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Third Party Administrators for Health Insurance

About Third Party Administrators

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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.


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If you have a question about health related issues, you can now post it in our Ask An Expert section on our community website Medwonders.com and get answers from our panel of experts.
Posted by:  kakatiyamohan(Guest)  Posted on: 05/23/2012
kindly update latest data and information



Posted by:  saravks  Posted on: 04/10/2012
Sir
Im working as PRO in a reputed hospital in salem, Tamilnadu. Looking for new tie up's with listed TPA's in this site. Request to please suggest me which are the companies that provides services in Tamilnadu region and also the process of tie up with those companies.



Posted by:  vandna1977(Guest)  Posted on: 02/20/2012
Please provide me with name of TPA's recruting docs or some placement consultancy in Chandigarh or punjab, please.



Posted by:  santosh92(Guest)  Posted on: 02/10/2012
Please send me the list of DHS hospitals in navi mumbai Vashi.



Posted by:  a.dube(Guest)  Posted on: 01/03/2012
sir, i am running a hospital at raipur chhatisgarh and associatted with rsby and central govt kindly send detail for empanellment.



Posted by:  SANJIVANI-FAMILY-HOSPITAL  Posted on: 12/29/2011
Sir, We are running a hospital in Orissa and have MOU with a number of TPAs for cashless treatment of their clients. Some of them are either not paying the claims in time or making arbitrary short payment and do not care to give justification for this. Our concern is as to what is the forum for lodging the complains in this regard.



Posted by:  Shokhi  Posted on: 12/04/2011
Hi m looking for job in TPA , have got 2.6 yrs of experience in Claims adjudication in Health Insurance from International BPO.



Posted by:  rajivdr(Guest)  Posted on: 12/03/2011
i am physician running 15 bedded hospital in punjab iwant to empanel with TPA.kindly tell me the procedure



Posted by:  navs2009  Posted on: 11/24/2011
i am gen.surgeon.running 20 bedded hospital.i want to empanel with TPA.what is procedure



Posted by:  muzammil_qureshi2002(Guest)  Posted on: 10/27/2011
Kindly please send me someone TPA list of Haryana on muzammil_qureshi2002@yahoo.com




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