What is the role of third party administrators in health insurance?

Buying a health insurance policy requires an insurer. But the responsibility to settle claims under these plans is taken over by a third party administrator (TPA).

Licensed by the IRDAI, TPA is a body that handles claim process for health insurance plans. The TPA may work independently or act as an entity belonging to the insurer.

The primary job of TPAs is to manage and identify a large number of health insurance claims. Their aim is to offer high quality and hassle free services to policyholders.

The role of a TPA is to issue health cards to customers and ensure a smooth claim process for both the insurer and insured. It can also assist in arranging value added services like ambulance, etc.

Customers can avail cashless treatment at network hospitals that work in collaboration with the insurers. TPAs make sure to enlist the names of such hospitals for the customer's perusal.

TPAs also have a helpline number that can be availed by policyholders or family members for any queries related to claim filing.

It is always advised to carry the TPA card or reference number while visiting a network hospital for treatment. This will allow you to avail cashless treatment immediately.

If you're looing to buy a good health insurance, make sure to look at the policy features, add-ons, exclusions, premium, waiting period, claim settlement ratio, sub limit and co-payment clause carefully.