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Health Insurance Third Party Administrator (TPA)

There is no way to predict medical emergencies or the quantum of their impact on your life. However, you can prepare yourself to be able to handle such events by opting for a suitable health insurance policy. Buying medical insurance is no longer a choice but almost a necessity, particularly considering the ever-widening range of health-related challenges.

By investing in a carefully selected health insurance plan, you can easily ensure that you are financially prepared for any medical emergency, from accidents to illnesses, from Daycare Procedures to hospitalisation . In the unfortunate event of any such occurrence, you can avail of the benefits of your health insurance policy and keep your savings intact. Filing a claim on your health insurance policy can be a tricky task, which is why you must be aware of Health Insurance TPAs.

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.

 

  1. United Healthcare Parekh TPA Private Limited

  2. Media Assist India TPA Private Limited

  3. MD India Healthcare (TPA) Services Private Limited

  4. Paramount Health Services & Insurance TPA Private Limited

  5. E Meditek (TPA) Services Limited

  6. Heritage Health TPA Private Limited

  7. Focus Healthcare Services TPA Private Limited

  8. Medicare TPA Services (I) Private Limited

  9. Family Health Plan (TPA) Limited

  10. Raksha TPA Private Limited

  11. Vidal Health TPA Private Limited

  12. Anyuta TPA in Healthcare Private Limited

  13. East West Assist TPA Private Limited

  14. Med Save Health Care TPA Private Limited

  15. Genins India Insurance TPA Limited

  16. Alankit Insurance TPA Limited

  17. Health India TPA Services Private Limited

  18. Good Health TPA Services Limited

  19. Vipul Med Corp TPA Private Limited

  20. Park Mediclaim TPA Private Limited

  21. Safeway Insurance TPA Private Limited

  22. Anmol Medicare TPA Limited

  23. Dedicated Healthcare Services TPA (India) Private Limited

  24. Grand Health Care TPA Services Private Limited

  25. Rothshield Healthcare (TPA) Services Limited

  26. Ericson Insurance TPA Private Limited

  27. 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.

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FAQs on TPAs In Health Insurance

  • ✔️What is a Third Party Administrator in health insurance?

    A Third Party Administrator in health insurance is an entity that carries the responsibility of the efficient and hassle-free processing of health insurance claims. 

  • ✔️Where can I check the list of the active TPAs of my health insurance provider?

    You can check the list of the TPAs for your health insurance provider by visiting their official website or checking your health insurance card. 

  • ✔️What types of health insurance claims do TPAs deal with?

    Third Party Administrators deal with the following main types of health insurance claims.

    • Cashless claims

    • Reimbursement claims 

  • ✔️Can a particular TPA be cancelled?

    Yes, a particular TPA can be cancelled by your health insurance provider or de-licensed by the Insurance Regulatory Development Authority of India (IRDAI). 

  • ✔️Do health insurance TPAs offer customer support?

    Yes, a part of the responsibilities of health insurance TPAs is that they provide customer support through their 24x7 toll-free helpline number. 

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