Third Party Administrators for Health Insurance
In an emergency, third-party administrators are extremely helpful. In terms of hospitalization claims, you can face difficulties if you don’t have health insurance coverage.
but those who have health insurance, a third-party administrator will help in doing hassle hassle-free claim settlement. As health insurance plans provide a wide range of services, it becomes difficult to comprehend the technical jargon.
Third Party is as phrase that is still unfamiliar to many people, and this article aims to explain the basic concept of Third Party Administrator in a detailed way.
In an emergency, third party administrators are extremely helpful. In terms of hospitalization claims, you can face difficulties if you don’t have health insurance cover. but those who have health insurance, a third party administrator will help in doing hassle free claim settlement. As health insurance plans provide a wide range of services, it becomes difficult in comprehending the technical jargons. Third Party is such as phrase which is still unfamiliar to many people and this article aims to explains the basic concept of Third Party Administrator in a detailed way.
Third Party Administrator (TPA) is an Insurance Regulatory and Development Authority of India (IRDAI) approved organization since the year 2001 which acts as an intermediary between the insured as well as the insurance company in order to process the health insurance claims in a smooth way. They act as outsourced entities which provide claim assistance and also assist in other activities on behalf of the insurance company. TPAs help the insured and the insurer in the complete phase of the journey right from searching the network hospital to submitting the right documents.
Third party administrators help customers in health insurance policies in a hassle free way and assist in resolving any claim related issues. Third Party administrators are basically the licensed entities that are selected by a health insurance company and is licensed by IRDAI to sell health insurance policies. In fact, it acts as a one point contact for all the insurance plan based queries as well as claim settlement needs for the buyers which make sure in providing faster claim settlement in case of emergency. As mentioned above, TPAs are the interlink between insurance companies and insurance policy holders.
TPAs aim to focus in claim settlement but there are some TPAs which offer valued added services like hospital beds, road ambulance, overall healthcare programs, doctor consultation, 24/7 helpline services, pharmacy service, data management, lifestyle management, and others.
What is Covered in Third Party Health Insurance?
Introduced by the IRDA in 2001, TPAs handle various pertinent aspects of insurance as listed below:
Key Aspects of Third Party Health Insurance
- Processing of claims and settlement (Includes Accepting intimations, Approving cashless claims, Disbursing the claims)
- Utilization review
- Provider network
- Enrolment
- Premium collection
- Database maintenance
- Cashless processing (if & when a policyholder is admitted to a listed hospital of an insurance provider, the latter pays the bill)
List of TPAs Empaneled with Health Insurance Companies
The list of IRDAI-licensed third party administrators are as follows:
Now, we will have a detailed list of Third Party Administrators available in India:
TPA | Name & Address | Contact Details |
United Health Care Parekh Insurance TPA Private Limited | Mr. Shiva BelavadiChief Executive Officer, 3B/1 Gundecha Onclave, Kherani Road, Saki Naka, Andheri (East),Mumbai – 400 072 | Toll Free No.: 1800 209 8884 Email:shiva.belavadi@uhcpindia.com Website: www.uhcpindia.com |
MD India Health Insurance TPA Private Limited | Mr. Suresh V. Karandikar Chief Executive Officer S. No. 46/1 E-space A-2 Building,3rd Floor, Pune-Nagar Road, Vadgaonsheri, Pune – 411 014. | Toll Free No.: 1800 233 1166 For senior citizens: 020-25300126 Email: skarandikar@mdindia.com website: www.mdindiaonline.com |
