Third Party Administrators for Health Insurance

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About Third Party Administrators

The Third Party Administrators are intermediaries who connect insurance companies, policyholders and health care providers.
The Insurance Regulatory Development Authority (IRDA) selects the TPAs on the basis of strict professional norms.

The Insurance industry in India has experienced a sea of change since the opening up of the sector for private participation. With a plethora of companies entering the foray in the near future, the health insurance sector is surging forward and is poised for a phenomenal growth.

Health insurance is an important mechanism to finance the health care needs of the people. To manage problems arising out of increasing health care costs, the health insurance industry had assumed a new dimension of professionalism with TPAs.

Further, the uncertainty related to a medical condition increases the need for a health insurance for all the citizens.

Health insurance is any health plan that pools resources up front by converting unpredictable medical expenses into a fixed health insurance premium. It also centralizes funding decisions on health needs of a policyholder. This covers private health plans as well as mediclaim policies.

While call center facilities and personalized financial planning tools are some of the innovative trends, experienced in the products front, the best thing to happen on the service front is the introduction of third party administrators as they serve as a vital link between insurance companies, policyholders and health care providers.

TPAs were introduced by the IRDA in the year 2001. The core service of a TPA is to ensure better services to policyholders. Their basic role is to function as an intermediary between the insurer and the insured and facilitate cash less service at the time of hospitalization.

A minimum capital requirement of Rs.10 million and a capping of 26% foreign equity are mandatory requirements for a TPA as spelt by the IRDA. License is usually granted for a minimum period of three years. Ideally, The TPA functions by collaborating with the hospitals in order for the patient to enjoy hospitalization services on a cashless basis.

Latest Publication and Research on Third Party Administrators for Health Insurance

TRICARE; TRICARE sanction authority for third-party billing agents. Final rule. - Published by PubMed
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HIHO123 Wednesday, May 11, 2016

The TPA concept took 15 years to come up though IRDAI approved the same long back in 2001. The benefit of TPA to the Insured has not improved any significantly except that the present TPA has just taken over only the fee part of the Insurer companies and to ensure that the claim gets reduced to the least. The facilities offered by them and to start with their 24X7 service to policy holders may kindly be seen. The vision statement states about eradication of fraudulent claims as if the health insurance industry was infested with this malaise in India. It says brightly about flashing I Card and about cashless treatment but it is equally silent why a payment under a covered illness will be postponed and it will be treated as a claim afterwards. At the time of discharge, the TPA will pay what it is supposed to pay and the rest will be borne by the patient. The introduction of pre-authorization approval has been made the monopoly of TPA which is wrong. It is just reaping the benefit of insurance without being responsible for it. IRDAI has a big role now.

nbnrc Thursday, February 25, 2016

Dear Sir, I am working as PRO in a reputed hospital in siliguri West Bengal. Sir we are tied up with Med India as well in order make our communication active kindly suggest me something.

okeeyehospital Sunday, January 3, 2016

Dear Sir
We, Oke eye hospital, Nagpur is a established eye care center at Nagpur, Maharashtra. we are empanelled with most of the TPAs working in this area. we have approached the TPA Mediassist couple of times sending our full information for getting empanelled. in last 3 years we have not been given any response. It causes lot of inconvenience to those patients who intend to get their surgeries done at our hospital and they have to adopt the course of reembursement. Kindly guide us regarding the proper mode of approaching Mediassist TPA.

mediclaim_disease Wednesday, April 17, 2013

pls. let me know the list of diseases under reimbursement from national insurance co limited.

seo2012 Thursday, April 4, 2013

For any insurance query please dial 1800113538. need any information about any policy please contact health insurance india. our expert feeling happy to help you.

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