the Authority, on a quarterly basis, details of all related party transactions and, on an annual basis its audited financial statements. The TPA shall also place such disclosures on its website. 12. For sub-regulation (3) of Regulation 26, the following shall be substituted- Transitory Provisions: (i) Any Certificate of Registration granted or renewed in respect of a Third Party Administrator after the commencement of the Sabka Bima Sabki Raksha (Amendment of Insurance Laws) Act, 2025, but before the commencement of these Regulations under the transitional arrangements in force, shall be deemed to be a Certificate of Registration issued under these Regulations and shall continue to remain valid in accordance with the provisions of these Regulations. (ii) Any application for renewal of a Certificate of Registration pending before the IRDAI, or falling due for renewal in accordance with the validity period specified in the existing Certificate of Registration as on the date of commencement of these Regulations, shall be processed in accordance with the provisions of the Principal Regulations as amended by these Regulations. The Certificate of Registration issued pursuant to such renewal shall be governed by and remain valid in accordance with the provisions of the Principal Regulations as so amended. 13. In Schedule - I of Principal Regulations, - (i) after clause 2, the following shall be inserted as 2A, 2A. Regulation 7 (7): Application for issuance of Certificate of Registration to existing TPAs. (ii) clauses 12, 13 & 14 shall be omitted. 14. The Schedule - AA of Principal Regulations, shall be omitted. G. R. SURYA KUMAR, Executive Director [ADVT.-III/4/Exty./252/2026-27] Uploaded by Dte. of Printing at Government of India Press, Ring Road, Mayapuri, New Delhi-110064 and Published by the Controller of Publications, Delhi-110054.