Medi Assist Insurance TPA Private Limited | Mr. Ganesh K Chief Administraive Officer, Tower D, 4th Floor, IBC Knowledge Park, 4/1, Bannerghatta Road, Bangalore, 560029 | Toll free number for senior citizens: 1800 419 9493 Toll Free No.:18004259 Email: cao@mediassist.i Website: www.mediassist.in |
Paramount Health Services & Insurance TPA Private Limited | Dr. Nayan Shah Chief Executive Officer Plot No. A-442, Road No. 28, Ram Nagar, MIDC Industrial Area, Wagle Estate, Thane (W) – 400 604 | Senior Citizen Helpline No.: 022 66629813 Toll Free No.: 1800 22 66 55 Email: nayan.shah@paramounttpa.co Website: www.paramounttpa.com |
Family Health Plan Insurance TPA Limited | Ms. G. Bharathamma Chief Executive Officer No: 8-2-269/A/2-1 to 6, 2nd Floor Srinilaya Cyber Spazio, Road No. 2, Banjara Hills, Hyderabad – 500 034 | Senior Citizen Helpline No.: 1800 102 427 Toll Free No.: 1800 102 4033 Email: bharathig@fhpl.ne Website: www.fhpl.net |
Heritage Health Insurance TPA Private Limited | Mr. Manash Chakraborty, Chief Administrative Officer NICCO HOUSE, 5th Floor, 2, Hare Street, Kolkata-700001 | Toll Free No.: 1800 345 3477 Email: mchakraborty@bajoria.in Website: www.heritagehealthtpa.com |
Raksha Health Insurance TPA Private Limited | Mr. Pawan Kumar Bhalla Chief Executive Officer C/o Escorts Corporate Centre 15/5, Mathura Road, Faridabad, Haryana – 121 003 | Toll Free No.: 1800 180 1444, 1800 220 456, 1800 425 8910 Email: pawan@rakshatpa.co |
East West Assist Insurance TPA Private Limited | Dr. Atul Arora Chief Executive Officer38, Golf Links, New Delhi – 110003 | Email: ceo@eastwestassist.com Website: www.eastwestassist.com |
Vidal Health Insurance TPA Private Limited | Ms. Sudha Suhas Kulkarni Chief Administrative Officer, First Floor, Tower No. 2, SJR iPark, EPIP Zone, Whitefield, Bangalore – 560 066 | Toll Free No.: 1860 425 0251, 080 46267018 Email: sudha@vidalhealthtpa.com Website: www.vidalhealthtpa.com |
Medsave Health Insurance TPA Limited | Mr. S. AravamuthanChief Administrative OfficerF-701A, Lado Sarai, Mehrauli, New Delhi – 110030 | Senior Citizen Helpline No.: 9319810070 Toll Free No.: 1800 111 142 Email: s.aravamuthan@medsave.in Website: www.medsave.in |
Alankit Insurance TPA Limited | Mr Bodh Raj PunjDirector & Chief Executive Officer Alankit House, 4E/2,Jhandewalan Extension, New Delhi – 110055 | Toll Free No.: 1800 11 3300 Ph. No.: 011-42541621-24 Email: alok@alankit.com Website: www.alankithealthcare.com |
Genins India Insurance TPA Limited | Mr. Subhash Chander Khanna, Chief Administrative OfficerD-34, Ground Floor, Sector-2 Noida – 201301 (U.P.) | Toll Free No.: 1800 345 3323 Ph. No.: 0120-4144100 Email: sckhanna@geninsindia.com Website: www.geninsindia.com |
Health India Insurance TPA Services Private Limited | Mr. Kamaljeet Gupta Chief Administrative Officer Neelkanth Corporate Park, Office No. 406 to 412, 4th Floor, Kirol Road/Village, Vidya Vihar Society, Vidya Vihar (West), Mumbai-400086 | Senior Citizen Toll Free No.: 1800 2269 70 Toll Free No.: 1800 2201 02 Ph. No.: 022-40881000 Email: kamaljeetg@healthindiatpa.com Website: www.healthindiatpa.com |
Vipul Medcorp Insurance TPA Private Limited | Mr. Rajan SubramaniamChief Executive Officer 515, Udyog Vihar, Phase 5, Gurgaon, Haryana – 122 016 | Senior Citizen Toll Free No.: 1800 120 3348 Toll Free No.: 1800 108 7477, 1800 102 7477 Ph. No.: 0124-4833900 Email: rs@vipulmedcorp.com Website: www.vipulmedcorp.com |
Good Health Insurance TPA Limited | Ms. Saigeeta Dikshit,Chief Administrative Officer Suite 403 – 406A, 4th Floor, Ashoka My Home Chambers, Behind Ashok Bhoopal Chambers, Sardar Patel Road, Secunderabad, Telangana State – 500003 | Senior Citizen Toll Free No.: 1800 102 9919 Toll Free No.: 1860 425 3232 Email: saigeeta@ghpltpa.com Website: www.ghpltpa.com |
Safeway Insurance TPA Private Limited | Mr. Mahesh Sharma Chief Executive Officer815, Vishwa Sadan, District Centre, Janakpuri, New Delhi-110058 | Toll Free No.: 1800 102 5671Ph. No.: 011-45451300 Email: ceo@safewaytpa.in Website: www.safewaytpa.in |
Park Mediclaim Insurance TPA Private Limited | Mr. Anurag Bhatnagar Chief Executive Officer702, Vikrant Tower, Rajindra Place, New Delhi-110008 | Toll Free No.: 1800 11 55 33 Ph. No.: 011-43191000 Email: anuragbhatnagar@parkmediclaim.co.in Website: www.parkmediclaim.co.in |
