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, 2025, the Miscellaneous Business -Revenue Account (also called the "Policyholders’ Account”), the Profit and Loss Account (also called the"Shareholders’ Account”) and the Receipts and Payments Account for the year then ended, and notes tothe financial statements, including a summary of significant accounting policies and other explanatorynotes forming part of the financial statements (herein after collectively referred to as "FinancialStatements” ).
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"),Insurance Regulatory and Development Authority of India (Actuarial, Finance and Investment Functions ofInsurers) Regulations, 2024 read with Master Circular No. IRDAI/ACTL/CIR/MISC/80/05/2024 dated May17, 2024 (the "IRDAI Financial Statements Regulations 2024"), the regulations/ orders/directions/circularsissued by the Insurance Regulatory and Development Authority of India ("the IRDAI") and the CompaniesAct, 2013, as amended ("the Act”) to the extent applicable, in the manner so required and give a trueand fair view in conformity with the Accounting Standards prescribed under Section 133 of the Act readwith the Companies (Accounting Standards) Rules, 2021, ("AS”) as amended, and accounting principlesgenerally accepted in India, as applicable to insurance companies:
a) in the case of the Balance Sheet, of the state of affairs of the Company as at March 31, 2025;
b) in the case of Miscellaneous Business - Revenue Account, of the operating profit for the year ended onthat 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 onthat date.
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 are furtherdescribed in the Auditor’s Responsibilities for the Audit of the Financial Statements’ section of our report.We are independent of the Company in accordance with the 'Code of Ethics’ issued by the Institute ofChartered Accountants of India ("ICAI”) together with the ethical requirements that are relevant to ouraudit of the Financial Statements under the provisions of the Act, and the Rules thereunder, and we havefulfilled our other ethical responsibilities in accordance with these requirements and the Code of Ethics. Webelieve that the audit evidence we have obtained is sufficient and appropriate to provide a basis for ouraudit opinion on the Financial Statements.
As discussed in Note 25 to the Financial Statements, the Company has filed an application for forbearanceof exceeding the Expenses of Management (EOM) over the allowable limit as per Expense of ManagementRegulations 2024 in respect of financial year 2024-25 with IRDAI, approval for which is yet to be received.Pending grant of forbearance by IRDAI, the consequential impacts, if any, of the above on the financialstatements cannot be presently determined. Our opinion is not modified in respect of this matter.
Key audit matters are those matters that, in our professional judgment, were of most significance inour audit of the Financial Statements for the financial year ended March 31, 2025. 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 of theFinancial Statements section of our report, including in relation to these matters. Accordingly, our auditincluded the performance of procedures designed to respond to our assessment of the risks of materialmisstatement of the Financial Statements. The results of our audit procedures, including the proceduresperformed to address the matters below, provide the basis for our audit opinion on the accompanyingFinancial Statements.
• Claims are a significant expense for the Company
• Provisioning of Outstanding Claims including Claims Incurred but Not Reported (IBNR) and Incurredbut Not Enough Reported (IBNER) are significant in magnitude and requires use of judgementsand estimates
• With regards to the claims provision, the Company makes a provision for claims upon intimation, onreceipt of documents, communication from co-insurer leader in cases of incoming co-insurance businessetc. The estimates undergo a revision based on further information and the settlement amount couldvary from the provision created
• The estimate of the claim involves a high degree of judgement
Our audit procedures included the following:
• We tested the design and operating effectiveness of controls around the due and intimated claimsrecording process. Also assessed and tested the operating effectiveness of key controls relatingto the claims handling process, including controls over completeness and accuracy of the claimoutstanding recorded
• Tested on a sample basis, claims paid and provision created with payment proof, claim intimationdocuments and communication from co-insurer leader in cases of incoming co-insurance business,which are material to assess whether claims are appropriately paid, estimated and recorded
• Performed analytical review procedures on the outstanding claims
• Tested the arithmetical accuracy of computation of claims provision performed by the Company
• The actuarial valuation of liability in respect of Claims Incurred but Not Reported (IBNR) and thoseIncurred but Not Enough Reported (IBNER) is as certified by the Company’s Appointed Actuary and wehave relied upon on the appointed actuary’s certificate in this regard.
