Role of Third Party Administrators in Health Insurance

TPA is a body that handles the claim process under health insurance plans

Role of Third Party Administrators in Health Insurance
Role of Third Party Administrators in Health Insurance
Ankit Agarwal - 28 July 2021

The world is fighting a health crisis that is affecting us both emotionally and financially. The huge treatment costs taking a toll on finances can hit like a ton of bricks. Health insurance plans can shield us from such medical emergencies.

To buy health insurance plans, we have health insurance companies, but to settle claims under those plans, we have Third Party Administrators (TPAs). As soon as an individual is admitted to a hospital, he or she is required to inform the TPA. Let us gather some more insights about TPAs in health insurance activity.

What is a Third Party Administrator (TPA)?

A Third Party Administrator (TPA) is a body that handles the claim process under health insurance plans. Usually, these administrators work independently, but may sometimes also act as an entity belonging to the insurer/s. The TPAs are licensed by the Insurance Regulatory and Development Authority of India.

Over the years, the number of insurers, the number of plans sold, and types of products increased considerably, due to which the need for TPAs was identified. The TPAs are responsible for the following:

  1. Manage and investigate a large number of health insurance claims

  2. Offering high quality and consistent services

  3. Share knowledge of healthcare services

  4. Observe cashless and reimbursement TAT

TPAs play a vital role in managing health insurance claims by doing the following jobs:

  • Issue Health Cards to the Insured: Health card is an important document required at the time of hospitalisation. A TPA is responsible to issue an authorised health card to the policyholder.

  • Smooth Processing of Claims: A TPA ensures a smooth claim settlement process by checking all the documents submitted by the insured.

  • Arrange for Value Added Services: TPAs arrange for value-added services including ambulance, well-being programs.

  • Strengthens the Hospital Network: A TPA builds a strong network of hospitals by enlisting the best hospitals where the insured can avail cashless treatment.

  • Helpline Facility: A TPA has a helpline number where the insured can call to get their claims-related queries solved.

Remember to consider factors like policy features, add-ons, exclusions, premium, waiting period, claim settlement ratio while buying a health insurance plan.


The author is CEO and Co-founder, InsuranceDekho

DISCLAIMER: Views expressed are the author's own, and Outlook Money does not necessarily subscribe to them. Outlook Money shall not be responsible for any damage caused to any person/organisation directly or indirectly.

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