The concept of TPA or the THIRD PARTY
ADMINISTRATOR has been introduced by IRDA (Insurance Regulatory and
Development Authority) for the benefit of both the insured and the insurer.
While the insured is benefited by quicker & better service, insurers are benefited
by reduction in their administrative costs, fraudulent claims and ultimately
bringing down the claim ratios.
In brief, the job of the TPA is to maintain databases of policyholders and issue
them identity cards with unique identification numbers and handle all the post
policy issues including claim settlements. In terms of infrastructure, the TPA
will need to run a 24-hour toll-free number, which can be accessed from anywhere
in the country. And they will have full-time medical practitioners under their
employment who will immediately take a decision on whether the ailment is covered
under the policy.
The policyholder will have full freedom to choose the hospitals from the empanelled
network and utilise the services as per their choice For every hospitalisation,
the policyholder will be well aware whether the treatment is covered under his
policy conditions or not.If covered, they can seek cashless facility at any
of empanelled hospitals.During the time of Emergency Hospitalisation, the policyholder
or relative can flash the Photo ID-Card as a part of identification of
the policyholder and gain admission into any of network hospitals.Treatment
at hospital is given without payment at the time of admission as per the terms
of the policy conditions. At the time of discharge, the insured will make payment
which exceeds sum insured or the benifits not covered under policy conditions.
A complete CASHLESS TREATMENT.Thus, the Individual does not run around
for arranging cash for paying for the hospital expenses