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Health Insurance 4806 views December 20, 2019
Third-Party Administrator or TPAs are licensed entities to help policyholder process health insurance claims and avail cashless facilities provided by the insurer. They can be a company, an agency or even an organization as approved by the Insurance Regulatory and Development Authority of India (IRDAI) to aid the claim process, etc. TPAs work as an intermediary between the policyholder and the insurance provider and coordinate with the policyholders, the insurance company and the healthcare provider.
Third-Party Administrators (TPAs) are beneficial not just because they smoothen the claim procedural for the policyholder but also because they help an individual pick the health policy in the first place. Therefore, a person looking to buy health insurance can approach TPAs to get assistance on buying, claiming and renewing a health insurance policy.
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To know more about Third Party Administrators, here are some of the commonly asked questions:
Simply put, TPAs are middlemen appointed by insurance companies selling health insurances. They help facilitate medical bill settlements under a policy claim and even complete the entire procedural like filling the form, submitting relevant documents etc. TPAs make the process hassle-free for the insured by handling it. However, it is important to know that they bare no responsibility if any claim gets rejected.
These Third Party Administrators, as mentioned, process insurance claims and also helps with filing a claim request etc. Furthermore, they also process specific factors of employee benefit plans acquired for separate entities, services like underwriting, additional insurance-oriented customer services, etc.
Firstly, the IRDAI stands for Insurance Regulatory and Development Authority of India. Secondly, it acts as a governing body and regulates the insurance market. The IRDAI circular with respect to Third Party Administrators mentions that an insured has the liberty to pick a TPA as listed by the insurer and is regulated by this governing body.
Choosing a TPA is as important as picking the right health insurance plan. The proposer should also look into the TPA’s abilities and result metrics. Compare and contrast the available candidates on the list on the basis of such criteria before opting for one.
In accordance with the circular by the Insurance Regulatory and Development Authority of India:
The concept of TPAs not just benefits for the insurer, for example—a reduction in the false claim ratio and administration charges, standardized treatment cost etc. but also the policyholder in the health-care market. Here are some of the common benefits of having a TPA;
Conclusion
In summary, Third Party Administrators are of many advantages as they guide the policyholder through the process of purchasing a health policy, filling claims and even at the time of renewal. They can be an agency, a company, or an organisation licensed by the Insurance Regulatory and Development Authority of India. These approved entities work as intermediaries between the insuring company and the policyholders. Most insurance companies mention explicitly all the TPAs in a list for the policyholder to pick from or to make the choice themselves if required. Similar to picking a health insurance policy, a Third Party Administrator must be carefully chosen.