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Third Party Administrator Health Insurance Research Team | Posted On Monday, December 31,2018, 06:36 PM

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Third Party Administrator Health Insurance



Third Party Administrator Health Insurance

What Is Health Insurance?

Health Insurance is an insurance policy, in which the insurer pays the hospitalization expenses of the policy holder, if he falls ill within the term of the plan. Insurer also reimburses the medical bills paid by the insured, in case of reimbursement plan. To keep the policy active, the insured must pay the premiums periodically.

SEE ALSO: How to Buy health insurance policy?

Benefits Of Health Insurance Policy

  • Cashless Hospitalization: If you have a cashless plan and get treated at a network hospital, then you don’t have to pay for anything that is covered under the policy. Insurer settles medical bills directly with the hospital.
  • Reimbursement of your medical expenses: If you choose to get hospitalized at a hospital which is not in your insurer’s circle (part of a network hospital), then you have to first pay your medical bills and the insurer would reimburse the same.
  • Ambulance Charges: Ambulance charges are also covered under Health Insurance Policies.
  • Pre and Post Hospitalization Charges: Most of the Health Insurance Policies cover Pre and Post Hospitalization charges, this includes diagnostic test expenses and scans done before and after hospitalization.
  • No Claim Bonus (NCB): Some policies offer the No Claim Bonus, if there are no claims filed by the insured in a year. This maybe in the form of higher sum assured.
  • Periodic Medical Checkups: Few policies offer medical check-ups spaced out periodically, based on previous NCB.
  •  Ward and ICU Charges: Some policies cover ward and ICU charges, for this, premiums payable would be higher.
  • Tax Exemption: As per Section 80D of Income Tax Act, Health Insurance Policy holders are eligible for tax exemption.

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SEE ALSO: How To Choose Health Insurance Plans For Parents?

Third Party Administrator Health Insurance

Documents Required For Health Insurance Plan

Generally, insurers would ask for a document for Identity Proof, Age Proof and Address Proof along with a latest photograph, to avail a Health Insurance Plan. You might be asked to undergo a few medical tests; this is because the insurers want to make sure your health conditions are good.

Following documents are accepted as Identity Proof and Age Proof:

  • Date of Birth Certificate
  • Class X marks card
  • Valid Passport
  • PAN Card
  • Valid Driving License
  • Voter ID
  • Aadhaar Card

Following documents are accepted as Address Proof:

  • Bank Passbook attested by the branch manager
  • Electricity Bill
  • Gas Connection Bill
  • Telephone Bill
  • Property Tax Assessment
  • Water Supply Bill
  • Ration Card

SEE ALSO: 10 Hidden Benefits In Health Insurance Policies

What is Third Party Administrator?

Third Party Administrators or TPA, are intermediaries between the insured and insurer. These administrators help policy holders settle insurance claims. A Third Party Administrator is a person or organization, that performs administrative services like claim filing, claim processing, adjustments and so on.

Third Party Administrator And Its Role In Health Insurance:

Following are the roles played by the Third Party Administrators in Healthcare Industry:

  • Undisrupted Customer Care Service: Most of the TPAs have 24*7 customer care services to help policy holders with their queries.
  • Immense Knowledge: TPAs are experts in the field of Health Insurance. TPAs would help you get claims settled and make the process smooth for you.
  • Tracking Claim Status: TPAs would track the status of your claim and guide you accordingly.
  • Cashless Hospitalization: TPAs are there to facilitate cashless hospitalization by being an intermediary between your insurer and healthcare provider.
  • Premium Collection: TPAs would remind you on policy premiums, to ensure that premiums are paid on time to avoid penalties.

Need for Third Party Administrators:

  • Efficiency: The efficiency of TPAs is high and ensures that best service is delivered at all times.
  • Standard Procedure: The procedure followed by a TPA is standard, and all the steps to be taken on your behalf would be executed without any mistake.
  • In-depth knowledge of healthcare services: TPAs know the in and out of healthcare services and would guide you in almost every possible way.
  • Greater use of your Health Insurance Policy: TPAs would look to maximize the use of your Health Insurance Policy.
  • Protocols to avoid delays in claims settlement: TPAs would do everything that they can to ensure that your claims are settled by the insurer at the earliest.
  • Cut down on expenditures: TPAs would give you all the information required to ensure you spend the minimum from your pocket. They leave no stone unturned to make sure you get the maximum benefits out of your Health Insurance Policy.

List Of TPAs In India:

Insurance Development Authority of India has authorized the below mentioned Third Party Administrators to function in India:

United Health Care Parekh Insurance TPA Private Limited

Medi Assist Insurance TPA Private Limited

MDIndia Health Insurance TPA Private Limited

Paramount Health Services & Insurance TPA Private Limited

E-Meditek Insurance TPA Limited

Heritage Health Insurance TPA Private Limited

Focus Health Insurance (TPA) Private Limited

Medicare Insurance TPA Services (India) Private Limited

Family Health Plan Insurance TPA Limited

Raksha Health Insurance TPA Private Limited

Vidal Health Insurance TPA Private Limited

Anyuta Insuance TPA In Health Care Private Limited

East West Assist Insurance TPA Private Limited

Medsave Health Insurance TPA Limited

Genins India Insurance TPA Limited

Alankit Insurance TPA Limited

Health India Insurance TPA Services Private Limited

Good Health Insurance TPA Limited

Vipul Medcorp Insurance TPA Private Limited

Park Mediclaim Insurance TPA Private Limited

Safeway Insurance TPA Private Limited

Anmol Medicare Insurance TPA Limited

Dedicated Healthcare Services TPA (India) Private Limited

Grand Insurance TPA Private Limited

Rothshield Insurance TPA Limited

Ericson Insurance TPA Private Limited

Health Insurance TPA of India Limited

Bottom Line:

Availing a Health Insurance Policy is extremely important as health care is becoming expensive each day. Availing a Health Insurance Policy comes in handy in case there is a need for hospitalization. TPAs would make your claims settlement process simple, by taking all the necessary steps on your behalf.  TPAs are open 24*7 to support you and their role is primarily to maximize the use of your Health Insurance Policy.

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