Third-Party
Administrator
- Role of TPA in Health Insurance
- How does TPAs work?
- Benefits & Limitation of TPA
When we talk about health insurance, TPA is one of the components of it. TPA in health insurance helps in buying and processing your health insurance policy, its renewal, and getting your policy claim approved and settled in times of emergency. Their role is not just limited to your policy settlements. They are also helpful in saving your time and efforts while raising a claim request during a medical emergency as well as becoming a mediator between the policyholder and the insurer to create a seamless customer experience for both parties.
This article covers the role a TPA plays between you and your insurance provider, the benefits of getting their assistance, and how they work. Read further to know more about a TPA and its benefits being a policyholder.
Third-Party Administrator is an organisation that came into effect in 2001, and, is IRDAI approved to act as a channel between the insurer and the policyholder. TPA helps the policy bearers in the smooth filing of claims, submitting the correct documents, and other insurance-related issues. Health insurance companies hire these TPAs on their behalf so that the customers can reach out to them in times of confusion. Network hospitals of the insurance companies have a separate TPA desk where the policyholders can go to get assistance for their insurance-related issues.
TPAs play an important role in the easy settlement of health insurance claims. They are the major support system of the insurer as they undertake crucial responsibilities on behalf of them. Let's understand the workings 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.
Third-party administrators or TPAs in health insurance act as the foundational block of insurance administration in bridging the gap between a policyholder and the health insurance provider. On the other hand, a health insurance provider offers an individual or group of people the best available health insurance plans. TPAs are capable of making the claim process, policy renewal and other policy-related activities easy and hassle-free for both the parties. There are prominent features to a TPA that give you an effective and smooth transition with a 24/7 customer care facility, managing your policy premium payments, and to optimise the gateway of policy upgradation, etc.
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.
The following table demonstrates how TPAs help the policyholder at every step of their insurance journey:
| Advantages | Explanation |
| Claim Settlement | TPAs can help the policyholder receive the claim against their policy. |
| Establishing Network | TPAs have a list of a wide range of networking hospitals that help the policyholder to receive advanced and best-quality treatment without wasting time searching for better facilitation. |
| Customer service | The policyholder can reach out to the customer support of their TPA at any hour for any of their queries related to policy, renewal, claim or reimbursement settlement, etc. |
| Affordable administration | Insurance providers elect TPA outsourcing to get help with the administration of their customers’ concerns effectively. Assigning them to the customer saves the insurer’s operational costs. |
| Transparency and reporting | You can see all the changes made to your policy, the validation of your policy claims, and usage of the sum insured limit, etc through the guidance of your health insurance TPA. They are also transparent to report to you about the expenses. |
The TPA needs 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. |
| Barriers 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 many services and advantages to insurance holders. PolicyX has curated a list of advantages offered by third-party administrators
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:
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-
Third Party Administrators or TPAs are known to provide service and facilitation for customers who have elected a health insurance policy from particular insurance companies. However, some of the insurance providers act as TPAs themselves. A TPA can help the policyholder get every inch of information without getting confused and agitated. In a growing market of the health sector, the demand for health insurance policies is growing as well. So the possibility of getting help from TPAs is increasing rapidly. If you have any queries regarding your health insurance TPA, reach out to us at Policyx.com.
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Simran has an experience of 3 years in insurance content writing. She transitioned from hospitality to the insurance industry after her emerging interest in how vast insurance is. With her ability to write complex insurance concepts in a simple, relatable manner she keeps her audience hooked and solves their doubts smoothly.
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