Requirements for Registering as a TPA

Requirements for registering as a TPA

Who is TPA?

“Third Party Administrator (TPA)” means a company registered with the Authority, and engaged by an insurer, for a fee or by whatever name called and as may be mentioned in the health services agreement, for providing health services as mentioned under the INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY OF INDIA (THIRD PARTY ADMINISTRATORS- HEALTH SERVICES) REGULATIONS, 2016 as amended from time to time.

Health Services provided by a TPA:
  • Servicing of claims under health insurance policies (Cashless/Reimbursement)
  • Servicing of claims for Hospitalization cover, if any, under Personal Accident Policy and domestic travel policy
  • Pre-insurance medical examinations in connection with underwriting of health insurance policies
  • Health services matters of foreign travel policies and health policies issued by Indian insurers covering medical treatment or hospitalization outside India
  • Servicing of health services matters of travel or health or medical insurance policies issued by foreign insurers for policyholders who are travelling to India
How can I as a Company get registered as a TPA?
  • Eligibility Criteria (in brief)
    • Only a company with a share capital and registered under the Companies Act, 2013 (18 of 2013) as amended from time to time, can function as a TPA.
    • The main and sole object of the TPA, on being registered with the Authority, shall be to exclusively carry on business of providing health services. A TPA shall not engage itself in any other business.
    • Every TPA and applicant seeking registration as TPA from the Authority shall have the words ‘Insurance TPA’ in its name to reflect that it is engaged or proposes to engage in the business of TPA for rendering health services.
    • A TPA shall maintain minimum paid up equity share capital of not less than rupees four crores.
    • The net worth of a TPA shall at no time during the period of registration fall below rupees one crore.
    • The foreign investment in the TPA shall comply with the policy and rules framed in this regard by Government of India and any regulations, guidelines or instructions issued by the Authority.
  • Application for License(-)
    • A company desirous of obtaining a certificate of registration as TPA from the Authority needs to first register itself on IRDAI BAP Portal. Please click here to register now.
    • The application for registration shall be submitted online to the Authority, accompanied by a non-refundable processing fee of Rs. 1,00,000/- and other taxes as may be applicable, paid via payment gateway facility provided by portal.
    • The Authority may ask for production of documents, as it may deem fit. It shall be incumbent upon the applicant to furnish the same online within the specified time.
    • The Authority, on examination of the application and details furnished by the applicant and on being satisfied that the applicant fulfils the requirements and conditions, may issue the Certificate of Registration to the applicant.
    • Every applicant approved by the Authority for grant of Certificate of Registration shall further do a Payment of Rs. 2,00,000/- and other taxes as may be applicable, to the Authority as registration fee prior to grant of Certificate of Registration
  • Fee Structure
    Sr.No. Payment Category Amount payable (Rs.)
    1 Processing Fee (non - refundable) Rs 1,00,000/- (Rupees One lakh only)
    2 Registration Fee (3 years) Rs 2,00,000/- (Rupees Two lakh only)
    3 Renewal Fee (Once in 3 years) Rs 1,50,000/- (Rupees One lakh Fifty thousand only)