Everything You Need to Know About TPAs in Health Insurance

Do you have an idea of how many people die due to the dearth of acute health care? Very often we come across cases wherein people lose their loved ones, just because they are unable to arrange funds for their expensive medical treatment. Given the ever rising costs of health care and the plausible benefits offered by the insurance sector, people have now started to invest in health insurance policies.

Read More

Get ₹5 Lac Health Insurance starts @ ₹200/month*
Get ₹5 Lac Health Insurance starts @ ₹200/month*
Tax Benefitup to Rs.75,000
Save up to 12.5%* on 2 Year Payment Plans
7 Lakh+ Happy Customers

*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C Apply
*Tax benefit is subject to changes in tax laws. Standard T&C Apply

Get insured from the comfort of your home No medicals required
I am a

My name is

My number is

By clicking on ‘View Plans’ you, agreed to our Privacy Policy and Terms of use
Close
Back
I am a

My name is

My number is

Select Age

City Living in

    Popular Cities

    Do you have an existing illness or medical history?

    This helps us find plans that cover your condition and avoid claim rejection

    Get updates on WhatsApp

    What is your existing illness?

    Select all that apply

    When did you recover from Covid-19?

    Some plans are available only after a certain time

    These arguments are not on flimsy ground, but are the outcome of a detailed research work done by McKinsey’s Global Insurance Pools (GIP). The organization works on Proprietary Markets’ Database that comprises of about 150,000 data points that are picked from 64 countries across the globe; and it covers around 99 percent of the insurance premiums that exist across the globe.

     

    Sidelining the potential regulatory and macroeconomic threats, McKinsey’s GIP predicts that the insurance sector will experience a whopping growth of 6.3 percent from 2014 to 2020. When compared to the growth of last decade which was reported on 2013, it was estimated that this decade will surpass it by 2.8 percent.

    To provide a seamless treatment procedure to those who are already going through physical as well as mental pain because of an ailment or injury, the insurance providers offer cashless facilities and ease the adverse conditions that people face because of lack of funds. This was the sole motivation running behind the innovation of TPAs in health insurance sector. Moreover, the growth of TPAs in health insurance sector can be judged from the Total sector employment as of April 2016 which was a noteworthy 175,000.

    This makes Third Party Administrators not only a force to reckon with, but also makes it the most convenient tools for insurance that we have so far.

    Now that you are convinced that TPAs have grown conveniently, we will further discuss what they are, how they function, and what are the benefits offered.

    You may also like to Read: Health Insurance - A Necessity, Not an Option

    List of Health Insurance TPAs

    TPA Name

    Name

    Email

    United Healthcare Parekh TPA Pvt. Ltd.

    Shiva Belavadi

    Shiva[dot]belavadi[at]uhcpindia[dot]com

    Medi Assist India TPA Pvt. Ltd.

    Ganesh K

    ganeshk[at]mediassistindia[dot]com

    MD India Healthcare (TPA) Services (Pvt.) Ltd.

    Suresh V. Karandikar

    skarandikar[at]mdindia[dot]com

    Paramount Health Services & Insurance TPA Pvt. Ltd.

    R D Misra

    nayan.shah[at]paramounttpa[dot]com

    E Meditek (TPA) Services Ltd.

    B.S. Kaintura

    bskaintura[at]emeditek[dot]com

    Heritage Health TPA Pvt. Ltd.

    Surendra Kumar Tiwari

    stiwari[at]bajoria[dot]in

    Focus Healthservices TPA Pvt. Ltd.

    Sujit Bhattacharya

    cao[at]focustpa[dot]com

    Medicare TPA Services (I) Pvt. Ltd.

    Dipankar Roy

    medicareho[at]medicaretpa.co.in

    Family Health Plan (TPA) Ltd.

    G. Bharathamma

    bharathig[at]fhpl.net

    Raksha TPA Pvt. Ltd.

