Third Party Administrators - Policy Holder


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. A TPA may render the following services to an insurer under an agreement in connection with health insurance business:

a servicing of claims under health insurance policies by way of pre authorization of cashless treatment or settlement of claims other than cashless claims or both, as per the underlying terms and conditions of the respective policy and within the framework of the guidelines issued by the insurers for settlement of claims.

b servicing of claims for Hospitalization cover, if any, under Personal Accident Policy and domestic travel policy.

c facilitating carrying out of pre-insurance medical examinations in connection with underwriting of the health insurance policies.

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