• Third Party Administrators for Health Insurance

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    Cashless Treatment

    Customer Service

    Medical Coverage

    Claim Experience

    Responsiveness

    What are TPAs or Third Party Administrators?

    TPA or Third Party Administrator (TPA) is a company/agency/organisation holding license from Insurance Regulatory Development Authority (IRDA) to process claims - corporate and retail policies in addition to providing cashless facilities as an outsourcing entity of an insurance company.

    TPAs function as an intermediary between the insurance provider and the insured. The stakeholders involved are as follows:

    • Insurance companies
    • Healthcare providers
    • Policyholders

    Introduced by the IRDA in 2001, TPAs handle various pertinent aspects of insurance as listed below:

    • Processing of claims and settlement includes the following:
      • Accepting intimations
      • Approving cashless claims
      • Disbursing the claims
    • Utilization review
    • Provider network
    • Enrolment
    • Premium collection
    • Cashless processing (if and when a policyholder is admitted to a listed hospital of an insurance provider, the latter pays the bill)
    • Value added services such as the following:
      Third-Party-Administrator
      • Ambulance services
      • Specialised consultation
      • Availability of beds
      • 24-hour toll-free helplines
      • Lifestyle management
      • Wellbeing programmes
      • Medicine supplies
      • Health facilities
    • Database maintenance

    According to experts, providing cashless hospitalization of the insured should be the primary service offered by TPAs. It is important to note that some insurance companies have a separate department which performs the functions of TPA instead of outsourcing it to another entity.

    Need for Third Party Administrators:

    According to industry observers, TPAs can bring in the following changes:

    • Greater efficiency/quality (delivery of services)
    • Improved standardisation (procedures and due diligence)
    • Increase knowledge base of healthcare services
    • New management system
    • Greater penetration of health insurance
    • Minimize costs/expenditure
    • Develop protocols to streamline investigation and avoid unnecessary delays
    • Pave way for lower insurance premiums

    All the same, there is much discrepancy between the aims and the ground realities of functioning of TPAs. As a result, the jury is still out on the efficacy of TPAs in the growing and complex health insurance sector in the country. The institutionalisation of TPAs, therefore, leaves a lot to be desired.

    Revenue model of Third Party Administrators:

    There is a view that the organisation and revenue generation model of TPAs will determine the extent of their success. TPA’s major revenue comes in the form of fees or commission on premium, which is standardised by the IRDA. The other sources of revenue of TPAs include the following:

    • Benefit management
    • Provider network management
    • Data management
    • Medical management
    • Claim administration

    Challenges galore:

    According to experts, there are several impediments to the effective functioning of TPAs. Some of the problem areas in the health insurance sector in the country adversely affecting TPA-related services are listed below:

    • Information asymmetry
    • Weak networking
    • Inordinate delay in the issuance of identity cards to the insured
    • Lack of strong standardisation procedures in terms of billing
    • Under-reporting across hospitals
    • Nexus between corporate hospitals and insurance companies (i.e., low claim ratio for individual insurance and high claim ratio for corporate insurance)
    • IRDA has not put any strict regulations or mechanisms in place to effectively appraise the performance of TPAs. IRDA, therefore, assesses TPAs based on the latter’s financial performance in terms of policy premium rather than customer satisfaction. There is, therefore, a view that TPAs should be evaluated/accredited on the basis of quality of services provided
    • Low awareness about TPAs amongst general public/policyholders. According to reports, many policyholders are unaware of the extra premium charged by insurance companies for TPA services. Likewise, pertinent information related to cashless hospitalization and exclusions listed in insurance policies is not examined by many policyholders.
    • Policyholders’ dependence on insurance agents rather than TPAs. In many cases, policyholders do not see TPAs as distinct entities vis-a-vis their insurance agents and intriguingly place more faith in the latter.
    • Most hospitals have no substantial evidence to prove that TPAs increased their patient turnover
    • Experts point out that TPAs need to invest in developing human capital to improve their delivery of services and rein in costs.
    • Inadequate knowledge about the provisions and benefits of TPAs amongst policyholders
    • Healthcare providers look for well-trained TPAs to effectively deal with the operational inadequacies in the system. Poorly developed and half-baked protocols and systems instil little confidence amongst stakeholders. TPAs should have several in-house experts such as legal experts, IT professionals, doctors, management consultants and hospital managers among others given that claims management and settlement requires bargaining power and negotiation skills, i.e., combination of technical and management skills
    • Hospitals which already have robust delivery mechanisms in place are more likely to pave way for hassle-free claims settlement and other related services offered by TPAs.
    • While the primary purpose of outsourcing claims settlement is to minimise the claim period, claims processing, in several cases, is riddled with delays.
    • The insured do not have adequate knowledge about empanelled hospitals for cashless services
    • Many hospitals also report additional expenditure incurred by them in terms of smooth coordination with TPAs for efficient delivery of services to the policyholders

    Some of the Third Party Administrators in India:

    • Medi Assist India TPA Pvt. Ltd
    • United Healthcare Parekh TPA Pvt. Ltd
    • E Meditek (TPA) Services Ltd
    • MD India Healthcare (TPA) Services (Pvt.) Ltd
    • Family Health Plan (TPA) Ltd
    • Focus Healthservices TPA Pvt. Ltd
    • Vidal Health TPA Private Limited
    • Heritage Health TPA Pvt. Ltd.
    • Vipul Med Corp TPA. Pvt. Ltd
    • Raksha TPA Pvt. Ltd
    • Rothshield Healthcare (TPA) Services Limited
    • Dedicated Healthcare Services TPA (India) Private Limited
    • Spurthi Meditech TPA Solutions Pvt. Ltd. No.
    • Ericson TPA Healthcare Pvt. Ltd
    • Sri Gokulam Health Services TPA (P) Ltd
    • Safeway TPA Services Pvt. Ltd

    GST rate of 18% applicable for all financial services effective July 1, 2017.

    Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.

    Third Party Administrators for Health Insurance Reviews

  • Page 1 of 50 1 2 3 4 5
    • Star Health Health Insurance
      "Good Service"
      0.5 4.0/5 "Great!"
      I've a health insurance policy with the Star Health. I have claimed this policy for 2 lacs. The whole claim process was easy, after discharge. The service was very good. I am really happy about the service of Star Health and it is a recommendable health insurance policy to have.
      Was this review helpful? 0
      , chennai
      Reviewed on Jun 20, 2018
    • ICICI Lombard Health Insurance
      "Good Service"
      0.5 5.0/5 "Blown Away!"
      I've a health insurance policy with the ICICI Lombard . I pay a premium of 5500 per year for this policy. I do not have any claim experience with the policy. They offers 5 lacs coverage for the entire family and the network list of hospitals are also pretty solid with their services.
      Was this review helpful? 0
      , new delhi
      Reviewed on Jun 20, 2018
    • Cigna TTK Health Insurance
      "Good Service"
      0.5 3.0/5 "Satisfactory"
      I've a health insurance provided by the Employer from the Cigna TTK . I do not have any claim experience , Company is paying the premium. It offers an annually coverage of 2 lacs for me and 1 lac for my wife and 50000 for my children. So far it has been a smooth experience and I'll have to wait and see how they respond to my claim in future.
      Was this review helpful? 0
      , chennai
      Reviewed on Jun 20, 2018
    • HDFC Ergo Health Insurance
      "Good policy to use"
      0.5 5.0/5 "Blown Away!"
      Got the health insurance policy from the HDFC ERGO around a year ago. The customer support service and the response is good with the HDFC ergo . This policy covers only one member in my family. I have the medical coverage up to Rs,3,00,000 and I am satisfied having the health insurance policy.
      Was this review helpful? 0
      , mumbai
      Reviewed on Jun 20, 2018
    • Star Health Health Insurance
      "Excellent"
      0.5 4.0/5 "Great!"
      I am having the health insurance policy with the Star health insurance company. Customer service is good one and their response too. Coverage value is fine one too with the Star health insurance company. I have not faced any such claims with them till now.
      Was this review helpful? 0
      , bangalore
      Reviewed on Jun 20, 2018
    • Max Bupa Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have my health insured with MAX BUPA from last 3 years and it is one of the good policy. It is a family coverage where spouse and children are covered. I pay a premium of Rs 18000 for this health insurance. My claim experience was good and they covered 70% of the billed amount.
      Was this review helpful? 0
      , bangalore
      Reviewed on Jun 19, 2018
    • Religare Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I was using health insurance policy with Religare from last 2 years, i am happy with the coverage value of this insurance policy. I am satisfied with the claim experience and it was a cashless treatment. I have a coverage value of Rs 3 lakhs for this insurance policy.
      Was this review helpful? 0
      , navi mumbai
      Reviewed on Jun 19, 2018
    • ICICI Lombard Health Insurance
      "Good Policy"
      0.5 5.0/5 "Blown Away!"
      I took health insurance from Icici health insurance . I have choose this insurance mainly because of convincing premium with too many benefits . This policy covers Cashless hospitalization. Pre diseases coverage . Overall am satisfied with customer care and service. Am getting income tax benefits
      Was this review helpful? 0
      , new delhi
      Reviewed on Jun 19, 2018
    • New India Health Insurance
      "Very good service"
      0.5 5.0/5 "Blown Away!"
      New India Assurance was the first health insurance provider with the Employer provided health insurance, They've partnered with the many hospitals in Pan India and also offered protection for the entire family. They were also offering cashless treatment facilities. Overall it has been a smooth experience.
      Was this review helpful? 0
      , chennai
      Reviewed on Jun 18, 2018
    • SBI General Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance with SBI general insurance from last 2 years, i am happy with the coverage value of this insurance policy. I have not claimed anything so far from this insurance company. I pay a premium of Rs 50 per month for this insurance policy.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Jun 18, 2018
    • Star Health Health Insurance
      "Good to have insurance policy"
      0.5 3.0/5 "Satisfactory"
