TPA in Health Insurance – Meaning, Full Form, Functions and Roles
TPA (full form – Third Party Administrator) is a licensed intermediary between health insurance policyholders and insurance companies. It can be a company, an organisation or an agency with a license from the Insurance Regulatory and Development Authority of India. Insurance companies could outsource claim settlements to TPAs to make the process hassle-free and reduce the overall burden of processing claims.
Some TPAs also provide certain value-added services. But, is having a TPA beneficial for policyholders? Can a policyholder opt out of TPA service? Continue reading to have a complete understanding on how TPA in health insurance works, its role, benefits and how to cancel TPA.
What are the Functions of TPA in Health Insurance?
The functions of a TPA in health insurance are
- Processing claims and settlements
- Approving cashless claims
- Disbursing claims
- Providing network facilities
- Database maintenance
- Collecting premiums
- Cashless processing for approved hospitals
- Enrolment
- Reimbursing hospitals bills with cash
Some TPAs provide value-added services such as:
- Ambulance services
- 24×7 toll-free helplines
- Medicine supplies
- Specialised consultation
- Health facilities
- Checking available beds
How TPAs in Health Insurance Help the Policyholders?
1. Provides Cashless Claim Facilities
If a policyholder gets admitted to a network hospital and stays for more than 24 hours, the policyholder can apply for a cashless claim (terms and conditions apply). The TPA collects relevant documents from the hospital and reimburses all expenses covered by the health insurance policy.
2. Assistance with Hospitalisation
TPAs provide health cards that allow patients’ family members to avail of medical facilities from the insurer’s hospital network. They could also provide consultation and emergency and back-end services making it easy for policyholders to get hospitalised.
3. Reduces Claim Processing Time
The involvement of TPA in the insurance sector has improved the quality of insurance services. They can take a lot of work off insurance companies, reducing the processing time for claims and payments.
4. Improves Standardisation
As TPAs serve the needs of a large number of hospitals and insurance agencies, they have standardised processes that are helpful for customers.
Apart from being extremely helpful to the policyholders, TPAs play other helpful roles as discussed in the following section.
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What is the Role of TPA in Health Insurance?
TPAs play a vital role in processing medical insurance claims:
1. Issues Health Cards
A TPA issues health cards to policyholders that hold details such as the policy number and the name of the TPA, which is required to process the claims. You can easily produce your health card at the time of admittance and you can easily get your claims approved.
2. Helps with Hassle-Free Claim Settlements
An essential role of a TPA is to coordinate between the insurer and hospital for the claim settlement process. They check all the bills and documents submitted by the claimant and cross-check all details before approving a settlement.
3. 24/7 Toll-Free Helpline Facilities
Many TPAs provide 24/7 assistance to all policyholders. Claimants can easily get helpful answers during emergencies.
4. Treatment at Network Hospitals
TPAs build a strong network of hospitals, which is essential for cashless treatments. The policyholder can go for treatments in any of these network hospitals and the TPA will take care of the payments on behalf of the policyholder.
5. Keeps Accurate Records of Claims
TPAs also help keep an accurate record of claims and other data related to the claims in a year. This helps the insurance company keep track of all the settlements.
There are many TPAs that act as an intermediary between the insurer and policyholders. Check out this 20 TPA list for your reference.:
20 Best TPAs in Health Insurance
Here’s a comprehensive TPA list sourced from IRDA’s official website. Please note that the below table is for reference purposes only.
| TPA | Regis.No | Registration Validity | Name & Address and Contact Details |
| United Health Care Parekh Insurance TPA Private Limited | 002 | 20/03/2023 | Shiva Belavadi, Chief Administrative Officer, 3B/1 Gundecha Onclave, Kherani Road,Saki Naka, Andheri (East),Mumbai – 400 072 Toll Free No.: 1800 209 8884 Email: [email protected] Website: www.uhcpindia.com |
| Medi Assist Insurance TPA Private Limited | 003 | 20/03/2023 | Mr. Ganesh K Chief Administrative Officer Tower D, 4th Floor, IBC Knowledge Park, 4/1,Bannerghatta Road, Bangalore, 560029 Toll free number for senior citizens: 1800 419 9493 Toll Free No.: 1800 425 9449 Email: [email protected] Website: www.mediassist.in |
| MD India Health Insurance TPA Private Limited | 005 | 20/03/2023 | Mr. Suresh V. Karandikar Chief Executive Officer S.No. 46/1 E-space A-2 Building,3rd Floor, Pune-Nagar Road,Vadgaonsheri, Pune – 411 014. For senior citizens: 020-25300126 Toll Free No.: 1800 233 1166 Fax: 1860 233 4449 Email: [email protected] Website: www.mdindiaonline.com |
| Paramount Health Services & Insurance TPA Private Limited | 006 | 20/03/2023 | 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: [email protected] Website: www.paramounttpa.com |
| Heritage Health Insurance TPA Private Limited | 008 | 20/03/2023 | Mr. Manas Chakraborty, Chief Administrative Officer NICCO HOUSE, 5th Floor, 2, Hare Street,Kolkata-700001 Toll Free No.: 1800 345 3477 Email: [email protected] Website: www.heritagehealthtpa.com |
| Family Health Plan Insurance TPA Limited | 013 | 20/03/2023 | 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: [email protected] Website: www.fhpl.net |
