• Role of TPA in Health Insurance
  • How does TPAs work?
  • Benefits & Limitation of TPA
TPA in Health Insurance
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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.

What is TPA in health insurance?

Third-party administrators aid customers in the hassle-free purchase of health insurance plans, and claim-related issues in health insurance. Third-Party administrators are licensed entities chosen by a health insurance company and licensed by (IRDAI) to sell health insurance policies to customers. It is a one-point contact for all insurance plan-related queries and claim settlement requirements for the customers and makes sure that there are no delays in claim processing when it is most needed by any customer. TPAs are intermediaries between insurance holders and insurance providers.

TPAs primary focus is usually claim settlement but some TPAs also provide value-added services such as road ambulance, hospital beds, doctor consultation, overall healthcare programs, pharmacy service, 24x7 helpline services, lifestyle management, data management, and more.

What is the Role of TPA in Health Insurance?

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.

  • TPA serves as a connecting link
    When an insurance holder wants to make a claim for hospitalization or other treatment expenses, the claim process is handled by a TPA. Insurance holders are given a health insurance card that contains their unique Identity number or policy number, which a TPA uses to navigate the claim process and settle it with the hospital with minimal involvement from the insurance holder, making it a hassle-free experience.
  • Consistent Service Providers
    Third-party administrators provide 24x7 service for grievance redressal, claim settlement, or health insurance policy queries, making it easier for customers to navigate a sea of health insurance policies and make the right decision. TPAs assist customers in determining how much sum insured is adequate for them and their families, what features are appropriate within a health insurance policy for them, and whether any optional covers are required.
  • Cashless network hospital
    TPAs are also responsible for monitoring cashless hospitals and determining whether they meet the criteria for being designated as a cashless network hospitals. To provide a smooth claim settlement process to insurance holders, cashless network hospitals must have an efficient and robust claim settlement system in place.
  • TPA database
    TPA keeps a separate database of its customers in order to better serve them in the event of a planned hospitalization or a medical emergency. All medical records, unique identification numbers, health insurance policy cards, and information about the policy purchased by the customer should be available in order to provide the proper service to the insurance holder.

How TPA helps Policyholders?

TPA helps policyholders in multiple ways

  • Acts as a touchpoint between policyholders and policy providers regarding cashless claim settlement.
  • The key responsibility of Third party administrator is to make sure that claim settlements are hassle-free and that policyholders do not undergo any issues during hospitalization or discharge.
  • TPAs have to make sure that the cashless network hospitals impaneled under the health insurance provider list are fulfilling all the necessary criteria in order to serve the insurance holders in need of any medical emergencies
  • TPAs are involved with policyholders during hospitalization and are coordinating with the cashless network hospital to make the experience of a policyholder hassle-free.
  • TPAs arrange the necessary value-added services such as road ambulance, wellness programs, doctor schedules, and more.

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.

Health Insurance Companies

How does TPAs work?

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.

  1. 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.

  2. 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 India.

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 TPAContact Person/AddressContact Details
Medi Assist Insurance TPA PrivateMr. 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
Website: www[dot]mediassist[dot]in
Paramount Health Services & Insurance TPA Private LimitedDr. 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
Website: www[dot]paramounttpa[dot]com
United Health Care Parekh Insurance TPA Private LimitedMr. 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 PrivateMr. 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 LimitedMr. 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 LimitedMs. 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 LimitedMr. 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 LimitedMs. 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 LimitedDr. 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 LimitedMr. 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 LimitedMr. 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 LimitedMr. 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 LimitedMr. 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 LimitedMs. 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 LimitedMr. 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 LimitedMr. 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][dot]in
Website: www[dot]parkmediclaim[dot]co[dot]in
Safeway Insurance TPA Private LimitedMr. 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 LimitedMr. 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 LimitedMr 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][dot]in
Website: www[dot]grandtpa[dot]co[dot]in
Rothshield Insurance TPA LimitedMs. 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 LimitedDr. 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 LimitedMr. 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][dot]in
Website: www[dot]hitpa[dot]co[dot]in
Vision Digital Insurance TPA Private LimitedMs. 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
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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 Articles

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.

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