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What is a Third-Party Administrator (TPA) in Health Insurance?

Team AckoJul 22, 2021

This article is about focussing solely on TPAs, their meaning, role, etc. so that you are acquainted with one component of health insurance and then move on to unravelling more to educate yourself and make informed decisions when it comes to buying and renewing health insurance policies. Read ahead to know more about Third-Party Administrators in health insurance.

What is a Third-Party Administrator (TPA) in Health Insurance?

What is a TPA?

TPA is the abbreviation for Third-party Administrator. As the name suggests, it is someone or some organization that is a third party and an administrator. This brings up the question: what is a third-party administrator? The simple answer is; someone who is not the first or the second party in a health insurance contract (not directly involved) and assists in the administrative aspect of the services mentioned in the contract.

For example, Health TPA is someone engaged in administering services related to health insurance.

What is a TPA in Health Insurance?

The scope of health insurance is a lot wider than other general insurance categories like vehicle or travel insurance. Due to this wide scope, health insurance involves a plethora of terminologies. This is the reason why probably potential and current policyholders perceive health insurance to be filled with complexities. From the outset, this does seem intricate, entangled, and maze-like. But it is simple to understand if you focus on one component at a time instead of getting overawed by the entirety of it. For example, not everyone might know about the concept of Third-party Administrators (TPA) in health insurance.

A TPA in health insurance is an entity that is a third party in a health insurance agreement and administers the claim settlement aspect of the contract between a policyholder and the insurer. Here are some points that will help you understand TPA in a better manner.

  • TPA is a link between the insurer and the insured in the case of a hospitalization claim.

  • TPA is chosen by the health insurance company.

  • TPA’s facilitate the claim settlement process by administrating tasks such as dealing with documents and settling hospital bills.

  • TPAs are licensed by the Insurance Regulatory and Development Authority of India (IRDAI).

  • Insurers associate with TPAs for a smooth claim settlement process.

  • One TPA can be associated with several insurers.

What is the Role of TPA in Health Insurance?

The following points will explain the role of TPA in health insurance.

Whenever there is a hospitalisation claim, the policyholder directly or indirectly meets the TPA. The TPA offers the ID card and a Unique Identification Number to the patient, which helps in claim settlement. Thus, the TPA is the link between the insurance company and the policyholder when it comes to availing the hospitalisation cover and processing claims.

2) Record Keeping

Crucial records related to the policyholder when admitted as a patient are maintained by the TPA. The records are stored in a dedicated database.

3) Claim Settlement

The role of a TPA is integral to the Cashless Claims settlement process. The coordination between the insurer and the hospital is crucial in a Cashless Claims process as the bill is settled directly between these two parties. The TPA offers back-end support in such situations.

4) Continuous Support

Several TPAs have a 24×7 support system where policyholders can raise their queries and get to know the answers seamlessly. Call centres and mobile applications help to offer such kind of support.

5) Empanel Hospitals

TPAs also perform duties related to hospital empanelment. They check whether the hospitals meet the set criteria concerning being a part of Network Hospitals (tie-ups for hassle-free claim settlement).

6) Extra Services

Some TPAs might also offer additional services related to ambulances, extra beds, medicine supply, etc. to the policyholder.

Benefits of Third-Party Administrators in Health Insurance for Policyholders:

The benefit of TPAs for the insurance company is obvious—they get assistance for settling claims. But how does a good health insurance TPA benefit the policyholders? The following points will let you know.

  • Hand-holding during hospitalization.

  • Providing ID cards to policyholders/patients.

  • Assistance regarding the right kind of documentation.

  • Efficient Cashless Claims settlement process.

  • 24×7 customer support.

  • Simplification of the entire claim settlement process.

Also, read: How To Renew Expired Health Insurance Policy Online?

How to Cancel TPAs in Health Insurance:

TPAs are facilitators. And if there is a time gap between the services being provided, you can contact your insurer and they will coordinate with the TPA and let you know about the progress. If you feel you want to cancel a TPA or switch to a different TPA, you can discuss such a change in service with your insurance company. Here are the steps concerning how to cancel the TPA in health insurance.

  • Step 1: Reach out to your insurer via call or email.

  • Step 2: Share policy details and unique ID (UID) if any.

  • Step 3: Explain the reason for TPA cancellation.

  • Step 4: If the insurer approves of the change, select another TPA from the available list.

List of Third-party Administrators for Health Insurance:

Here’s a detailed list of Third-party Administrators for health insurance that has been sourced from the Insurance Regulatory and Development Authority’s official website. Note that this information is mentioned for informational purposes only. Appropriate discretion and verification are advised.

