We have audited the accompanying financial statements of Niva Bupa Health Insurance Company Limited(“the Company"), which comprise the Balance sheet as at March 31, 2024, the Miscellaneous Business- Revenue Account (also called the "Policyholders' Account"), the Profit and Loss Account (also calledthe “Shareholders' Account") and the Receipts and Payments Account for the year then ended, andnotes to the financial statements, including a summary of significant accounting policies and otherexplanatory notes forming part of the financial statements (herein after collectively referred to as“Financial Statements" ).
In our opinion and to the best of our information and according to the explanations given to us, theaforesaid Financial Statements give the information required by the Insurance Act, 1938, as amended,("the Insurance Act"), the Insurance Regulatory and Development Authority Act, 1999 ("the IRDAI Act"),the Insurance Regulatory and Development Authority (Preparation of Financial Statements and Auditor'sReport of Insurance Companies) Regulations, 2002, as amended (the " IRDAI Financial StatementsRegulations"), the regulations/ orders/directions/circulars issued by the Insurance Regulatory andDevelopment Authority of India ("the IRDAI") and the Companies Act, 2013, as amended ("the Act") tothe extent applicable, in the manner so required and give a true and fair view in conformity with theAccounting Standards prescribed under Section 133 of the Act read with the Companies (AccountingStandards) Rules, 2021, (“AS”) as amended, and accounting principles generally accepted in India, asapplicable to insurance companies:
(a) in the case of the Balance Sheet, of the state of affairs of the Company as at March 31, 2024;
(b) in the case of Miscellaneous Business - Revenue Account, of the operating profit for the year ended
on that date;
(c) in the case of Profit and Loss Account, of the profit for the year ended on that date; and
(d) in the case of the Receipts and Payments Account, of the receipts and payments for the year
ended on that date.
Basis for Opinion
We conducted our audit of the Financial Statements in accordance with the Standards on Auditing("SAs"), as specified under section 143(10) of the Act. Our responsibilities under those Standards arefurther described in the 'Auditor's Responsibilities for the Audit of the Financial Statements' section ofour report. We are independent of the Company in accordance with the ‘Code of Ethics' issued by theInstitute of Chartered Accountants of India ("1CAl") together with the ethical requirements that arerelevant to our audit of the Financial Statements under the provisions of the Act, and the Rulesthereunder, and we have fulfilled our other ethical responsibilities in accordance with theserequirements and the Code of Ethics. We believe that the audit evidence we have obtained is sufficientand appropriate to provide a basis for our audit opinion on the Financial Statements.
Emphasis of Matter
As discussed in Note 25 of Schedule 16 (C) to the Financial Statements, the Company has filed anapplication for forbearance for exceeding the Expenses of Management (EOM) over the allowable limitfor. financial year 2023-24 with IRDAI, approval for which is yet to be received. The grant of suchforbearance is at IRDAI's discretion and the impact of the same on the Financial Statements will dependon the future developments. Our opinion is not modified in respect of this matter.
Key Audit Matters
Key audit matters are those matters that, in our professional judgment, were of most significance in ouraudit of the Financial Statements for the financial year ended March 31, 2024. These matters wereaddressed in the context of our audit of the Financial Statements as a whole, and in forming our opinionthereon, and we do not provide a separate opinion on these matters. For each matter below, ourdescription of how our audit addressed the matter is provided in that context.
We have determined the matters described below to be the key audit matters to be communicated in ourreport. We have fulfilled the responsibilities described in the Auditor's responsibilities for the audit ofthe Financial Statements section of our report, including in relation to these matters. Accordingly, ouraudit included the performance of procedures designed to respond to our assessment of the risks ofmaterial misstatement of the Financial Statements. The results of our audit procedures, including theprocedures performed to address the matters below, provide the basis for our audit opinion on theaccompanying Financial Statements.
