TPA in Health Insurance

Third-Party Administrator TPA is an IRDAI approved organization (since 2001) that acts as an intermediary between the insured and insurer to smoothly process the health insurance claims. They function as outsourced entities that offer claim-assistance and help in other activities on behalf of the insurer. From searching for the nearest network hospital to submitting the required documents for claim settlement, TPAs assist the policyholders and the insurers in every step of the journey.

Read along to find more about TPAs.

Whats the importance of third-party administrators (TPA) to insurance companies?

Insurance companies partially rely on TPAs for smooth settlement of claims. Other reasons as to why health insurance companies need TPAs are listed below:

Having a dedicated institute to facilitate claim settlement.Co-ordinating the complete process (from treatment to discharge).Proper management and investigation of claim requests.Better quality of services.

What are the Benefits of TPA to a Policyholder?
A policyholder can profit from a TPA in the following manner:
Avail faster and focused claims management.Ambulance services.24-hour toll-free helplines.Grab a list of trusted network hospitals of a respective insurer.Tracking claims.Increase the knowledge base of healthcare services.

How does TPAs work?What are the limitations of TPAs?

TPAs play an important role in an easy settlement of health insurance claims. They are the major support system of the insurer as they undertake crucial responsibilities on behalf of them. Lets understand the working of a TPA with the help of the below example:

Ramesh works in Genpact. His wife is diagnosed with a kidney stone and the doctor suggests an immediate operation. He has taken a health insurance policy from HDFC ERGO General Insurance Company. Below are two cases, which will showcase the role of TPAs in health insurance.

Case 1: Cashless Treatment
Ramesh plans to go for cashless treatment, gets in touch with the respective TPA of HDFC ERGO, and selects a suitable network hospital with their guidance. At the hospital insurance desk, the TPA guides Ramesh to submit the required documents to avail of the treatment. After approval, the assigned TPA settles the treatment expenses with the hospital.
Case 2: Non-Cashless Treatment
Due to some reason, Ramesh decides to visit a non-network hospital. He informs the assigned TPA regarding the same, gets the treatment done, and pays the bills. After discharge, Ramesh files for reimbursement. The TPA guides him with the list of required documents for submission. After the approval, the insurer transfers the claim amount to the registered bank account.

How TPA Works

List of TPAs in IndiaWhat are the limitations of TPAs?

According to the IRDAI circular, the policyholder can choose a TPA of his/her choice from a list of TPAs engaged by the insurer. Below is the list of TPAs available in India:

Name of TPA	Contact Person/Address	Contact Details
Medi Assist Insurance TPA Private	Mr. Ganesh K Chief Administrative Officer Tower D, 4th Floor, IBC Knowledge Park, 4/1, Bannerghatta Road, Bangalore, 560029	Toll-free for senior citizens: 1800 419 9493 Toll-Free No.: 1800 425 9449 Email:cao[at]mediassist[dot]in Website: www[dot]mediassist[dot]in
Paramount Health Services & Insurance TPA Private Limited	Dr. Nayan Shah Chief Executive Officer Plot No. A-442, Road No. 28, Ram Nagar, MIDC Industrial Area, Wagle Estate, Thane (W) - 400 604	Senior Citizen Helpline No.: 022 66629813 Toll-Free No.: 1800 22 66 55 Email:nayan[dot]shah[at]paramounttpa[dot]com Website: www[dot]paramounttpa[dot]com
United Health Care Parekh Insurance TPA Private Limited	Mr. Shiva Belavadi Chief Executive Officer, 3B/1 Gundecha Onclave, Kherani Road, Saki Naka, Andheri (East), Mumbai – 400 072	Toll-Free No.: 1800 209 8884 Email: shiva[dot]belavadi[at]uhcpindia[dot]co Website: www[dot]uhcpindia[dot]com
MD India Health Insurance TPA Private	Mr. Suresh V. Karandikar Chief Executive Officer S.No. 46/1 E-space A-2 Building, 3rd Floor, Pune-Nagar Road, Vadgaon Sheri, Pune – 411 014	For senior citizens: 020-25300126 Toll-Free No.: 1800 233 1166 Fax : 1860 233 4449 Email: skarandikar[at]mdindia[dot]com Website: www[dot]mdindiaonline[dot]com
Heritage Health Insurance TPA Private Limited	Mr. Manash Chakraborty, Chief Administrative Officer NICCO HOUSE, 5th Floor, 2, Hare Street, Kolkata-700001	Toll-Free No.: 1800 345 3477 Email: mchakraborty[at]bajoria[dot]in Website: www[dot]heritagehealthtpa[dot]com
Family Health Plan Insurance TPA Limited	Ms. G. Bharathamma Chief Executive Officer No: 8-2-269/A/2-1 to 6, 2nd Floor, Srinilaya Cyber Spazio, Road No. 2, Banjara Hills, Hyderabad – 500 034	Senior Citizen Helpline No.: 1800 102 4273 Toll-Free No.: 1800 102 4033 Email: bharathig[at]fhpl[dot]net Website: www[dot]fhpl[dot]net
Raksha Health Insurance TPA Private Limited	Mr. Pawan Kumar Bhalla Chief Executive Officer C/o Escorts Corporate Centre 15/5, Mathura Road, Faridabad, Haryana – 121 003	Toll Free No.s: 1800 180 1444, 1800 220 456, 1800 425 8910 Email: pawan[at]rakshatpa[dot]com Website: www[dot]rakshatpa[dot]com
Vidal Health Insurance TPA Private Limited	Ms. Sudha Suhas Kulkarni Chief Administrative Officer First Floor, Tower No. 2, SJR iPark, EPIP Zone, Whitefield, Bangalore - 560 066.	Toll-Free No.: 1860 425 0251, 080 46267018 Email: sudha[at]vidalhealthtpa[dot]com Website: www[dot]vidalhealthtpa[dot]com
East West Assist Insurance TPA Private Limited	Dr. Atul Arora Chief Executive Officer 38, Golf Links, New Delhi - 110003	Ph. No.: 011-47222666 FAX: 011-47222640 Email: ceo[at]eastwestassist[dot]com Website: www[dot]eastwestassist[dot]com
Medsave Health Insurance TPA Limited	Mr. S. Aravamuthan Chief Administrative Officer F-701A, Lado Sarai, Mehrauli, New Delhi - 110030	Senior Citizen Helpline No.: 9319810070 Toll-Free No.: 1800 111 142 Email: s.aravamuthan[at]medsave[dot]in Website: www[dot]medsave[dot]in
Genins India Insurance TPA Limited	Mr. Subhash Chander Khanna, Chief Administrative Officer D-34, Ground Floor, Sector-2 Noida - 201301 (U.P.)	Toll-Free No.: 1800 345 3323 Ph. No.: 0120-4144100 Fax:0120-4144170-71 Email: sckhanna[at]geninsindia[dot]com Website: www[dot]geninsindia[dot]com
Alankit Insurance TPA Limited	Mr. Bodh Raj Punj Director & Chief Executive Officer Alankit House, 4E/2, Jhandewalan Extension, New Delhi - 110055	Toll-Free No.: 1800 11 3300 Ph. No.: 011-42541621-24 Fax:011-42541620-30 Email: alok[at]alankit[dot]com Website: www[dot]alankithealthcare[dot]com
Health India Insurance TPA Services Private Limited	Mr. Kamaljeet Gupta Chief Administrative Officer Neelkanth 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 70 Toll-Free No.: 1800 2201 02 Ph. No.: 022-40881000 Email: kamaljeetg[at]healthindiatpa[dot]com Website: www[dot]healthindiatpa[dot]com
Good Health Insurance TPA Limited	Ms. Saigeeta Dikshit, Chief Administrative Officer Suite 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 9919 Toll-Free No.: 1860 425 3232 Email: saigeeta[at]ghpltpa[dot]com Website: www[dot]ghpltpa[dot]com
Vipul Medcorp Insurance TPA Private Limited	Mr. Rajan Subramaniam Chief Executive Officer 515, Udyog Vihar, Phase 5, Gurgaon, Haryana – 122 016	Senior Citizen Toll-Free No.: 1800 120 3348 Toll-Free No.: 1800 108 7477, 1800 102 7477 Ph. No.: 0124-4833900 Fax: 0124-4699611 Email: rs[at]vipulmedcorp[dot]com Website: www[dot]vipulmedcorp[dot]com
Park Mediclaim Insurance TPA Private Limited	Mr. Anurag Bhatnagar Chief Executive Officer 702, Vikrant Tower, Rajindra Place, New Delhi-110008	Toll-Free No.: 1800 11 55 33 Ph. No.: 011-43191000 Email: anuragbhatnagar[at]parkmediclaim.co[dot]in Website: www[dot]parkmediclaim[dot]co[dot]in
Safeway Insurance TPA Private Limited	Mr. Mahesh Sharma Chief Executive Officer 815, Vishwa Sadan, District Centre, Janakpuri, New Delhi-110058	Toll-Free No.: 1800 102 5671 Ph. No.: 011-45451300 Email: ceo[at]safewaytpa[dot]in Website : www[dot]safewaytpa[dot]in
Anmol Medicare Insurance TPA Limited	Mr. P. S. Kshatriya Chief Executive Officer 2nd Floor, NBCC House, Opp. Ahmedabad Stock Exchange, Ambavadi, Ahmedabad – 380015, Gujarat	Toll-Free No.: 1800 233 1999 Ph. No.: +91-79-61609926, 61609930 E-mail: prithvi[at]anmolmedicare[dot]com Website: www[dot]anmolmedicare[dot]in
Grand Insurance TPA Private Limited	Mr Bibhutosh Chattopadhyay Chief Administrative Officer Grand House, 45A, Hindustan Park, Kolkata 700 029 (West Bengal)	Toll-Free No.: 1800 102 4747 Ph. No.: 033-40274747 Fax: 033-40043344 Email: cao[at]grandtpa.co[dot]in Website: www[dot]grandtpa[dot]co[dot]in
Rothshield Insurance TPA Limited	Ms. Janki M Bhate Chief Executive Officer 402, Raheja Chambers, Nariman Point, Mumbai 400 021	Toll-Free No.: 1800 228 144 Ph. No.: 022-22048144 Fax: 022-22854415 Email: janki[at]rothshield[dot]co[dot]in Website: www[dot]rothshield[dot]co[dot]in
Ericson Insurance TPA Private Limited	Dr. Krishna P. Jaiswal, MD 11-C, Corporate Park, ST Road, Chembur, Mumbai - 400 071 (Maharashtra)	Senior Citizen Helpline No.: 022-25280208 Toll-Free No.: 1800 22 2034 Ph. No.: 022-25280280 Email: krishna[at]ericsontpa[dot]com Website: www[dot]ericsontpa[dot]com
Health Insurance TPA of India Limited	Mr. SK Mehra Chief Executive Officer 2nd Floor, Majestic Omnia Building, A-110, Sector-4, Noida 201301 (Uttar Pradesh)	Toll-Free No.: 1800 180 3600, 1800 102 3600 Email: sk.mehra[at]hitpa.co[dot]in Website: www[dot]hitpa[dot]co[dot]in
Vision Digital Insurance TPA Private Limited	Ms. Priyanka Jain Chief Administrative Officer Time Square Building 3rd & 4th Floor, Sushant Lok-1, Block-B, Gurugram - 122002	Toll-free no: 1800-419-9982 Ph. No.: 0124-4003171 Email: priyanka.jain[at]visiontpa[dot]in Website: www[dot]visiontpa[dot]in