No. TPA Registration No. Registration Validity Name & Address Contact Details
1 United Health Care Parekh Insurance TPA Private Limited No. 002 20.03.2023 Mr. Shiva BelavadiChief Executive Officer,3B/1 Gundecha Onclave, Kherani Road,Saki Naka, Andheri (East),Mumbai – 400 072 Toll Free No.: 1800 209 8884Email: [email protected] Website: www.uhcpindia.com
2 Medi Assist Insurance TPA Private Limited No. 003 20.03.2023 Mr. Ganesh K Chief Administrative OfficerTower D, 4th Floor, IBC Knowledge Park, 4/1,Bannerghatta Road, Bangalore, 560029 Toll free number for senior citizens: 1800 419 9493Toll Free No.: 1800 425 9449Email: [email protected]: www.mediassist.in
3 MD India Health Insurance TPA Private Limited No. 005 20.03.2023 Mr. Suresh V. KarandikarChief Executive OfficerS.No. 46/1 E-space A-2 Building,3rd Floor, Pune-Nagar Road,Vadgaonsheri, Pune – 411 014. For senior citizens: 020-25300126Toll Free No.: 1800 233 1166Fax: 1860 233 4449Email: [email protected]: www.mdindiaonline.com
4 Paramount Health Services & Insurance TPA Private Limited No. 006 20.03.2023 Dr. Nayan ShahChief Executive OfficerPlot No. A-442, Road No. 28, Ram Nagar,MIDC Industrial Area, Wagle Estate, Thane (W) – 400 604 Senior Citizen Helpline No.: 022 66629813Toll Free No.: 1800 22 66 55Email: [email protected] Website: www.paramounttpa.com
5 Heritage Health Insurance TPA Private Limited No. 008 20.03.2023 Mr. Manash Chakraborty,Chief Administrative OfficerNICCO HOUSE, 5th Floor, 2, Hare Street,Kolkata-700001 Toll Free No.: 1800 345 3477Email: [email protected]: www.heritagehealthtpa.com
6 Family Health Plan Insurance TPA Limited No. 013 20.03.2023 Ms. G. BharathammaChief Executive OfficerNo: 8-2-269/A/2-1 to 6, 2nd FloorSrinilaya Cyber Spazio, Road No. 2,Banjara Hills, Hyderabad – 500 034. Senior Citizen Helpline No.: 1800 102 4273Toll Free No.: 1800 102 4033Email: [email protected]: www.fhpl.net
7 Raksha Health Insurance TPA Private Limited No. 015 31.03.2023 Mr. Pawan Kumar BhallaChief Executive Officer C/o Escorts Corporate Centre 15/5, Mathura Road, Faridabad,Haryana – 121 003 Toll Free No.: 1800 180 1444, 1800 220 456, 1800 425 8910Email: [email protected] Website: www.rakshatpa.com
8 Vidal Health Insurance TPA Private Limited No. 016 15.05.2023 Ms. Sudha Suhas Kulkarni Chief Administrative OfficerFirst Floor, Tower No. 2, SJR iPark, EPIP Zone, Whitefield, Bangalore – 560 066. Toll Free No.: 1860 425 0251, 080 46267018Email: [email protected]: www.vidalhealthtpa.com
9 East West Assist Insurance TPA Private Limited No. 018 15.05.2023 Dr. Atul AroraChief Executive Officer38, Golf Links, New Delhi – 110003 Ph. No.: 011-47222666 FAX: 011-47222640 Email: [email protected]: www.eastwestassist.com
10 Medsave Health Insurance TPA Limited No. 019 14.05.2023 Mr. S. AravamuthanChief Administrative OfficerF-701A, Lado Sarai, Mehrauli, New Delhi – 110030 Senior Citizen Helpline No.: 9319810070Toll Free No.: 1800 111 142Email: [email protected] Website: www.medsave.in
11 Genins India Insurance TPA Limited No. 020 10.06.2023 Mr. Subhash Chander Khanna,Chief Administrative OfficerD-34, Ground Floor, Sector-2Noida – 201301 (U.P.) Toll Free No.: 1800 345 3323Ph. No.: 0120-4144100 Fax:0120-4144170-71Email: [email protected]: www.geninsindia.com
12 Alankit Insurance TPA Limited No. 021 17.11.2020 Mr Bodh Raj PunjDirector & Chief Executive Officer Alankit House, 4E/2,Jhandewalan Extension, New Delhi – 110055 Toll Free No.: 1800 11 3300Ph. No.: 011-42541621-24 Fax:011-42541620-30Email: [email protected]: www.alankithealthcare.com
13 Health India Insurance TPA Services Private Limited No. 022 17.11.2020 Mr. Kamaljeet GuptaChief Administrative OfficerNeelkanth Corporate Park, Office No. 406 to 412,4th Floor, Kirol Road/Village, Vidya Vihar Society,Vidya Vihar (West), Mumbai-400086 Senior Citizen Toll Free No.: 1800 2269 70Toll Free No.: 1800 2201 02Ph. No.: 022-40881000Email: [email protected]: www.healthindiatpa.com