      Idon't have any experience of claim hence i never get a chance to call their customer care. They used to call me for renewing the policy. I can claim about 3.5 lakhs per annum. If i use 10% or not claim the policy, they wont give additional benefits for the next year. Their is a insured amount by 10%. My premium amount will be same but the claim amount they will increase by 10% next year. Cashless treatment is available in this policy
      Was this review helpful? 0
      , noida
      Reviewed on Jun 18, 2018
    • National Insurance Health Insurance
      "Very late back policy"
      0.5 3.0/5 "Satisfactory"
      My company people have taken health insurance policy to the employees. Once i have claimed the policy for my mother. The service is not good as per experience. They have a separate hospital list, in that they have mentioned cashless facility is available but when i went for those hospital, they said their is no cashless facility for this insurance. They will not response from the National Health insurance. The number will keep on ringing. After that my company asked me to send the bill. But i never done to this company. The claim is very low which is less than 20000.
      Was this review helpful? 0
      , bangalore
      Reviewed on Jun 18, 2018
    • Religare Health Insurance
      "BEST"
      0.5 4.0/5 "Great!"
      From past 7months i am using this health insurance. Documents i have done through the on line. The coverage is for 10k. Per annual i pay of rupees 7-8k. Disease coverage is there. Free medical checkup once in a year is also available in my insurance.
      Was this review helpful? 0
      , new delhi
      Reviewed on Jun 17, 2018
    • New India Health Insurance
      "Chatting with customer at clamp time"
      0.5 0.5/5 "Unacceptable"
      This is a type of fraud company.This does not pass the claim.When they go to the customer to make a claim, it only rotates it, this time of direction can be more than 8 months.thay do not have any response anymore, only you have to call them these times and you have to consider the information.Out of which it does not raise your phone more than half the time. Each time they constantly ask for something new, they never tell you once and after 8 or 9 months of the final, you cancel your claim according to the new rule.They do not deliberately describe the whole processor, either by either losing the customer tired or in the last. I will request all individual personal and special corporate offices to never do any bonding with this type of company.Because the new rules which it says in 8 or 9 months, how will the customer know at first sight, they deliberately conceal the rules so that the customer does not get disturbed and do not claim.
      Was this review helpful? 0
      , neemuch
      Reviewed on Jun 16, 2018
    • National Insurance Health Insurance
      "Good Service"
      0.5 4.0/5 "Great!"
      I've a health insurance policy from the National Insurance. I am paying the premium of 1400 per year. You can claim this policy at any network hospitals in the country. The need to nofity the customers about the partnered hospitals. If they have tie up with the a new hospital they need to send updates to the customers or publish it on their website.
      Was this review helpful? 0
      , chennai
      Reviewed on Jun 16, 2018
    • Star Health Health Insurance
      "Average Service"
      0.5 2.0/5 "Expected more"
      I'm using the Star Health insurance policy. I do not have any claim experience yet. I pay a premium of 8000 Per year. They don't send any renewal notifications. Their Service is good. The coverage is 1 lac for whole family per year. They need to improve their notifications and keep the customer posted about important dates.
      Was this review helpful? 0
      , chennai
      Reviewed on Jun 16, 2018
    • Royal Sundaram Health Insurance
      "Good Service"
      0.5 3.5/5 "Pretty good"
      I've been using the health insurance policy from Royal Sundaram for a while. I am paying the premium of 8000, many of my friends recommended Royal Sundaram. I never had any claim experience with the policy. Overall it has been a smooth experience. I'll have to wait and see how they respond to my requirement in future.
      Was this review helpful? 0
      , chennai
      Reviewed on Jun 16, 2018
    • Apollo Munich Health Insurance
      "The Best"
      0.5 5.0/5 "Blown Away!"
      Since I'm working with health insurance. It is easy to claim in Apollo Munich. The best hospital list covered in this policy. The best health insurance company in PAN India. In my company, they are paying the insurance premium for me and my family.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Jun 14, 2018
    • HDFC Ergo Health Insurance
      "Good Service"
      0.5 3.5/5 "Pretty good"
      I've a health insurance policy with the HDFC Ergo. I pay a premium of 6100 Per year, I do not have any claim experience with the policy and it offers full coverage for my entire family. They offer a coverage 2 lacs annually which is pretty good for me. Overall it has been a good experience with the features of the policy. .
      Was this review helpful? 0
      , ghaziabad
      Reviewed on Jun 14, 2018
    • Bajaj Allianz Health Insurance
      "Good Health Insurance policy"
      0.5 5.0/5 "Blown Away!"
      So far i have never claim the health insurance. I can claim upto 7 lakhs. I have taken this insurance policy for me and dependent. The employer take care of the premium amount. I have never contact the customer care. Almost most of the hospital has been covered in this health insurance
      Was this review helpful? 0
      , coimbatore
      Reviewed on Jun 14, 2018
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