Group Health Insurance TPA

What is TPA?

TPA stands for Third-party administrator. The third-party administrator is the one that is not directly involved under the health insurance contract. TPA is licensed by the Insurance Regulatory and Development Authority of India.

The health insurance scope is wider than the rest of the general insurance policies. Because of this wide scope, health insurance comes with many terminologies. This makes it difficult for the buyer to understand the health plans due to their complexities. But if you focus a little bit on one thing instead of everything at once, you can understand it very easily.

Since we are talking about TPA here, so health insurance tpa is a third-party organization in the health insurance agreement that looks after the aspect of claim settlement between the insurer and policyholder.

Why Third-Party Administrator is Required?

There are several intermediaries in the insurance industry. A third-party administrator is one of them and IRDAI license these administrators. TPA has its role in the health insurance segment. Here are some of the reasons why TPA is required?

• It is a link between the insured and the insurance company during the claim settlement after the hospitalization.
• The health insurance provider chose the third-party administrator.
• A third-party administrator issues the ID cards to the insured that the insured will have to show in the hospital to get a cashless claim settlement.
• Before raising the claim, the insured has to inform the TPA. Then they will assist the insured and direct him to the hospital that is tied up with them.
• The policyholder can choose another hospital as per their convenience but then they will not get a cashless claim and the expenses get reimbursed.
• TPA sends an authorization letter to the hospital to help them track the case and once the insured gets discharged the bills are sent to the TPA.
• TPA takes care of the documentation and settles the hospital bills.
• Insurance company associates with a third-party administrator to carry out smooth claim settlements.
• Single TPA can work with several insurance companies.

How to Choose Right Health Insurance TPA?

Before 2019, the health insurance companies used to provide TPA to the policyholders. The health insurance companies consumed a lot of time in settling the claim. As an initiative to make the claim settlement quick and easy for the customers, the Insurance Regulatory and Development Authority of India has allowed policyholders to choose a third-party administrator of their choice while purchasing or renewing the insurance policy.

Under the amendment made by IRDAI in 2019, IRDAI asked the health insurance companies to provide a list of Third-party administrators to their customers while selling the policy. Then the buyer has the right to chose the TPA as per their choice. The insurance companies were not allowed to change the third-party administrator at the time of renewal. However, the insurance company can limit the list of TPAs as per the insurance policy coverage and the policyholder’s location.

Here are the changes that IRDAI made in favour of the policyholders to choose a TPA of their choice.

• The insured can pick one TPA that is registered with the insurance company.
• The customer can choose a TPA at the time of buying or renewing the insurance policy.
• If the policyholder does not choose a TPA then the insurance company has the right to choose one TPA for the insured.
• The policyholder cannot dispense the services provided by the TPA and ask the insurer to render the services directly.
• If the chosen TPA gets terminated during the policy tenure then the insurance company will have to provide alternative options to the insured to choose from.
• If the insurance company is registered with one TPA then the insured will have no choice.

Health Insurance TPA In India

Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurance company, third-party administrator, product, or service offered by any insurer or third-party administrator.

Is TPA Mandatory For Health Insurance?

A third-party administrator is a body/organization that is provided by the insurance company to ease your claim settlement process. When you raise a claim the third-party administrator works as a mediator between you and the insurer to settle your raised claim for the expenses incurred during the hospitalization. The TPA provides an ID card that you use to get a cashless claim, also you have the right to choose the third-party administrator of your choice while purchasing or renewing the insurance policy.

Health Insurance TPA FAQs