الهيئة العامة للرقابة المالية

Dr. Farid:

• FRA seeks to boost service efficiency and secure advanced, safe healthcare for citizens.
• Strengthening stability and discipline in the healthcare market, safeguarding customer funds and rights.
• Temporary companies must regularize their status by July 10, 2026.
• Companies require prior approval to manage self-funded programs, backed by a mandatory EGP 5 million insurance policy.
• TPA companies are prohibited from marketing insurance policies or practicing any insurance activity outside their licensed scope.
• Companies must meet a minimum paid-up capital of EGP 20 million.

Financial Regulatory Authority (FRA) chaired by Dr. Mohamed Farid, issued the first comprehensive regulatory framework for Third-Party Administrator (TPA). This aims to integrate the TPA activity into non-banking financial services, enhance insurance efficiency and boost market confidence, aligning with FRA’s governance and market regulation strategy.

Resolution No. 229 of 2025 outlines the new framework, covering licensing and capital requirements, technical standards for medical claims management and modern technology and security criteria.

Dr. Mohamed Farid affirmed the new resolution is a critical step to regulate TPA activities, which will enhance service efficiency and ensure the provision of advanced and safe healthcare for citizens.

TPA services are specialized administrative activities performed by a third party on behalf of insurance companies to manage and operate healthcare systems for the insured. TPA firms are strictly prohibited from issuing policies or bearing the financial risk of the coverage.

He added that the comprehensive framework ensures full oversight and transparency, reinforcing stability and discipline while preventing unregulated practices in the market.

FRA Chairman clarified that these proactive controls aim to protect customer funds and rights from potential conflicts of interest, ensuring that corporate decisions are based on integrity and serving the public interest.

The resolution mandates that TPA applicants must be dedicated Egyptian joint-stock companies with a minimum paid-up capital of EGP 20 million. Applications, including a registry extract, board/executive structure, and a five-year feasibility study, must be submitted within three months of commercial registration.

FRA issues its licensing decision within 30 days. Companies must commence activity within six months of licensing, extendable once.

According to the new rules, existing companies established before the Unified Insurance Law must apply for a temporary license (per FRA resolution No. 90/2025) and must fully regularize their status before July 10, 2026.

Additional controls apply to companies managing self-funded healthcare programs, including mandatory prior FRA approval, a civil liability insurance policy of at least EGP 5 million and strict separation of self-funded program accounts.

The new rules stipulate board membership criteria, including independence, reputation, relevant qualifications. The CEO requires 5 years’ experience in insurance or healthcare and must pass FRA interview. The board must have a non-executive majority, female representation and diverse expertise (e.g., actuarial, legal, IT). Dual roles for Chairman and CEO are prohibited.

Companies must maintain an integrated organizational structure with designated officers for Claims, Medical/Financial Approvals, IT/Digital Transformation, Internal Audit, Compliance, Customer Complaints and Anti-Money Laundering/Terrorist Financing.

Moreover, TPA firms must manage medical documents accurately and neutrally, verify claims/coverage before referral to insurers, maintain separate accounts for each insurer, ensure data confidentiality/security and obtain FRA approval before contracting with external parties.

The resolution prohibits TPA companies from selling, marketing, or mediating insurance policies; conducting any insurance activity (like setting/collecting premiums); retaining claims settlements less than received; or taking any action that influences an insured person’s choice of insurer; or publishing data inconsistent with that submitted to FRA.

Additionally, TPA firms are required to maintain detailed records including policies, benefit schedules, contracts, receipts, complaints, litigation and account balances for each insurer/self-funded program for a minimum of five years.

Upon contracting with external parties for developing or operating digital programs, the company must fully verify technical and technological compliance, subject the programs to rigorous operational testing under its supervision and assume full responsibility for operational risks. Additionally, companies are required to have a clear plan for the procurement and operation of the programs.