THIRD PARTY

ADMINISTRATOR
SUBMITTED BY :
TIYASA MUKHERJEE
PALLABI PALIT
SHRAMANA GHOSH
DEBAPRIYA MUKHERJEE
INTRODUCTION

 THIRD PARTY ADMINISTRATOR is an organisation that processes

insurance claim on behalf of an insurance company.
 TPA plays an important role in health insurance sector by assuring
better services to policy holders
 TPA’s normally have a contract with the insurance company in this
regard.
OVERVIEW OF TPA
TPA’S IN INDIA

 In India TPA’s are regulated by insurance regulatory and development

authority (IRDA)
 TPA should be licensed by IRDA
 TPA was introduced by IRDA in 2001 through notification on TPA health
service regulation
BENEFITS OF TPA

 Introduction of TPA benefits the both the insured and the insurer in the
health care industry
 While the insured benefits from the 24×7 service, the insurer is
benefited by reduction in administration cost
 TPA health insurer in analysing the data
CONDITIONS FOR LICENSE

 TPA should be a Company as defined in the Companies Act

 The primary objective shall be to carry on the business of TPA in health
services
 One crore is the minimum paid-up capital
 At least one of the doctors shall be a qualified medical doctor
 It shall not be engaged in any other business
CODE OF CONDUCT

 Disclose its identity and license details to the policy holders

 Obtain all the request documents pertaining to the examination of the
insurance claim
 Not to trade information records of its businesses
 Required to maintain confidentiality of the health information obtain
TYPES OF SETTLEMENT

1. Cash less claim

2. Comprehensive claim
TYPES OF SETTLEMENT
 CASH LESS CLAIM

 This can be available only in networked hospitals .

 Policy holders are normally required to inform TPA in advance
 Required to produce the id card issued to policy holders
 Settlement is made by TPA directly to the hospital
Comprehensive claim
COMPREHENSIVE CLAIM

 Same as other insurance claim policy holders is required to first pay the
treatment amount
 Send the report and other document to TPA
 Get the claim amount later
 It takes about 7-15 days for settlement
MAJOR TPA IN INDIA

 Medi Assist India TPA PVT LTD

 United health care parekh TPA pvt ltd
 E medi tech TPA services ltd
 Md India Health Care TPA pvt ltd
 Family Health Plan TPA ltd
 Focus Health services TPA pvt ltd
 Pramount health services and insurance TPA pvt ltd
 Vidal health insurance TPA pvt ltd