The carrying values of Investments represents more than 80% of total assets as disclosed in the Financial
Statements which are to be valued in accordance with accounting policy framed as per the extant
regulatory guidelines.
• The valuation of all investments should be as per the investment policy framed by the Company whichin turn should be in line with IRDAI Investment Regulations and Preparation of Financial StatementRegulations. The valuation methodology specified in the regulation is to be used for each class
of investment
• The classification and valuation of these investments is considered to be one of the matters of materialsignificance in the Financial Statements due to the materiality of the total value of investments to theFinancial Statements
• The Company performs an impairment review of its investments periodically and recognizesimpairment charge when the investments meet the trigger/s for impairment provision as per thecriteria set out in the investment policy. Further, the assessment of impairment 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 have been made by the Company to ensure that theinvestments are in accordance with Regulation of Investments as stated in the IRDAI guidelines
• Tested the management oversight and controls over valuation of investments
• Independently test-checked valuation of quoted and unquoted investments
• Reviewed the Fair Value Change Account for specific investments
• Reviewed the basis of provisions accounted in respect of non-performing investments and ensured thatthe provision meets the IRDAI guidelines
• Reviewed and assessed the adequacy with respect to management assessment of impairment chargeon investments outstanding at the year end.
companies (Including Government Receivables), outstanding premium and agent balances:
• "Dues from Other entities carrying on insurance business" is INR 86,848 Lakhs as at the year end.
• "Outstanding premium" amounting to INR Nil (net of provision of INR 391 Lakhs in relation to premiumdue from Central Government, State Government and others).
• "Recoverable Agent balances" at the year-end amounted to Nil (net of provision of INR 584 Lakhs).
• Due to the significance of the amount and judgement involved in assessing the recoverability of dues,this has been considered as key audit matter.
The audit procedures performed by us included the following:
• Evaluation and testing of controls over the recording, monitoring and ageing of outstanding premium,Agents' Balances and due from other entities carrying on insurance business
• Evaluating the adequacy of the process of reconciliation followed by the Company with respect toamounts due from other entities carrying on insurance business
• We reviewed the historical provision for bad debts and compared it to the actual amounts written off, todetermine whether management's estimates have been prudent and reasonable
• Reviewed the details of co-insurance transactions uploaded on the ETASS portal by the Company andOther Insurance Companies and reconciled with the transactions accounted by the Company
• Sending out direct confirmations of balances to select parties on a test check basis as required under"SA 505-External Confirmations”
• We discussed with management and reviewed correspondences, where relevant, to identify disputes,if any, on any of the recoverable balances and review the assessment of the management as to therequirement of provisioning, if any on these disputed dues. Relied on the management estimates withrespect to such provisions.
The Company is highly dependent on its information technology ("IT”) systems for carrying out itsoperations and owing to the significant number of transactions that are processed on daily basis as partof its operations, which impacts key financial accounting and reporting items such as premium income,claims, commission expense and investments among others.
The controls implemented by the Company in its IT environment determine the integrity, accuracy,completeness and validity of the data that is processed by the applications and is ultimately used forfinancial reporting. Theses controls contribute to mitigating risk of potential misstatements caused byfraud or error.
Accordingly, our audit was focused on key IT systems and controls due to the pervasive impact on theFinancial Statements.
We involved our IT specialists to obtain an understanding of the entity's IT related control environment,perform risk-based testing and identification of IT applications, databases and operating systems that arerelevant to our audit.
Our area of focus, for the key IT systems relevant to financial reporting, included Access control, ProgramChange controls and Network Operations.
In this regard -
• we obtained an understanding of the entity's IT environment and key changes, if any, during the auditperiod that may be relevant to the audit
• we tested the design effectiveness of the general IT controls over the key IT systems and applicationsthat are critical to financial reporting
• we tested the entity's controls to ensure segregation of duties, access rights controls
• we conducted testing of manual and automated IT controls along with related interdependencies, whereapplicable and critical for financial reporting, to evaluate completeness and accuracy
• we tested the security environment implemented by the entity to prevent, detect and respond tonetwork security incidents
• we tested compensating controls or performed alternate procedures to assess whether there were anyunaddressed IT risks that would impact the controls or completeness and accuracy of data.