Key audit matters
How our audit addressed the key audit matter
Claim settlement
• Claims are a significant expense forthe Company
• Provisioning of Outstanding Claimsincluding Claims Incurred but NotReported (IBNR) and Incurred butNot Enough Reported (IBNER) aresignificant in magnitude andrequires use of judgements andestimates
• With regards to the claims provision,the Company makes a provision forclaims upon intimation, on receipt ofdocuments, communication fromco-insurer leader in cases ofincoming co-insurance business etc.The estimates undergo a revisionbased on further information andthe settlement amount could varyfrom the provision created
• The estimate of the claim involves ahigh degree of judgement
Our audit procedures included the following:
• We tested the design and operating effectivenessof controls around the due and intimated claimsrecording process. Also assessed and tested theoperating effectiveness of key controls relating tothe claims handling process, including controlsover completeness and accuracy of the claimoutstanding recorded
• Tested on a sample basis, claims paid and provisioncreated with payment proof, claim intimationdocuments and communication from co-insurerleader in cases of incoming co-insurance business,which are material to assess whether claims areappropriately paid, estimated and recorded
• Performed analytical review procedures on theoutstanding claims
• Tested the arithmetical accuracy of computation ofclaims provision performed by the Company
• The actuarial valuation of liability in respect ofClaims Incurred but Not Reported (IBNR) and thoseIncurred but Not Enough Reported (IBNER) is ascertified by the Company’s Appointed Actuary and
we have relied upon on the appointed actuary'scertificate in this regard.
Valuation of Investments
The carrying values of Investmentsrepresents more than 80% of totalassets as disclosed in the FinancialStatements which are to be valued inaccordance with accounting policyframed as per the extant regulatoryguidelines.
• The valuation of all investmentsshould be as per the investmentpolicy framed by the Company whichin turn should be in line with IRDAIInvestment Regulations andPreparation of Financial StatementRegulations. The valuationmethodology specified in theregulation is to be used for eachclass of investment
• The classification and valuation ofthese investments is considered tobe one of the matters of materialsignificance in the FinancialStatements due to the materiality ofthe total value of investments to theFinancial Statements
• The Company performs animpairment review of itsinvestments periodically andrecognizes impairment charge whenthe investments meet the trigger/sfor impairment provision as per thecriteria set out in the investmentpolicy. Further, the assessment ofimpairment involves significantmanagement judgement
To ensure' that the valuation of investments and
impairment provision considered in the Financial
Statements is adequate, we have performed the following
procedures:
• Reviewed the manner in which the investments havebeen made by the Company to ensure that theinvestments are in accordance with Regulation ofInvestments as stated in the IRDAI guidelines
• Tested the management oversight and controls overvaluation of investments
• Independently test-checked valuation of quoted andunquoted investments
• Reviewed the Fair Value Change Account for specificinvestments
• Reviewed the basis of provisions accounted in respectof non-performing investments and ensured that theprovision meets the IRDAI guidelines
• Reviewed and assessed the adequacy with respect tomanagement assessment of impairment charge oninvestments outstanding at the year end.
Provision for bad & doubtful debts relating to receivables from other insurance companies
(Including Government Receivables), outstanding premium and agent balances:
• "Dues from Other entities carryingon insurance business" is INR26,24,106 0000) as at the year end.
• "Outstanding premium" amountingto INR 39,338 0000) (net ofprovision of INR 45,522 0000) inrelation to premium due fromCentral Government, StateGovernment and others).
The audit procedures performed by us included thefollowing:
• Evaluation and testing of controls over the recording,monitoring and ageing of outstanding premium,Agents1 Balances and due from other entities carryingon insurance business
• Evaluating the adequacy of the process ofreconciliation followed by the Company with respect to
• "Recoverable Agent balances" at theyear-end amounted to Nil (net ofprovision of INR 49,635 ('000)).
• Due to the significance of theamount and judgement involved inassessing the recoverability of dues,this has been considered as key auditmatter.
amounts due from other entities carrying on insurancebusiness
• We reviewed the historical provision for bad debts andcompared it to the actual amounts written off, todetermine whether management's estimates have beenprudent and reasonable
• Reviewed the details of co-insurance transactionsuploaded on the ETASS portal by the Company andOther Insurance Companies and reconciled with thetransactions accounted by the Company
• Sending out direct confirmations of balances to selectparties on a test check basis as required under "SA 505-External Confirmations"
• We discussed with management and reviewedcorrespondences, where relevant, to identify disputes,if any, on any of the recoverable balances and reviewthe assessment of the management as to therequirement of provisioning, if any on these disputeddues. Relied on the management estimates withrespect to such provisions.
Information Technology systems
The Company is highly dependent on itsinformation technology ("IT") systemsfor carrying out its operations and owingto the significant number of transactionsthat are processed on daily basis as partof its operations, which impacts keyfinancial accounting and reporting itemssuch as premium income, claims,commission expense and investmentsamong others.
The controls implemented by theCompany in its IT environmentdetermine the integrity, accuracy,completeness and validity of the datathat is processed by the applications andis ultimately used for financial reporting.Theses controls contribute to mitigatingrisk of potential misstatements causedby fraud or error.
Accordingly, our audit was focused onkey IT systems and controls due to thepervasive impact on the FinancialStatements.
