TPA in Health Insurance

If you want to pay your hospital bills stress-free in India, you need health insurance. But the insurance claims process can often be long-winded and confusing for a lot of people. This is where TPAs in health insurance come in. They help bridge the gap between you and your insurance company.

Let's discuss the meaning of TPA in insurance, along with their roles and responsibilities.

TPA in Insurance Full Form: What is TPA in Health Insurance?

A Third-Party Administrator in health insurance, or TPA, is an authorised entity licensed by the IRDAI (Insurance Regulatory and Development Authority of India). TPAs are appointed by health insurance companies to assist with various administrative tasks. These include policy issuance, claims settlement, grievances and more.

For example, if you require cashless treatment, the TPA acts as a link between the hospital and your insurance provider, making claims settlement easier and hassle-free for you.

Role of Third-Party Administrator in Health Insurance

Claims Processing

A TPA handles various administrative tasks related to claims filing and processing. They assist in raising claims, preparing documentation and ensuring timely settlement.

Cashless Hospitalisation Assistance

Third Party Administrators assist policyholders seeking cashless hospitalisation. They help policyholders get approval for cashless treatment from the insurer and help the insurers settle claims at the chosen hospital.

Customer Support

Reliable TPAs also offer round-the-clock support, ensuring timely resolution of claims and other policy-related queries/complaints.

Policy Management

A third party administrator in medical insurance takes care of policy management tasks such as issuing smart cards, maintaining health records of policyholders, assisting policyholders in their policy related matters.

Network Hospital Management

TPAs also maintain partnerships with the network hospitals of the insurance company. They ensure smooth communications and operations between both parties.

Benefits of TPA in Medical Insurance for Policyholders

Transparent Communication

Policyholders can rely on TPAs for updates about their claims settlement. This helps them stay informed and clears any confusion or misunderstanding in the settlement process.

Cashless Treatment

TPAs also help policyholders get hassle-free cashless treatment at the network hospitals without worrying about upfront payments. From approval for hospitalisation to final settlement, TPAs help in the entire process.

Is it Possible to Cancel TPAs in Health Insurance?

Although TPA makes health insurance administration simple and hassle-free, some insurance providers as well as policyholders may want to settle their claims in-house.

However, it should be noted that TPA is appointed by the insurance company. Hence, only they can cancel or opt out of them.

As a policyholder, if you don't want to involve TPAs in your claims settlement or policy management, you can enquire about non-TPA policies.

List of Third-Party Administrators for Health Insurance in India

*The list of TPAs licenced by the IRDAI stated here as of 31st July 2024, and registrations are valid for 3 years from the date of issue/renewal. Please ensure you check the current IRDAI TPA list before proceeding with any processes.

Reliance General Insurance for Seamless Health Insurance Process

If you haven't purchased a medical insurance policy or are planning to upgrade to a better health insurance plan, Reliance General Insurance has got you covered. We offer health insurance policies with benefits like 100% claims settlement, low premiums, easy buy/renewal and attractive discounts.

We also partner with reliable TPAs to help you focus on your treatment and recovery while they handle critical documentation and claims processing. With our extensive network of hospitals and assistance from trusted TPA partners, we offer a smooth and seamless insurance experience without any complexities.

For more information, contact us!

Frequently Asked Questions

• Do I have to pay money to the TPA?

  You don't have to pay any charges to the TPA as they are appointed by the insurance provider.

• Who is responsible for hiring the TPA?

  The TPA is hired by the health insurance provider to assist in the claim processing.

• Which is the best TPA for health insurance in India?

  There are many reputed TPAs in India each with their own services and benefits. You can choose any reliable provider based on their reputation and service quality.

• Can one TPA work with multiple insurance companies?

  Yes. A third-party administrator (TPA) can work with multiple insurance companies efficiently.

• How to select the best TPA in health insurance?

  When selecting the right TPA, take into consideration factors such as their customer service, reputation, reviews and network of hospitals. Also ensure that the selected TPA has a proven track record of processing claims and offering satisfactory services to the policyholders.

*T&C Apply. For more details on risk factors, terms conditions, brochure, and exclusions, please read the policy wording and CIS carefully before concluding a sale.

Claim Settlement Ratio: This is the overall claim settlement ratio for FY 2023-24 without claim outstanding at the start of the financial year as per public disclosure of Reliance General Insurance Co. Ltd.