Everything You Need to Know About TPA in Insurance
Health Insurance

Everything You Need to Know About TPA in Insurance

To combat the uncertainties of life, you can rely on various forms of insurance. Insurance policies can be a real boon; from health insurance to help you cover rising medical costs to motor insurance that protects your automobile and associated driver. However, to effectively use your policy, you must familiarise yourself with important insurance–based terms like TPA. This article will help you get a clearer picture of what is TPA in insurance.

What is a third–party administrator?

TPA full form in insurance is Third Party Administrator, and it refers to a body that has the power to process claims that are admissible under insurance policies. Essentially, these administrators are intermediaries who are either independent of or belong to the insurance provider. They are licensed by the body overseeing insurance in India, the Insurance Regulatory and Development Authority of India (IRDAI).

Such TPAs are appointed to reduce the administrative burden placed on insurance providers and to ensure that policyholders receive the quality of service they have signed up for. TPAs are generally responsible for carrying out duties associated with processing large volumes of insurance claims. For the sake of this article, we will take a look at the role of TPAs in the health insurance sector.

What is TPA in health insurance?

TPAs play a crucial role in the health insurance sector and are relied upon to carry out the following jobs:

  • Issuing health cards: The validation procedure conducted after a health insurance policy is issued involves issuing an authorised health card. This card displays the pertinent details like the policy number and which TPA will carry out claims processing. TPAs issue this card that you can show while getting admitted to a hospital and filing a claim.

  • Efficient claim processing and settlement: TPAs are appointed to expedite the process of filing claims. They are tasked with checking details and documents and cross–verifying information. In case of a cashless settlement, the TPA also has to collect documents from the hospital. If it is a reimbursement, then the TPA must ask the policyholder to provide the required documents

  • Arrange value–added services: Apart from the core functions of claims processing, TPAs are also required to arrange for add–on services like arranging for ambulances, well–being initiatives, etc.

  • Helpline: To help policyholders with information and other support, TPAs also oversee a helpline that runs 24x7. This customer service facility can be availed of from anywhere in India, and policyholders can rely on it to check on the status of their claims.

  • Supports the hospital networks: To optimise your health insurance policy, it is crucial to have a TPA. TPAs support building a strong network of hospitals that can be relied upon when you require medical care or treatment. TPAs are responsible for getting the best and most prominent hospitals to get on board so you can make use of swift and cashless medical care.

Now that you know more about TPA meaning and the role of TPA in insurance, you can make sure that your policy allows you to benefit from the advantages provided.

Disclaimer: The above information is indicative in nature. For more details on the risk factor, terms and conditions, please refer to the Sales Brochure and Policy Wordings carefully before concluding a sale.

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