The Insurance Regulatory and Development Authority of India (Irdai) have permitted third party administrators (TPAs) to process health claims of foreigners who have bought policies from Indian life insurance companies. The authority also declared that a TPA can offer health services to several insurance companies. Similarly, an insurance company can connect multiple TPAs for offering health services to its insured.
As per the regulator, TPA can expand its services for overseas travel policies and health policies provided by Indian insurance companies covering medical treatment or hospitalisation outside India. This comprises health services under travel insurance provided by foreign insurance companies to those visiting India. However, such services shall be limited to the treatment essential during the India stay of an international policyholder.
In those cases where the claim amount is more than the sum insured, the regulator declared that the decided discount would have to be setteled on the gross amount of the bill, before letting the policyholder or the claimant bear the extra cost.
Similarly, in cases where fundamental health insurance policies have co-payment or deductible circumstances, the insurer or TPA must make sure that the co-payment or deductible is effected only after netting off the discounts provided by a hospital.
A TPA is essential to preserve a minimum paid-up equity share capital of Rs 4 crore. Further, at least one director of a TPA must have a MBBS degree.