We involved our IT specialists to obtain an understanding ofthe entity's IT related control environment, perform risk-based testing and identification of IT applications,databases and operating systems that are relevant to ouraudit.
Our area of focus, for the key IT systems relevant tofinancial reporting, included Access control, ProgramChange controls and Network Operations.
In this regard -
• we obtained an understanding of the entity's ITenvironment and key changes, if any, during the auditperiod that may be relevant to the audit
• we tested the design effectiveness of the general ITcontrols over the key IT systems and applications thatare critical to financial reporting
• we tested the entity's controls to ensure segregation ofduties, access rights controls
• we conducted testing of manual and automated ITcontrols along with related interdependencies, whereapplicable and critical for financial reporting, toevaluate completeness and accuracy
• we tested the security environment implemented bythe entity to prevent, detect and respond to networksecurity incidents
• we tested compensating controls or performedalternate procedures to assess whether there were anyunaddressed IT risks that would impact the controls orcompleteness and accuracy of data.
Information Other than the Financial Statements and Auditor's Report Thereon
The Company's Board of Directors is responsible for the other information. The other informationcomprises the information included in the Board report and the annexures thereto but does not includethe Financial Statements and our auditor's report thereon.
Our opinion on the Financial Statements does not cover the other information and we will not expressany form of assurance conclusion thereon.
In connection with our audit of the Financial Statements, our responsibility is to read the otherinformation and, in doing so, consider whether such other information is materially inconsistent with theFinancial Statements or our knowledge obtained in the audit or otherwise appears to be materiallymisstated. If, based on the work we have performed, we conclude that there is a material misstatementof this other information, we are required to report that fact. We have nothing to report in this regard.
Responsibilities of Management and Those Charged with Governance for the Financial Statements
The Company's Board of Directors is responsible for the matters stated in section 134(5) of the Act withrespect to the preparation of these Financial Statements that give a true and fair view of the BalanceSheet, the Related Revenue Account, the Profit and Loss account and the Receipts and Payments of theCompany in accordance with the requirement of the Insurance Act read with IRDAI Act, the IRDAIFinancial Statements Regulations, the regulations/ orders/directions/circulars/guidelines/ issued by theIRDAI and the Act in this regard and in accordance with the accounting principles generally accepted inIndia, including the Accounting Standards specified under section 133 of the Act read with theCompanies (Accounting Standards) Rules, 2021 specified under section 133 of the Act to the extentapplicable and in the manner so required. This responsibility also includes maintenance of adequateaccounting records in accordance with the provisions of the Act for safeguarding of the assets of theCompany and for preventing and detecting frauds and other irregularities; selection and application ofappropriate accounting policies; making judgments and estimates that are reasonable and prudent; andthe design, implementation and maintenance of adequate internal financial controls, that were operatingeffectively for ensuring the accuracy and completeness of the accounting records, relevant to thepreparation and presentation of the Financial Statements that give a true and fair view and are free frommaterial misstatement, whether due to fraud or error.
In preparing the Financial Statements, management and Board of Directors is responsible for assessingthe Company's ability to continue as a going concern, disclosing, as applicable, matters related to goingconcern and using the going concern basis of accounting unless management either intends to liquidatethe Company or to cease operations, or has no realistic alternative but to do so.
Those charged with governance are also responsible for overseeing the Company's financial reportingprocess.
Auditor's Responsibilities for the Audit of the Financial Statements
Our objectives are to obtain reasonable assurance about whether the Financial Statements as a whole
are free from material misstatement, whether due to fraud or error, and to issue an auditor's report thatincludes our opinion. Reasonable assurance is a high level of assurance but is not a guarantee that anaudit conducted in accordance with SAs will always detect a material misstatement when it exists.Misstatements can arise from fraud or error and are considered material if, individually or in theaggregate, they could reasonably be expected to influence the economic decisions of users taken on thebasis of these Financial Statements.
As part of an audit in accordance with SAs, we exercise professional judgment and maintain professionalskepticism throughout the audit. We also:
? Identify and assess the risks of material misstatement of the Financial Statements, whether due tofraud or error, design and perform audit procedures responsive to those risks, and obtain auditevidence that is sufficient and appropriate to provide a basis for our opinion. The risk of notdetecting a material misstatement resulting from fraud is higher than for one resulting from error,as fraud may involve collusion, forgery, intentional omissions, misrepresentations, or the overrideof internal control.
