What Is A Third Party Administrator In Health Insurance?
A Third Party Administrator or health insurance TPA is an entity tasked with the processing of health insurance claims. A TPA can either be an entity belonging to or affiliated with the health insurance provider or an independent organisation altogether. The Insurance Regulatory Development Authority of India (IRDAI) issues licenses to TPAs.
The primary role of a health insurance TPA is to ensure that the entire process of health insurance claims is completed in a streamlined and time-efficient manner. Should you require any assistance in filing a health insurance claim, you can seek the assistance of the TPA affiliated with your health insurer.
What Is The Role Of TPA in Health Insurance?
The role of Third Party Administrators in health insurance is multifaceted. Although their main role is to process health insurance claims, they also perform several other tasks. Here are the various tasks performed by health insurance TPAs.
1. The issuance of health insurance cards
A Health Insurance Card is an important document that comprises significant details about your health insurance policy, including the policy number, sum insured, validity period, your date of birth, the details of TPAs, etc. When you go to the insurance desk at a hospital to start the health insurance claims process, you must produce your health insurance card. Although health insurance cards are usually issued by the selected insurance company, this task is sometimes outsourced to Third Party Administrators.
2. Streamlined settlement of health insurance claims
As discussed earlier, the primary responsibility of a health insurance TPA is to ensure that the claim applications submitted by policyholders are processed in a hassle-free manner. In addition to checking the aforementioned application and the necessary supporting documents, TPAs can also seek additional information related to the application from a policyholder (if necessary).
In case of a cashless claim for health insurance, you must submit the necessary documents to the hospital, which, in turn, shares them with the Third Party Administrator. For reimbursement claims, you must submit all the required documents directly to the TPA.
3. Offering customer support
If you require any assistance at any point during the claims process, you can reach out to the customer support team of the TPA via phone or email. The contact number for your health insurance TPA is usually listed on your health insurance card. However, you can look up this number online as well.
4. Provision of additional services
Health Insurance TPAs are also engaged in the provision of additional services, for instance, ambulance service and health and well-being programs, to name a few.
How TPAs in Health Insurance Help Policyholders
Since a Third Person Administrator in Health insurance is an intermediary between an insurance company and their policyholder/s, they serve as a link between the two. Whether you are filing a cashless claim or a reimbursement claim, a health insurance TPA can be of great assistance to you.
1. Cashless claims
If you wish to avail the benefit of cashless treatment available under your health insurance policy, you must inform the relevant health insurance TPA about your admission to a hospital (before a planned hospitalisation and within 24 hours of an emergency hospitalisation). The TPA shall ensure the provision of cashless treatment to you at the selected network hospital. Your hospital bills shall be shared by the hospital with the TPA for the processing of the cashless claim. You will not have to pay any bills as long as the treatment is covered under your health insurance policy.
2. Reimbursement claims
In the case of a reimbursement claim, you have to bear the expenses of the treatment yourself, and subsequently submit a health insurance claim with the relevant TPA. Such a claim should be accompanied by the required supporting documents, such as your hospital bills, doctor's consultation, medicine bills, discharge report, etc.
What Are The Benefits Of TPAs In Health Insurance?
Third Party Administrators in health insurance can make the claims process easier for policyholders. Here are the major benefits of TPAs in health insurance.
1. Standardisation of the claims process
Since health insurance TPAs follow a standard procedure to process and verify health insurance claims, the whole process becomes more streamlined. This leads to the swift settlement of claims, which is beneficial for both the insurer and the insured.
2. Support to the policyholders
Another benefit of TPAs in health insurance is that policyholders can seek their support through a 24x7 helpline number. Therefore, any doubts that policyholders may have vis-a-vis the claims process can be readily addressed.
3. Awareness of health insurance benefits
Policyholders can become more aware about the various benefits available under their health insurance policy with the help of TPAs.
4. Elimination of fake claims
With the expertise of health insurance Third Party Administrators, fake and fraudulent claims can be identified during the processing of the claims. This can be beneficial for the insurer in terms of savings of time and cost alike.
Cancellation Of TPAs In Health Insurance
It is important to remember that since a health insurance Third Party Administrator is appointed by your health insurance provider, they can be cancelled by the latter as well. Therefore, you must stay updated on the active TPAs affiliated with your health insurer and reach out to the insurer as your primary point of contact vis-a-vis claims.
During the claims process, however, if there are any documents missing or any other issue arises, then you must co-operate with your health insurance TPA.
List of Health Insurance TPAs
Here is the list of the popular health insurance Third Party Administrators operating in India.
United Healthcare Parekh TPA Private Limited
Media Assist India TPA Private Limited
MD India Healthcare (TPA) Services Private Limited
Paramount Health Services & Insurance TPA Private Limited
E Meditek (TPA) Services Limited
Heritage Health TPA Private Limited
Focus Healthcare Services TPA Private Limited
Medicare TPA Services (I) Private Limited
Family Health Plan (TPA) Limited
Raksha TPA Private Limited
Vidal Health TPA Private Limited
Anyuta TPA in Healthcare Private Limited
East West Assist TPA Private Limited
Med Save Health Care TPA Private Limited
Genins India Insurance TPA Limited
Alankit Insurance TPA Limited
Health India TPA Services Private Limited
Good Health TPA Services Limited
Vipul Med Corp TPA Private Limited
Park Mediclaim TPA Private Limited
Safeway Insurance TPA Private Limited
Anmol Medicare TPA Limited
Dedicated Healthcare Services TPA (India) Private Limited
Grand Health Care TPA Services Private Limited
Rothshield Healthcare (TPA) Services Limited
Ericson Insurance TPA Private Limited
Health Insurance TPA of India Limited
To Sum It Up
The role of Third Party Administrators in health insurance is utterly significant, particularly with regard to the claims process. You can check the list of the active TPAs for your health insurance provider on their official website.