    Pawan Bhalla

    pawan[at]rakshatpa.com

    Vidal Health TPA Private Limited

    Sudha Suhas Kulkarni

    sudha[at]vidalhealth.com

    Anyuta TPA in Healthcare Pvt. Ltd.

    Ratna Seetarama

    ravi[at]anyuta.com

    East West Assist TPA Pvt. Ltd.

    Neeraj Batra

    nbatra[at]eastwestassist.com

    Med Save Health Care TPA Ltd.

    Vivek Tiwari

    vt[at]medsave.in

    Genins India Insurance TPA Ltd.

    Subhash Chander Khanna

    sckhanna[at]geninsindia.com

    Alankit Insurance TPA Limited

    Bodh Raj Punj

    alok[at]alankit.com

    Health India TPA Services Private Limited

    Kamaljeet Gupta

    kamaljeetg[at]healthindiatpa.com

    Good Health TPA Services Ltd.

    Saigeea Dikshit,

    saigeeta[at]ghpltpa.com

    Vipul Med Corp TPA. Pvt. Ltd.

    Rajan Subramaniam

    rs[at]vipulmedcorp.com

    Park Mediclaim TPA Private Ltd.

    N.K. Malhotra

    park[at]parkmediclaim.com

    Safeway Insurance TPA Pvt. Ltd

    Mahesh Sharma

    drdivneet[at]safewaymediclaim.com

    Anmol Medicare TPA Ltd.

    P. S. Kshatriya

    prithvi[at]anmolmedicare.com

    Dedicated Healthcare Services TPA (India) Private Limited,

    Anahita Daver,

    anahita[at]dhs-india.com

    Grand Health Care TPA Services Private Limited

    Bibhutosh Chattopadhyay

    adm.grandtpa[at]gmail.com

    Rothshield Healthcare (TPA) Services Limited

    Janki M Bhate

    janki[at]rothshield.co.in

    Ericson Insurance TPA Pvt. Ltd.

    Krishna P. Jaiswal

    krishna[at]ericsontpa.com

    Health Insurance TPA of India Ltd.

    M.N. Sarma,

    sarma.mn[at]healthinsurancetpa.co.in

    TPAs in Health Insurance: At a Glance

    As discussed above, during of any medical emergency, you just need to take care of your ill family member or friend, and the rest shall be taken care of by your TPA. All in all, TPAs look after the payment of your hospital bills and claims made with respect to them in the future. This is the basic function of a TPA; however, read on to know more about TPAs.

    Cancellation of TPAs in Health Insurance

    A TPA does not have a say in being appointed or dismissed as your TPA; it's something that your insurance provider decides. All the insurance takers need to assimilate this information because if in case you encounter any issues regarding the health insurance claim settlement then you need to visit or contact your insurer and not your TPA. However, you need to note that if there is an issue with the process of claim, then the TPA shall look after it.

    Service Related Issues:

    In case of service related issues, you need to contact your insurance provider instead of your TPA. For instance, if the TPA is taking more than two days for processing your claim even after completion of documentation process from your end, then you need to contact your insurer.

    Insurance companies are responsible for communication all the changes, with respect to TPAs, to its customer. And the TPAs must provide a full-fledged customer support and answer the queries of the policy-owners. TPAs must deliver a complete guide to all the insurers individually; that renders all the information about providing complete support and assistance.

    TPAs do not Charge for the Services they Provide.

    In case of Cashless Claim Facility, the hospital coordinates with the TPA in order to seek authorization. To seek a cashless claim, you just need to carry the valid policy proofs along with an identity proof to the hospital. However, you must know that there are few scenarios mentioned below when the hospital does not support cashless treatment:

    • Missing or incomplete details of hospitalization
    • Diseases not covered under the policy

    Thus, this facility saves you from paying your hospitalization bills at the time of discharge and thus, helps you get a hassle-free treatment. Additionally, the TPAs also offer you a referral to ambulance, surgeons and specialists.

