What is TPA in Insurance? Roles & List of Popular TPAs in India

TPA or Third Party Administrator is the bridge between the insurance company and policy holder. TPAs assist in cashless claims and reimbursement. Read the below article to understand what is TPA in Insurance.

What is TPA in Insurance

What is TPA in Insurance: Third Party Administrator (TPA) is an intermediary between policy holders and insurance companies to enable smooth and timely insurance claims. The TPAs essentially operate in Health Insurance and are of valuable support to policy holders in the time of distress or medical urgency. TPA organisations provide services to insurance companies, individual policy holders as well as business organization that provide health insurance to their employees as part of employment benefit.

You would have noticed, that at the time of admission, hospitals ask people whether they have health insurance or not and then ask for TPA as well as the health insurance executive. In every hospital and health organizations, various TPA companies are listed on their panel. Let’s understand the role and responsibility of TPA in Insurance.

TPA: Role and Responsibility

The main role of TPAs is to manage claims process and maintain medical record. They are of much need in cashless treatments and early settlement of insurance in compliance with terms and condition. Issuing smart cards, verification of policy holder, renewing of smart cards, maintaining health record, and addressing queries of policy holders are also a TPA’s responsibility.

TPA: Relationship with Insurance Company

TPAs act as a bridge between health insurance companies and policy holders. The insurance companies hire TPAs to provide assistance to their policy holders regarding insurance claims and queries. The TPAs charge fee for their services from the insurance companies.

TPA: Need and Importance

• Verifies the process of cashless claim once the policy holder processes the claim.
• Evaluates and informs the policy holder if the health condition/treatment is covered in the policy and how much can be claimed.
• Manages hospital network for cashless treatment
• Provides assistance in documentation  and paper work
• Verifies bills and prescriptions to confirm medical insurance claim (both cashless and reimbursement).

Overall, the TPAs perform the following tasks for the policy holder once they are at a hospital for admission:

1. Coordinates with the hospital registered on the panel
2. Verifies and approves cost as per terms and condition of the policy under which the claim is being filed.
3. Pays hospital bills on behalf of the insurer

Also Read: How to become an Insurance Agent?

List of Popular TPAs in India

Here is the list of popular TPAs in India. Most likely one of them would by the TPA of your or your family’s health insurance policy.

1. Medi Assist Insurance TPA Private Limited
2. MDIndia Health Insurance TPA Private Limited
3. Paramount Health Services & Insurance TPA Private Limited
4. Heritage Health Insurance TPA Private Limited
5. Family Health Plan Insurance TPA Limited
6. Raksha Health Insurance TPA Private Limited
7. Vidal Health Insurance TPA Private Limited
8. Volo Health Insurance TPA Pvt. Ltd
9. Medsave Health Insurance TPA Limited
10. Genins India Insurance TPA Limited
11. Health India Insurance TPA Services Private Limited
12. Good Health Insurance TPA Limited
13. Park Mediclaim Insurance TPA Private Limited
14. Safeway Insurance TPA Private Limited
15. Ericson Insurance TPA Private Limited
16. Health Insurance TPA of India Limited
17. Vision Digital Insurance TPA Private Limited 
18. Link-K Insurance TPA Private Limited
19. AKNA Health Insurance TPA Private Limited

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