HIGHLIGHTS
- Irdai has allowed policyholders to choose a TPA of their choice while buying or renewing a health insurance coverage plan
- TPA plays an important role in processing health insurance claims
Gone are those days when health insurance policy customers buyers were solely dependent on insurers for third-party administrators (TPAs) for health coverage. To make health insurance policies more accessible and attractive, the Insurance Regulatory and Development Authority of India (Irdai) has recently allowed policyholders to choose a TPA of their choice while buying or renewing a health insurance coverage.
Under the Insurance Regulatory and Development Authority of India (Third Party Administrators – Health Services) (Amendment) Regulations, 2019, Irdai has asked health insurance companies to provide a host of TPAs to policyholders at the time of selling a policy. Buyers will choose a TPA which will suit their need. However, policyholders are only allowed to change a TPA of their choice at the time of renewal. The insurer may also limit the number of TPAs based on the health insurance product and geographical location of the policyholders.
TPA plays an important role in processing your health insurance claims available under mediclaim policy. TPAs work as intermediaries between the insurers and the insured.
Here are changes that Irdai has made regarding the TPA in health insurance:
1) “The policyholder can choose a TPA of their choice from amongs the TPAs engaged by the insurer,” said the regulator.
2) The policyholder can only choose TPA from the names provided by the health insurers at the time of buying the policy or renewing the policy.
3) If a policyholder does not choose any of the TPAs provided by the insurance company, the insurer will have the right to allot a TPA of its choice.
4) The policyholder shall have no right to seek dispensing of the services of the TPA and request the insurer to undertake rendering the health service directly, said Irdai.
5) If a TPA service is terminated during health coverage, the insurer must allow the policyholder to choose an alternate TPA.
6) If the insurer engages the services of only one TPA, no option will be provided to the policyholders.
The insurer will have the last choice to engage TPA or terminate the services of the TPA. To engage the services of the TPA for a particular health insurance product or discontinue the services of the TPA to service a particular health insurance product will be insurers’ prerogative.