What are the limitations of TPAs?

Though TPAs are quite useful, they do struggle with a few limitations. Here they are-

Since TPAs are not the actual health insurance providers, they may not have adequate information.
Customers often get confused between agents and TPAs.
As TPAs are middlemen, they dont have a major say in claim settlement.

To sum it up…

TPAs not only make our claim settlement journey easier but also increase our knowledge base of healthcare services. Both the parties (insurer and insured) can easily profit from them if used correctly.

Health Insurance TPA FAQ

1. If I take the help of an assigned TPA, do I need to pay them in return?

No. TPAs are hired by insurance companies and they only pay their fees/service charges.

2. Do TPAs play any role in the acceptance and rejection of the claims?

No, they are only responsible for managing the claim settlement process.

3. What documents are required for making a Health Insurance TPA Claim?

Below is the list of documents required for making a Health Insurance TPA Claim:

Aadhar Card of the policyholder.
Health Insurance TPA e-card copy or the insurance certificate copy.
Hospital and Pharmacy Bills.
Hospital Discharge Summary.
Doctor’s Prescriptions.
If required, the company may ask for further documents.

4. Can I trust the TPA of my insurer?

Yes, you can. TPAs are IRDAI approved and act as intermediaries between the insurance providers and the policyholders.

Written By : Naval Goel

Last Updated : December, 2019

Naval Goel is the CEO & founder of PolicyX.com. Naval has an expertise in the insurance sector and has professional experience of more than a decade in the Industry and has worked in companies like AIG, New York doing valuation of insurance subsidiaries. He is also an Associate Member of the Indian Institute of Insurance, Pune. He has been authorized by IRDAI to act as a Principal Officer of PolicyX.com Insurance Web Aggregator.

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TPA in Health Insurance

Whats the importance of third-party administrators (TPA) to insurance companies?

How does TPAs work?What are the limitations of TPAs?

List of TPAs in IndiaWhat are the limitations of TPAs?