? Obtain an understanding of internal control relevant to the audit in order to design audit proceduresthat are appropriate in the circumstances. Under section 143(3)(i) of the Act, we are alsoresponsible for expressing our opinion on whether the Company has adequate internal financialcontrols with reference to Financial Statements in place and the operating effectiveness of suchcontrols.
? Evaluate the appropriateness of accounting policies used and the reasonableness of accountingestimates and related disclosures made by management.
? Conclude on the appropriateness of management's use of the going concern basis of accountingand, based on the audit evidence obtained, whether a material uncertainty exists related to eventsor conditions that may cast significant doubt on the Company's ability to continue as a goingconcern. If we conclude that a material uncertainty exists, we are required to draw attention in ourauditor's report to the related disclosures in the Financial Statements or, if such disclosures areinadequate, to modify our opinion. Our conclusions are based on the audit evidence obtained up tothe date of our auditor's report. However, future events or conditions may cause the Company tocease to continue as a going concern.
? Evaluate the overall presentation, structure and content of the Financial Statements, including thedisclosures, and whether the Financial Statements represent the underlying transactions andevents in a manner that achieves fair presentation.
We communicate with those charged with governance regarding, among other matters, the plannedscope and timing of the audit and significant audit findings, including any significant deficiencies ininternal control that we identify during our audit.
We also provide those charged with governance with a statement that we have complied with relevantethical requirements regarding independence, and to communicate with them all relationships and othermatters that may reasonably be thought to bear on our independence, and where applicable, relatedsafeguards.
From the matters communicated with those charged with governance, we determine those matters thatwere of most significance in the audit of the Financial Statements for the financial year ended March 31,2024 and are therefore the key audit matters. We describe these matters in our auditor's report unlesslaw or regulation precludes public disclosure about the matter or when, in extremely rare circumstances,we determine that a matter should not be communicated in our report because the adverseconsequences of doing so would reasonably be expected to outweigh the public interest benefits of suchcommunication.
Other Matter
The actuarial valuation of liabilities in respect to Claims Incurred but Not Reported (IBNR), includingClaims Incurred but Not Enough Reported (IBNER), included under claims outstanding, and PremiumDeficiency and Free Look Reserve as at March 31, 2024 is the responsibility of the Company's AppointedActuary ("Actuary") and has been duly certified by the Actuary. The Actuary has also certified that inhis opinion, the assumptions for such valuation are in accordance with guidelines and norms, if any,issued by the IRDAI and the Institute of Actuaries of India in concurrence with the IRDAI. We have reliedupon the Appointed Actuary's certificate in this regard for forming our opinion on the financialsstatements of the Company.
Our opinion is not modified in respect of this matter.
Report on Other Legal and Regulatory Requirements
1. As required by the IRDAI Financial Statements Regulations, we have issued a separate certificate
dated May 10, 2024 certifying the matters specified in paragraphs 3 and 4 of Schedule C to the
IRDAI Financial Statements Regulations.
2. As required by the paragraph 2 of Schedule C of the IRDAI Financial Statements Regulations, read
with Section 143(3) of the Act, we report, to the extent applicable, that:
(a) We have sought and obtained all the information and explanations which to the best of ourknowledge and belief were necessary for the purposes of our audit;
(b) In our opinion, proper books of account as required by law have been kept by the Companyso far as it appears from our examination of those books except for the matters stated in theparagraph 2(l)(vi) below on reporting under Rule 11(g);
(c) As the Company's financial accounting system is centralized at Head Office, no returns forthe purpose of our audit are prepared at the branches and other offices of the Company;
(d) The Balance Sheet, the Revenue Account, the Profit and Loss Account and the Receipts andPayments Account dealt with by this Report are in agreement with the books of account;
(e) In our opinion, the aforesaid Financial Statements comply with the Accounting Standardsspecified under Section 133 of the Act, read with Companies (Accounting Standards) Rules,2021 specified under section 133 of the Act to the extent they are not inconsistent with theaccounting principles prescribed in the IRDAI Financial Statements Regulation and theregulations/orders/directions/circulars issued by the IRDAI in this regard;
(f) In our opinion and to the best of our information and according to the explanations given tous, investments have been valued in accordance with the provisions of the Insurance Act, theIRDAI Act and the IRDAI Financial Statements Regulations and/or theregulations/orders/directions/ circulars issued by the IRDAI in this regard.
