Third-Party
Administrator
- Role of TPA in Health Insurance
- How does TPAs work?
- Benefits & Limitation of TPA
In an emergency, third-party administrators for health insurance are useful. When it comes to hospitalization claims, it might be difficult if you do not have health insurance coverage, but for those who do, a third-party administrator can help with hassle-free claim settlement. Because health insurance policies cover a wide range of services, it is critical to comprehend the technical jargon. TPA Insurance is not a phrase that everyone is familiar with, which is why this article seeks to explain the concept of Third Party Administrator in depth.
Read along to find more about TPAs.
Third-Party Administrator is an organization who came in effect since 2001, and, is IRDAI approved to act as a channel between the insurer and the policyholder. TPA helps the policy bearers in smooth filing of claims, submitting the correct documents, and other insurance-related issues. Health insurance companies hire these TPAs on behalf of them so that the customers can reach out to them in times of confusion. Network hospitals of the insurance companieshave a separate TPA desk where the policyholders can go to get assistance for their insurance related issues.
TPAs play an important role in the health insurance industry and provide excellent service to policyholders. Policyholders can always rely on Third Party Administrators for all pertinent information about their health insurance policy. Here are a few examples of how a TPA can assist you.
Following table demonstrates how TPAs help the policyholders at every step of their insurance journey:
| Advantages | Explanation |
| Claims Settlement Process | TPA in medical insurance specialises in handling claims efficiently, ensuring a hassle-free reimbursement for policyholders. |
| Establishing Network | Third party administrator in health insurance has well-established networks of healthcare providers, which makes it easier for customers to access quality medical services. |
| Customer service | TPA in medical insurance has dedicated 24*7 customer service support, which helps to assist policyholders with their queries, claims, and other policy-related matters. |
| Affordable administration | Outsourcing administrative tasks to TPAs can be cost-effective for insurance companies, as it reduces their operational expenses. |
| Transparency and reporting | TPAs offer transparent processing of claims and provide reports on usage, costs, and any new changes. |
It is essential for the TPA to match the expectations and demands of the insurance company and the customers at a time but sometimes mismatch in both can lead to discrepancies. Here are a few disadvantages of TPAs in Health Insurance:
| Disadvantages | Explanation |
| Control over the claims process | Insurers have minimal control over the claim settlement process, which TPA primarily manages, this impacts service quality. |
| Barrier in Communication | Miscommunication or delays in communication between the TPA, and policyholders, can lead to annoyance and insufficiencies. |
| The Conflicts of Interest | TPAs may bond financially with specific healthcare providers, which could influence how they manage their networks and handle claims efficiently. |
| Reliance on the external service providers | Insurance companies are dependent on TPAs for their essential tasks, and any interruption in the services could negatively impact customer experience. |
| Limited options for customisation | TPAs offer a standard process, which may sometimes differ from the expectations of the particular insurance company. |
TPA in health insurance provides a plethora of services and advantages to insurance holders. PolicyX has curated a list of advantages offered by third-party administrators
Third-Party Administrators are responsible for handling various aspects of insurance provided by insurance providers. Some of the examples are smooth and hassle-free claim process, premium payment management, and efficient customer service. The role of TPA in health insurance is that of a bridge between insurance providers and insured lives. Meanwhile, health insurance providers are responsible for providing the best health insurance plans to individuals, families, groups, and others. Third Party Administrators in health insurance are the administrative foundation in the health insurance system.
Insurance companies partially rely on TPAs for smooth settlement of claims. Other reasons as to why health insurance companies need TPAs are listed below:
A policyholder can profit from a TPA in the following manner:
Know More About Health Insurance Companies
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.
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 |
Though TPAs are quite useful, they do struggle with a few limitations. Here they are-
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.
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