| Raksha Health Insurance TPA Private Limited | 015 | 31/03/2023 | Mr. Pawan Kumar Bhalla Chief Executive Officer C/o Escorts Corporate Centre 15/5, Mathura Road, Faridabad,Haryana – 121 003 Toll Free No.: 1800 180 1444, 1800 220 456, 1800 425 8910 Email: [email protected] Website: www.rakshatpa.com |
| Vidal Health Insurance TPA Private Limited | 016 | 15/05/2023 | 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: [email protected] Website: www.vidalhealthtpa.com |
| East West Assist Insurance TPA Private Limited | 018 | 15/05/2023 | Dr. Atul Arora Chief Executive Officer 38, Golf Links, New Delhi – 110003 Ph. No.: 011-47222666 FAX: 011-47222640 Email: [email protected] Website: www.eastwestassist.com |
| Medsave Health Insurance TPA Limited | 019 | 14/05/2023 | Mr. S. AravamuthanChief Administrative OfficerF-701A, Lado Sarai, Mehrauli, New Delhi – 110030 Senior Citizen Helpline No.: 9319810070 Toll Free No.: 1800 111 142 Email: [email protected] Website: www.medsave.in |
| Genins India Insurance TPA Limited | 020 | 10/06/2023 | Mr. Subhash Chander Khanna, Chief Administrative Officer D-34, Ground Floor, Sector-2Noida – 201301 (U.P.) Toll Free No.: 1800 345 3323 Ph. No.: 0120-4144100 Fax:0120-4144170-71 Email: [email protected] Website: www.geninsindia.com |
| Health India Insurance TPA Services Private Limited | 022 | 17/11/2023 | 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-40008 Senior Citizen Toll Free No.: 1800 2269 70 Toll Free No.: 1800 2201 02 Ph. No.: 022-40881000 Email: [email protected] Website: www.healthindiatpa.com |
| Good Health Insurance TPA Limited | 023 | 26/01/2024 | 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: [email protected] Website: www.ghpltpa.com |
| Vipul Medcorp Insurance TPA Private Limited | 024 | 28/02/2025 | 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: [email protected] Website: www.vipulmedcorp.com |
| Park Mediclaim Insurance TPA Private Limited | 025 | 27/09/2022 | 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: [email protected] Website: www.parkmediclaim.co.in |
| Safeway Insurance TPA Private Limited | 026 | 19/07/2023 | 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: [email protected] Website: www.safewaytpa.in |
| Anmol Medicare Insurance TPA Limited | 027 | 26/10/2023 | 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: [email protected] Website: www.anmolmedicare.in |
| Rothshield Insurance TPA Limited | 030 | 15/07/2022 | 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: [email protected] Website: www.rothshield.co.in |
| Ericson Insurance TPA Private Limited | 035 | 18/12/2024 | Dr. Krishna P. Jaiswal, MD11-C, Corporate Park,ST Road, Chembur,Mumbai – 400 071 (Maharashtra) Senior Citizen Helpline No.: 022-25280208 Toll Free No.: 1800 22 2034Ph. No.: 022-25280280 Email: [email protected] Website: www.ericsontpa.com |
| Health Insurance TPA of India Limited | 036 | 05/06/2023 | 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: [email protected] Website: www.hitpa.co.in |
How to Cancel TPA?
If you are not satisfied with the services of your current TPA, you may choose to cancel the TPA. To do so, follow these steps:
- Call or email your insurer.
- Share your Unique ID (UID) and policy details.
- Explain the reasons for requesting TPA cancellation.
- After the insurer’s approval, choose another available TPA from the list.
Need for Third Party Administrators
According to industry experts, TPA can present the following changes:
- Improved efficiency/quality (delivery of services)
- Enhanced standardisation (procedures and due diligence)
- Increase your understanding of healthcare services
- Implement new management system
- Increased availability of health insurance
- Reduce expenses/costs
- Create protocols to streamline investigations and eliminate unnecessary delays
- Reduce insurance premiums by paving the way
Revenue Model of Third Party Administrators
TPAs’ organisational structure and revenue generation model can determine their level of success. The main source of revenue for TPAs is fees or commissions on premiums, which are set by the IRDA. TPAs’ other revenue sources include the following:
- Deliver Network Management
- Data administration
- Medical supervision
- Administration of claims
Final Word
TPA health insurance handles all the essential management functions. From record-keeping, processing claims and settlements to providing value-added services. TPA insurance ensure better and high-quality healthcare by allowing policyholders easy and hassle-free access to funds for treatments.
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FAQs
TPAs issue identity cards to insurers for cashless claims. When patients need treatment, they have to inform the TPA on a 24×7 toll-free number and visit a network hospital for cashless treatments. For non-cashless claims, you can claim the compensation later and get reimbursed subject to terms and conditions.
To get the services of a TPA, you will need to carry the following documents:
-Hospitalisation form
-Original prescription by the doctor
-Policy documents
Yes. Insurance companies typically have a list of Third Party Administrators. If you need to change or cancel a TPA, you can follow the given steps:
1. Contact your insurer
2. Share UID (Unique Identification Details) and policy details
3. Provide a reasonable explanation for the change/cancellation
4. Select another TPA from the given list
The following are some of the reasons why Third Party Administrators are required:
-To improve standardisation for due diligence and proceedings
-Increasing knowledge base for healthcare services
-Greater penetration of health insurance
-To minimise expenditure and costs
-For developing protocols for streamlining investigations to avoid delays
-Making premise for lower insurance premium
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Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.
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