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All you need to know about Third Party Administrator
What is a Third Party Administrator (TPA)?
What is a TPA in Health Insurance?
A third-party administrator is a licensed outsourcing entity selected by a medical insurance company and regulated by the Insurance Regulatory and Development Authority of India (IRDAI). TPA works with the employer and the insurer to establish clear communication between the two, process claims, enrolment and many other two-days activities.
Role of TPA in Health Insurance
TPA plays a crucial role in the total processing of medical insurance claims. The role of TPA begins immediately after the insurer issues the best health insurance policy. Some of the essential functions that TPA in insurance include:
The role of TPA in health plan can be understood with the points below:
- Connecting Link: In most hospitalisation claims, the policyholder directly or indirectly meets the TPA. The TPA provides the policyholder with a Unique Identification Number and ID card, which aids in claim settlement.
- Record Maintenance: TPA helps maintain vital records related to policyholders when admitted as patients.
- Claim Settlement: TPA ensures smooth coordination between the hospital and insurance company during cashless claim settlement. TPA offers back-end support in such cases.
- Full-time Support: Most TPAs have a 24/7 customer support system where the policyholders can raise their queries and get feedback.
- Additional Services: Most TPAs can also provide other services like extra beds, ambulances, medical supplies, etc., to policyholders.
Benefits of Third Party Administrator in Health Insurance for Policyholders
While the more prominent insurance companies have their in-house claims department, they also engage with TPAs to share the workload. Therefore, when choosing a medical insurance plans, you may also have to look at the TPA facility to understand the process better. The parameters below can help you choose a TPA for processing claims:
- Hand-holding during hospitalisation.
- Providing ID cards to policyholders/patients.
- Assistance regarding the right kind of documentation.
- Efficient Cashless Claims settlement process.
- 24×7 customer support.
- Simplification of the entire claim settlement process.
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List of TPAs in India for Medical Insurance
Here's a thorough list of TPAs for health plan that has been sourced from the Insurance Regulatory and Development Authority of India's (IRDAI) official website:
| S. No. | TPA | Registration No. | Validity Upto |
1 |
Medvantage Insurance TPA Private Limited (formerly known as United Health Care Parekh Insurance TPA Private Limited) |
No. 002 |
20.03.2023 |
2 |
Medi Assist Insurance TPA Private Limited |
No. 003 |
20.03.2023 |
3 |
MDIndia Health Insurance TPA Private Limited |
No. 005 |
20.03.2023 |
4 |
Paramount Health Services & Insurance TPA Private Limited |
No. 006 |
20.03.2023 |
5 |
Heritage Health Insurance TPA Private Limited |
No. 008 |
20.03.2023 |
6 |
Family Health Plan Insurance TPA Limited |
No. 013 |
20.03.2023 |
7 |
Raksha Health Insurance TPA Private Limited |
No. 015 |
31.03.2023 |
8 |
Vidal Health Insurance TPA Private Limited |
No. 016 |
15.05.2023 |
9 |
East West Assist Insurance TPA Private Limited |
No. 018 |
15.05.2023 |
10 |
Medsave Health Insurance TPA Limited |
No. 019 |
14.05.2023 |
11 |
Genins India Insurance TPA Limited |
No. 020 |
10.06.2023 |
12 |
Health India Insurance TPA Services Private Limited |
No. 022 |
17.11.2023 |
13 |
Good Health Insurance TPA Limited |
No. 023 |
26.01.2024 |
14 |
Park Mediclaim Insurance TPA Private Limited |
No. 025 |
27.09.2025 |
15 |
Safeway Insurance TPA Private Limited |
No. 026 |
19.07.2023 |
16 |
Anmol Medicare Insurance TPA Limited |
No. 027 |
26.10.2023 |
17 |
Ericson Insurance TPA Private Limited |
No. 035 |
18.12.2024 |
18 |
Health Insurance TPA of India Limited |
No. 036 |
05.06.2023 |
19 |
Vision Digital Insurance TPA Private Limited |
No. 037 |
24.06.2021 |
How TPA Works in India?
A TPA acts as an intermediary between the policyholder and the insurance company. Their work is to simplify the claim settlement procedure under health insurance policies. As we know, there can be two processes of claim settlement:
- Cashless Settlement
- Reimbursement Settlement
How to Cancel TPAs in Medical Insurance?
TPAs act as facilitators. And if there is any delay between the services being provided, you can contact the insurer, and they shall coordinate with the TPA and let you know about the progress. In addition, if you feel you want to cancel a TPA or switch to another TPA, you can discuss a change in service with the insurance company. Here are the steps to cancel a TPA in health plan:
- Step 1: Reach out to your insurer via email or call.
- Step 2: Communicate policy details and unique ID (UID), if any.
- Step 3: Explain your reason for TPA cancellation.
- Step 4: Select another TPA from the list if the insurer approves the change.
Frequently Asked Questions
Does the policyholder need to pay TPA for their services?
TPA's team consists of which members?
Do all medical insurance companies have TPA?
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