14 Good Health Insurance TPA Limited No. 023 26.01.2021 Ms. Saigeeta Dikshit,Chief Administrative OfficerSuite 403 – 406A, 4th Floor, Ashoka My Home Chambers,Behind Ashok Bhoopal Chambers, Sardar Patel Road,Secunderabad, Telangana State – 500003 Senior Citizen Toll Free No.: 1800 102 9919Toll Free No.: 1860 425 3232Email: [email protected] Website: www.ghpltpa.com
15 Vipul Medcorp Insurance TPA Private Limited No. 024 28.02.2022 Mr. Rajan SubramaniamChief Executive Officer515, Udyog Vihar, Phase 5,Gurgaon, Haryana – 122 016 Senior Citizen Toll Free No.: 1800 120 3348Toll Free No.: 1800 108 7477, 1800 102 7477Ph. No.: 0124-4833900 Fax: 0124-4699611Email: [email protected]: www.vipulmedcorp.com
16 Park Mediclaim Insurance TPA Private Limited No. 025 27.09.2022 Mr. Anurag BhatnagarChief Executive Officer702, Vikrant Tower,Rajindra Place,New Delhi-110008 Toll Free No.: 1800 11 55 33Ph. No.: 011-43191000Email: [email protected]: www.parkmediclaim.co.in
17 Safeway Insurance TPA Private Limited No. 026 19.07.2020 Mr. Mahesh SharmaChief Executive Officer815, Vishwa Sadan, District Centre,Janakpuri, New Delhi-110058 Toll Free No.: 1800 102 5671Ph. No.: 011-45451300Email: [email protected]: www.safewaytpa.in
18 Anmol Medicare Insurance TPA Limited No. 027 26.10.2020 Mr. P. S. KshatriyaChief Executive Officer2nd Floor, NBCC House, Opp. Ahmedabad Stock Exchange,Ambavadi, Ahmedabad – 380015, Gujarat Toll Free No.: 1800 233 1999Ph. No.: +91-79-61609926, 61609930E-mail: [email protected]: www.anmolmedicare.in
19 Grand Insurance TPA Private Limited No. 029 15.05.2021 Mr Bibhutosh ChattopadhyayChief Administrative OfficerGrand House, 45A,Hindustan Park,Kolkata 700 029 (West Bengal) Toll Free No.: 1800 102 4747Ph. No.: 033-40274747 Fax: 033-40043344Email: [email protected]: www.grandtpa.co.in
20 Rothshield Insurance TPA Limited No. 030 15.07.2022 Ms. Janki M BhateChief Executive Officer402, Raheja Chambers,Nariman Point,Mumbai 400 021 Toll Free No.: 1800 228 144Ph. No.: 022-22048144 Fax: 022-22854415Email: [email protected]: www.rothshield.co.in
21 Ericson Insurance TPA Private Limited No. 035 18.12.2021 Dr. Krishna P. Jaiswal, MD11-C, Corporate Park,ST Road, Chembur,Mumbai – 400 071 (Maharashtra) Senior Citizen Helpline No.: 022-25280208Toll Free No.: 1800 22 2034Ph. No.: 022-25280280Email: [email protected]: www.ericsontpa.com
22 Health Insurance TPA of India Limited No. 036 05.06.2023 Mr. SK MehraChief Executive Officer2nd Floor, Majestic Omnia Building,A-110, Sector-4, Noida 201301 (Uttar Pradesh) Toll Free No.: 1800 180 3600, 1800 102 3600Email: [email protected]: www.hitpa.co.in
23 Vision Digital Insurance TPA Private Limited No. 037 24.06.2021 Ms. Priyanka JainChief Administrative OfficerTime Square Building 3rd & 4th Floor,Sushant Lok-1, Block-B,Gurugram – 122002 Toll free no: 1800-419-9982Ph. No.: 0124-4003171Email: [email protected]: www.visiontpa.in

Also, read: Understanding Waiting Period and Survival Period in Health Insurance

Frequently Asked Questions:

Here are some of the prominent frequently asked questions related to TPA in health insurance. If you have specific queries, you can send an email at [email protected]

Do I have to pay money to the TPA?

You do not have to pay money to the TPA as you must deal directly with the insurance company.

Do I get a say in selecting a TPA?

Recent reports suggest that such an option might be possible. Please discuss the same with your insurance company.

What kind of individuals are there in the TPA’s team?

The TPA team can consist of experts belonging to the following fields: doctors, insurance consultants, legal experts, Informational Technology (IT) professionals, etc.

Who hires the TPA?

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

Can a TPA help in reducing fake claims?

Yes, TPA’s services can help the insurance company to reduce the instances of fake claims.

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