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 include theFinancial Statements and our auditor’s report thereon. Our opinion on the Financial Statements does notcover the other information and we will not express any form of assurance conclusion thereon.
In connection with our audit of the Financial Statements, our responsibility is to read the other informationand, in doing so, consider whether such other information is materially inconsistent with the FinancialStatements or our knowledge obtained in the audit or otherwise appears to be materially misstated. If,based on the work we have performed, we conclude that there is a material misstatement of this otherinformation, we are required to report that fact. We have nothing to report in this regard.
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 IRDAI FinancialStatements Regulations 2024, the regulations/ orders/directions/circulars/guidelines/ issued by the IRDAIand the Act in this regard and in accordance with the accounting principles generally accepted in India,including the Accounting Standards specified under section 133 of the Act read with the Companies(Accounting Standards) Rules, 2021 specified under section 133 of the Act to the extent applicableand in the manner so required. This responsibility also includes maintenance of adequate accountingrecords in accordance with the provisions of the Act for safeguarding of the assets of the Company andfor preventing and detecting frauds and other irregularities; selection and application of appropriateaccounting policies; making judgments and estimates that are reasonable and prudent; and the design,implementation and maintenance of adequate internal financial controls, that were operating effectivelyfor ensuring the accuracy and completeness of the accounting records, relevant to the preparationand presentation of the Financial Statements that give a true and fair view and are free from materialmisstatement, 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 financialreporting process.
Our objectives are to obtain reasonable assurance about whether the Financial Statements as a wholeare 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 an auditconducted in accordance with SAs will always detect a material misstatement when it exists. Misstatementscan arise from fraud or error and are considered material if, individually or in the aggregate, they couldreasonably be expected to influence the economic decisions of users taken on the basis of theseFinancial 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 to fraudor error, design and perform audit procedures responsive to those risks, and obtain audit evidencethat is sufficient and appropriate to provide a basis for our opinion. The risk of not detecting a materialmisstatement resulting from fraud is higher than for one resulting from error, as fraud may involvecollusion, forgery, intentional omissions, misrepresentations, or the override of 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 also responsible forexpressing our opinion on whether the Company has adequate internal financial controls with referenceto Financial Statements in place and the operating effectiveness of such controls.
• 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 events orconditions that may cast significant doubt on the Company’s ability to continue as a going concern. Ifwe conclude that a material uncertainty exists, we are required to draw attention in our auditor’s reportto the related disclosures in the Financial Statements or, if such disclosures are inadequate, to modifyour opinion. Our conclusions are based on the audit evidence obtained up to the date of our auditor’sreport. However, future events or conditions may cause the Company to cease to continue as a goingconcern.
• Evaluate the overall presentation, structure and content of the Financial Statements, including thedisclosures, and whether the Financial Statements represent the underlying transactions and events in amanner that achieves fair presentation.
We communicate with those charged with governance regarding, among other matters, the planned scopeand timing of the audit and significant audit findings, including any significant deficiencies in internalcontrol 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 andother matters that may reasonably be thought to bear on our independence, and where applicable,related safeguards.
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,
2025 and are therefore the key audit matters. We describe these matters in our auditor’s report unless lawor regulation precludes public disclosure about the matter or when, in extremely rare circumstances, wedetermine that a matter should not be communicated in our report because the adverse consequences ofdoing so would reasonably be expected to outweigh the public interest benefits of such communication.
The actuarial valuation of liabilities in respect to Claims Incurred but Not Reported (IBNR), including ClaimsIncurred but Not Enough Reported (IBNER), included under claims outstanding, estimate of loss ratio fordetermining profit commission on re-insurance treaties and Premium Deficiency and Free Look Reserveas at March 31, 2025 is the responsibility of the Company’s Appointed Actuary ("Actuary”) and has beenduly certified by the Actuary. The Actuary has also certified that in his opinion, the assumptions for suchvaluation are in accordance with guidelines and norms, if any, issued by the IRDAI and the Institute ofActuaries of India in concurrence with the IRDAI. We have relied upon the Appointed Actuary’s certificatein this regard for forming our opinion on the financials statements of the Company.
Our opinion is not modified in respect of this matter.
