Best Third-Party Administrator (TPA) In Health Insurance
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We purchase a health insurance policy from the general insurance companies, but then, we also have a TPA i.e. a third-party administrator provided by the insurance company. These TPAs are registered under Insurance Regulatory and Development Authority of India (IRDAI) and they are specialized in settling and processing the health insurance claims of the insured. So, as soon as any individual is admitted to the hospital in case of a health emergency, an intimation of the same is shared with the TPA, who handles everything related to speedy claims.
Here’s a guide for you to have a better understanding of the role of a TPA in health insurance along with the list of best TPAs in India.
Featured Partners
1
Aditya Birla Activ Fit Health Insurance
Sum Insured
INR 2 lakh to INR 2 crore
Network Hospitals
9,000+
Minimum and Maximum age
5 years and no limit
2
Tata AIG Health Insurance
Tax Benefit
Upto INR 75,000
Cashless Hospitals
10,000+
Claim Settlement Ratio
94.21%
3
Acko Health Insurance
Initial waiting period
0 Days
Claim Settlement Ratio
98%
Other Benefits
No room rent limit, 100% Bills covered
What is TPA In Health Insurance and How Does It Work?
A third-party administrator, popularly known as TPA in health insurance, means a middleman or administrator who acts like a third-party between the insurance company and the policyholder. In other words, TPA is a connecting link between the insurer and the insured, which helps to settle the hospitalization claims quickly and seamlessly.
- The policyholder directly or indirectly meets the TPA at the time of making hospitalization claims.
- TPA provides the e- card and a unique identification number to the patient (insured), which helps in claim settlement.
- The health insurance company selects the TPA for a smooth claim settlement process.
- One TPA can have as many insurance partnerships and network hospitals.
- All TPAs are licensed by Insurance Regulatory and Development Authority of India (IRDAI).
What Is The Role Of TPA In Health Insurance?
Issuance of Health Cards To Insured: This is one of the crucial roles of TPA, where they issue health cards which carry an identification number and the policy number. The insured has to show this card to the hospital insurance desk to avail claims against their hospitalization. It is the responsibility of TPA to issue an authorized health card to the insured.
Smooth Claim Settlement Process: It is the responsibility of TPA to speed up the claim process as soon as it gets notified by the insured. Their role is to check all the submitted documents as cross verify the details and expedite the claim process. In the case of cashless, the TPA gathers the documents from the hospital. In other cases, the TPA generally ask for the supporting papers and bills from the policyholder.
Provides Other Value-Added Services: Apart from claim processing, enrollment card issuance, a TPA also arranges for other services such as ambulance, well-being and health related programs, and others.
Tie-up with Hospital Networks: This is a very essential element as TPA further helps in building a strong network of hospitals where the policyholders can take the treatment. The TPA also aims to enlist the top hospitals which can provide cashless facilities at better negotiated rates.
Robust Customer Support: It is very easy to approach the TPA, in the need of hours. All the insured can have a dedicated customer desk and 24xx7 customer service which can be called from anywhere in India. The insured can know the status of their claims by calling them on their toll-free number or via their mobile app.
What Are The Benefits Of TPA For Policyholders?
- Simplify the claim settlement procedure.
- Keeping a track of all documents related to the insurance policy.
- Review the hospitals and do due diligence.
- Offers 24×7 service and support to policyholders.
- Provides other additional services such as ambulance support, supplying medicines, helping with exit paperwork.
- Helps in eliminating fake and fraudulent claims.
Process Of Canceling TPAs In Health Insurance
As an insured you have full flexibility to change your TPAs, if you are dissatisfied with their services. Let’s see the process of canceling the TPA and switching to another one.
- Step 1: Reach out to your insurance company.
- Step 2: Share the policy details and unique ID of your present TPA.
- Step 3: State the valid reason for TPA cancellation with clear explanation.
- Step 4: If the insurer approves, go ahead with selecting another TPA from the available list.
List of Best Third-Party Administrator In Health Insurance
Methodology
Forbes Advisor India analyzed the 25 IRDAI-licensed TPAs and prepared the list of the top TPAs for health insurance policies in India. This selection has been done on the basis of the following parameters:
- Network hospital’s strength.
- Number of insurance partnerships.
- Efficient method to handle claim settlement.
- Digitization and advanced analytical tools.
- Customer support system.
Featured Partners
1
Aditya Birla Activ Fit Health Insurance
Sum Insured
INR 2 lakh to INR 2 crore
Network Hospitals
9,000+
Minimum and Maximum age
5 years and no limit
2
Tata AIG Health Insurance
Tax Benefit
Upto INR 75,000
Cashless Hospitals
10,000+
Claim Settlement Ratio
94.21%
3
Acko Health Insurance
Initial waiting period
0 Days
Claim Settlement Ratio
98%
Other Benefits
No room rent limit, 100% Bills covered
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