This paper was submitted for eINDIA 2011 conference Page 3
insurance and health care markets, insurance intermediaries face immense challenges. IRDA hasdefined the role of TPAs as one of managing claims and reimbursement; their role in controllingcosts of health care and ensuring appropriate quality of care remains less defined. TPAs areexpected to ensure better efficiency, standardization of charges and more penetration of healthinsurance in the country.
Services offered by Third Party Administrators
: TPA provides ID cards to all their policy holders in order to validate theiridentity at the time of admission.
before a surgical procedure to ease claimprocessing
24 hours customer support services
: The TPA provide assistance through their 24hrs call centre that provides information regarding policyholder's data, providernetwork, claim status, benefits available with existing cardholder, etc All these detailsare furnished on request.
: Each policyholder is provided with a list of empanelledhospitals where in he/she can avail cashless hospitalization.
: On behalf of the insurance companies TPA administers andsettles claims for hospitals and policyholders.Policyholders have the privilege of expressing their grievances to the concernedinsurance company or at the consumer's court if they are not satisfied with the servicesof a TPA.
Regulation of Third Party Administrators
IRDA has approved
services of TPA‟s as Insurance intermediaries(2001)
IRDA has drawn up a code of conduct for
the TPA‟s & put stringent conditions for