1. As required by the IRDAI Financial Statements Regulations 2024, we have issued a separate certificate
dated May 07, 2025 certifying the matters specified in paragraphs 3 and 4 of Part III of Schedule II to
the IRDAI Financial Statements Regulations 2024.
2. As required by the paragraph 1 of Part III of Schedule II of the IRDAI Financial Statements Regulations
2024, 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 Company so faras it appears from our examination of those books except for the matters stated in the paragraph2(l)(vi) below on reporting under Rule 11(g);
c) As the Company’s financial accounting system is centralized at Head Office, no returns for thepurpose 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 Standards specifiedunder Section 133 of the Act, read with Companies (Accounting Standards) Rules, 2021 specifiedunder section 133 of the Act to the extent they are not inconsistent with the accounting principlesprescribed in the IRDAI Financial Statements Regulation and the regulations/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 2024 and/or the regulations/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 to us,the accounting policies selected by the Company are appropriate and are in compliance with theapplicable Accounting Standards specified under Section 133 of the Act and with the accountingprinciples as prescribed in the IRDAI Financial Statements Regulations 2024 and the regulations/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, 2025 takenon record by the Board of Directors, none of the directors is disqualified as on March 31, 2025 frombeing 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 these FinancialStatements and the operating effectiveness of such controls, refer to our separate Report in"Annexure A” to this report;
j) The modification relating to the maintenance of accounts and other matters connected therewithare 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 also refer note14 of Schedule 16(C) to the Financial Statements which details the status of IRDAI approval undersection 34A of the Insurance Act. The Ministry of Corporate Affairs has not prescribed other detailsunder 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 with Rule 11of the Companies (Audit and Auditors) Rules, 2014, as amended in our opinion and to the best ofour information and according to the explanations given to us:
i. The Company has disclosed the impact of pending litigations on its financial position in itsFinancial 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 for whichthere were any material foreseeable losses;
iii. There were no amounts which were required to be transferred to the Investor Education andProtection Fund by the Company.
iv. A. The management has represented that, to the best of its knowledge and belief, other thanas disclosed in the note 36 of Schedule 16(C) to the Financial Statements, no funds (whichare material either individually or in the aggregate) have been advanced or loaned or invested(either from borrowed funds or share premium or any other sources or kind of funds) by theCompany to or in any other person or entity, including foreign entities ("Intermediaries”),with the understanding, whether recorded in writing or otherwise, that the Intermediaryshall, whether, directly or indirectly lend or invest in other persons or entities identified in anymanner whatsoever by or on behalf of the Company ("Ultimate Beneficiaries”) or provide anyguarantee, security or the like on behalf of the Ultimate Beneficiaries;
B. The management has represented that, to the best of its knowledge and belief, other thanas disclosed in the note 37 of Schedule 16(C) to the Financial Statements, no funds (whichare material either individually or in the aggregate) have been received by the Company fromany person or entity, including foreign entities ("Funding Parties”), with the understanding,whether recorded in writing or otherwise, that the Company shall, whether, directly orindirectly, lend or invest in other persons or entities identified in any manner whatsoever by oron behalf of the Funding Party ("Ultimate Beneficiaries”) or provide any guarantee, security orthe like on behalf of the Ultimate Beneficiaries; and
C. Based on such audit procedures performed that have been considered reasonableand appropriate in the circumstances, nothing has come to our notice that has causedus to believe that the representations under sub-clause (a) and (b) above contain anymaterial misstatement.
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 and the same has operated throughout the year for all relevant transactionsrecorded in the software except that, audit trail feature is not enabled for direct changes todata in Credence when using certain access rights, as described in note 49 of Schedule 16(C)to the financial statements. Further, during the course of our audit we did not come acrossany instance of audit trail feature being tampered with, in respect of accounting software(s)where the audit trail has been enabled. Additionally, the audit trail has been preserved by theCompany as per the statutory requirements for record retention from the date of enablementof audit trail for the respective accounting software as described in note 49 of Schedule 16(C)to the financial statements.
Chartered Accountants Chartered Accountants
Firm Registration Number: 301003E/E300005 Firm Registration Number: 006711N/N500028
Partner Partner
Membership Number: 102102 Membership Number: 057986
UDIN: 25102102BMOBFE5052 UDIN: 25057986BMIKKR8468
Date: May 07, 2025 Date: May 07, 2025