    When you buy a health policy, your insurer provides you with a kit containing a Guide Book and a List of Network Hospitals. Moreover, you can also get to know about the TPA’s from their official website.

    The waiting period under any health insurance policy is about 30 days, meaning, any disease happening or being diagnosed in that period shall not covered under the policy. However, any accident that takes place in the initial 30 days of the policy shall be covered.

    Another benefit of having a TPA as the first point of your contact is that it allows you to switch to another hospital during any ongoing treatment, if the need arises. However, this shift shall be scrutinized by the TPA on the basis of the scenario and as per the terms and conditions of the policy.

    In case you fail to provide the complete information in the hospitalization form or you are not sure about the history of the disease, then you would not be able to avail the cashless facility. In such cases the TPA would not be able to help you and you would have to go through the usual claim process eben in a network hospital.

    In order to leverage cashless facility, you need to visit any of the network hospitals that fall under the network group of your insurer. If you wish to be referred to a network hospital, then you must present the following documents to your. On the basis of these documents the TPA can issue him/her preadmission authorization for a cashless facility.

    • An original prescription from the doctor, comprising of a detailed description of the symptoms of the disease, as diagnosed, on the letterhead of an authorized medical practitioner.
    • Hospitalization form in the as mentioned by the insurer.
    • Details of the old policy, if the TPA does not have a copy of it.

    Opting for a cashless facility totally depends on your discretion and is not a compulsory facility. So you can either choose a cashless facility or opt for a reimbursement. However, looking at the advantages offered by cashless claims it is advised to go for it; especially, if your hospital falls under the group of network hospital. Doing so will generate a financial support as you would not need to pay your heavy medical bills and the same funds could then be used to tackle the post-hospitalization expenses.


    *All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C apply.

    Benefits of a Health Card

    One of the most apparent benefits of using a health card is that it allows the insured and his/her family members to avail medical facility from any of the network hospitals, under your TPA, without having to pay your medical bills and later on run around to get your claims settled.

    To sum it up, you must always be prepared in advance so as to tackle with any of the adverse situations that may arise in life; and seeking a TPA’s support is one such step that empowers a policyholder to overcome a haphazard situation.

    You may also like to Read: Tax Benefits on Health Insurance

    Written By: PolicyBazaar - Updated: 29 June 2021
    Search
    Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

    Health insurance articles

    Recent Articles
    Popular Articles
    Most-Important Lessons from the Covid-19 Pandemic

    23 Sep 2021

    Not very long back, the entire world was thrown aback by a...
    Does Health Insurance Cover Preventive Health Check-ups?

    22 Sep 2021

    Every object needs to be checked regularly to identify a...
    Bid Goodbye to Seasonal Diseases during the Pandemic with 7 Basic Practices

    21 Sep 2021

    Adding to the insurmountable loss of life the ongoing COVID-19...
    What is the Survival Period in Health Insurance?

    21 Sep 2021

    The prevalence of critical diseases in India has increased...
    Health Insurance for Autoimmune Diseases in India

    16 Sep 2021

    Every human body comes with an immune system to fight against...
    Best Health Insurance Plans in India 2021
    Finding the best health insurance plan from so many different health insurance companies can get confusing for many...
    Top Maternity Insurance Plans
    Maternity or pregnancy is an important phase of life, and one needs to prepare in advance to embrace parenthood...
    Top Family Health Insurance Policies in India 2021
    From the air we breathe to the food we eat; everything is intentionally or unintentionally subjected to...
    Health Insurance Claims Ratio- Things You Should Look Before Buying Health Insurance
    There has always been a doubt in customers mind about whether the private company will keep its side of the bargain...
    Best Health Insurance Plans for Senior Citizens in 2021
    Considering the increasing percentage of medical inflation in India, it has become an absolute necessity to buy...
    Close
    Download the Policybazaar app
    to manage all your insurance needs.
    INSTALL