(g) In our opinion and to the best of our information and according to the explanations given tous, the accounting policies selected by the Company are appropriate and are in compliancewith the applicable Accounting Standards specified under Section 133 of the Act and with theaccounting principles as prescribed in the IRDAI Financial Statements Regulations and theregulations/orders/directions/circulars issued by the IRDAI in this regard;
(h) On the basis of the written representations received from the directors as on March 31, 2024taken on record by the Board of Directors, none of the directors is disqualified as onMarch 31, 2024 from being appointed as a director in terms of Section 164 (2) of the Act;
(i) With respect to the adequacy of the internal financial controls with reference to theseFinancial Statements and the operating effectiveness of such controls, refer to our separateReport in "Annexure A" to this report;
(j) The modification relating to the maintenance of accounts and other matters connectedtherewith are as stated in the paragraph 2(b) above on reporting under Section 143(3)(b)and paragraph 2(l)(vi) below on reporting under Rule 11(g).
(k) The remuneration paid by the Company to its directors is in accordance with and within theprovisions of Section 197 of the Act read with Section 34A of the Insurance Act. We alsorefer note 14 of Schedule 16 (C) to the Financial/Statements which details the status of IRDAIapproval under section 34A of the Insurance Act. The Ministry of Corporate Affairs has notprescribed other details under Section 197(16) which are required to be commented by us;
(l) With respect to the other matters to be included in the Auditor's Report in accordance withRule 11 of the Companies (Audit and Auditors) Rules, 2014, as amended in our opinion andto the best of our information and according to the explanations given to us:
i. The Company has disclosed the impact of pending litigations on its financial position inits Financial Statements - Refer Note 1 of Schedule 16 (C) to the Financial Statements;
ii. The Company did not have any long-term contracts including derivative contracts forwhich there were any material foreseeable losses;
iii. There were no amounts which were required to be transferred to the Investor Educationand Protection Fund by the Company.
iv. a) The management has represented that, to the best of its knowledge and belief, otherthan as disclosed in the note 36 of Schedule 16 (C)to the Financial Statements, no funds(which are material either individually or in the aggregate) have been advanced or loanedor invested (either from borrowed funds or share premium or any other sources or kindof funds) by the Company to or in any other person or entity, including foreign entities("Intermediaries"), with the understanding, whether recorded in writing or otherwise,that the Intermediary shall, whether, directly or indirectly lend or invest in other personsor entities identified in any manner whatsoever by or on behalf of the Company("Ultimate Beneficiaries") or provide any guarantee, security or the like on behalf of theUltimate Beneficiaries;
b) The management has represented that, to the best of its knowledge and belief, otherthan as disclosed in the note 37 of Schedule 16 (C) to the Financial Statements, no funds(which are material either individually or in the aggregate) have been received by theCompany from any person or entity, including foreign entities ("Funding Parties"), withthe understanding, whether recorded in writing or otherwise, that the Company shall,whether, directly or indirectly, lend or invest in other persons or entities identified in anymanner whatsoever by or on behalf of the Funding Party ("Ultimate Beneficiaries") orprovide any guarantee, security or the like on behalf of the Ultimate Beneficiaries; andc) Based on such audit procedures performed that have been considered reasonable andappropriate in the circumstances, nothing has come to our notice that has caused us tobelieve that the representations under sub-clause (a) and (b) above contain any materialmisstatement.
v. No dividend has been declared or paid during the year by the Company.
vi. Based on our examination which included test checks, the Company has used accountingsoftware for maintaining its books of account which has a feature of recording audit trail(edit log) facility except that the audit trail facility was not enabled and hence did notoperate throughout the year for all relevant transactions recorded in the software asdescribed in Note 50 of Schedule 16 (C) to the financial statements. Further no instanceof audit trail feature being tampered with was noted in respect of accounting softwareexcept that we are unable to comment on such matter for period preceding theenablement of the audit trail feature as explained in the above.
As proviso to Rule 3(1) of the Companies (Accounts) Rules, 2014 is applicable from April1, 2023, reporting under Rule 11(g) of the Companies (Audit and Auditors) Rules, 2014on preservation of audit trail as per the statutory requirements for record retention isnot applicable for the financial year ended March 31, 2024.
For S.R. Batliboi & Co. LLP For T R Chadha & Co. LLP
^ Chartered Accountants Chartered Accountants
| ; r Firm Registration Numba^s6^ro^^/E300005 Firm Registration Number:006711N/N500028
'Ý ' . ;T-
per Shrawan Jalan ,u'%i II Neena Goel
Partner Partner ,2 2
Membership Number: Membership Number: 057986'' -
UDIN: 24102102BKBZZB^^S^ UDIN: 2^05 /986BKELPW1146
Place of Signature: Mumbai Place of Signature: Noida
Date: May 10, 2024 Date: May 10, 2024