If you are planning to take up an insurance policy, you must have contemplated how the entire process works or what steps you will be required to perform in case a need arises for you to make a claim. In your quest to look for the perfect health insurance policy, you must have come across the words ‘TPA’. TPA in health insurance has a significant role to play between insurance providers and takers; these agents are authorized to process claims by Insurance Regulatory Development Authority (IRDA). Let’s understand what TPA stands for and what its roles and benefits are.
The Meaning of TPA:
TPA’s full form is Third Party Administrator. They help the insurance companies smoothen out the process of claim settlement. Moreover, they act as a link between both parties, the insurance policy provider and the policyholder. TPAs in health insurance are licensed companies hired by health insurance providers that are responsible for handling settlement claims and providing other facilities, such as issuing health cards.
What is a Health Card?
E-card/ Health card is a card issued by the third-party administrator that consists of all the necessary details of the policyholder. Important details such as information about the dependents, insurance policy number, name of the TPA, etc., are mentioned in the card. Whenever a policyholder gets admitted to a hospital, they are required to present this card so that TPA insurance can be notified further.
The Role Played by TPA in Health Insurance:
1) Thorough Document Verification
It is the responsibility of TPA to make sure that they check the documents provided by the policyholder thoroughly. They are also responsible for asking for any incomplete or remaining documents. It is their job to ensure that the documents are verified and can be used to process a claim further.
2) Rapid Claim Settlement:
Whether the claim in question is cashless or reimbursement, TPA makes certain that it gets settled properly. They have the authority to ask for any pending documents from the policyholder, or they can directly gather the documents from the hospital in case of reimbursement.
3) Ensuring Seamless Service:
TPA’s role in health insurance also includes providing seamless services to the policyholders. They can help in assisting them with any issues that may arise with their insurance policies. They also share any necessary information about their policies with the holders. Making sure at the same time that they take feedback and keep upgrading their services as per the needs of their users.
4) Other Facilities:
A Third Party Administrator offers some extremely beneficial facilities along with ensuring complete verification of the policies for policyholders. Additional facilities include arranging ambulances, providing emergency assistance to the policyholders, introducing well-being programs, etc.
Benefits of Third Party Administrator:
Now that you have understood TPA’s full form in medical insurance and what role it plays, let’s throw some light on the benefits it has to offer, which are as follows:
- Easy to reach- They are always a call or mail away from the policyholders to assist them effectively. You can reach out to them by calling their helpdesk number or mailing them to the provided email address. They are available 24 hours a day, seven days a week, pan India.
- High quality of service- They provide excellent customer service to help ease the process. TPAs are there to answer your queries swiftly in case you have any doubts related to the insurance policy.
- Security- If a third-party administrator is involved, the chances of you feeling lost in the process of making a claim minimizes. There will not be a need to run behind an insurance company in times of need.
- Better management of the data- An insurance policy requires some serious paperwork. TPA in health insurance gathers all such information and keeps it secured.
Summary:
It is assumed that you have learned the TPA full form and its benefits by now. TPA is known to bridge the gap between the involved parties, i.e., the insurance policyholder and the insurance company. The TPA ascertains the flaws in the process and provides services to fix them. Whether providing a trouble-free claim settlement or answering the queries of the policyholders, they do it all. Third-Party Administrators (TPAs) act as a facilitator by making the claim disbursement process easier for insurance companies, hospitals, agents, and policyholders.