Anmol Medicare Insurance TPA Limited | Mr. P. S. Kshatriya Chief Executive Officer 2nd Floor, NBCC House, Opp. Ahmedabad Stock Exchange, Ambavadi, Ahmedabad – 380015, Gujarat | Toll Free No.: 1800 233 1999 Ph. No.: +91-79-61609926, 61609930 E-mail: prithvi@anmolmedicare.com Website: www.anmolmedicare.in |
Rothshield Insurance TPA Limited | Ms. Janki M Bhate Chief Executive Officer 402, Raheja Chambers,Nariman Point, Mumbai 400 021 | Toll Free No.: 1800 228 144 Ph. No.: 022-22048144 Email: janki@rothshield.co.in Website: www.rothshield.co.in |
Grand Insurance TPA Private Limited | Mr Bibhutosh Chattopadhyay, Chief Administrative Officer Grand House, 45A,Hindustan Park, Kolkata 700 029 (West Bengal) | Toll Free No.: 1800 102 4747 Ph. No.: 033-40274747 Email: cao@grandtpa.co.in Website: www.grandtpa.co.in |
Ericson Insurance TPA Private Limited | Dr. Krishna P. Jaiswal, MD11-C, Corporate Park, ST Road, Chembur, Mumbai – 400 071 (Maharashtra) | Senior Citizen Helpline No.: 022-25280208 Toll Free No.: 1800 22 2034 Ph. No.: 022-25280280 Email: krishna@ericsontpa.com Website: www.ericsontpa.com |
Health Insurance TPA of India Limited | Mr. SK Mehra Chief Executive Officer2nd Floor, Majestic Omnia Building, A-110, Sector-4, Noida 201301 (Uttar Pradesh) | Toll Free No.: 1800 180 3600, 1800 102 3600 Email: sk.mehra@hitpa.co.in Website: www.hitpa.co.in |
Vision Digital Insurance TPA Private Limited | Ms. Priyanka Jain Chief Administrative Officer Time Square Building 3rd & 4th Floor, Sushant Lok-1, Block-B, Gurugram – 122002 | Toll free no: 1800-419-9982 Ph. No.: 0124-4003171 Email: priyanka.jain@visiontpa.in Website: www.visiontpa.in |
Documents Required for TPA Claim Settlement in Health Insurance
The following are the documents needed to make a TPA Health Insurance Claim:
- Aadhar Card
- The insurance copy of the policyholder
- Health Insurance TPA e-card
- Pharmacy and hospital discharge bills or receipts
- Doctor’s prescriptions
- Hospital discharge documents
TPAs not only help in making our claim settlement journey much easier but also help in increasing their knowledge base of the healthcare facilities. Both insured and insurer can get profit from them.
How TPAs in Health Insurance Help the Policyholders?
TPA in health insurance offers a wide range of services and benefits to the insurance policy holders. Given below are the some of the key advantages provided by TPAs:
- Third Party Administrators act as the interlink between hospitals and policyholders in terms of claim settlement process during hospitalization.
- TPA insurance ensures that cashless network hospitals which are included under the list of health insurance providers are fulfilling all the required criteria so that they can serve the policyholders when they are facing medical emergencies.
- The third party administrators are responsible to provide assistance in the hospitalization and claim settlement process.
- Third Party Administrators help the policyholders when they are hospitalized and connect with the cashless network hospitals to make the entire process hassle free.
- Third Party Administrators make sure to arrange some of the important value added services like wellness programs, road ambulance, doctor schedules, etc.
- If a policyholder places a request for a reimbursement claims after availing the treatment from a non network hospital during an emergency, the Third Party Administrator helps in settling the claim in a hassle free way.
How to Change or Cancel a TPA in Health Insurance?
TPA acts as a facilitator. Additionally, if there is a delay in the services being rendered, you can get in touch with your insurance company, who get in touch with the TPA and update you on the situation. You may talk to your insurer about changing your TPA if you decide you want to cancel one or transfer to another one. The following are the steps to cancel the TPA in health insurance:
- Firstly, you have to get in touch with your insurance company either via call or email.
- Next, share your policy details as well as your unique ID.
- You also have to let your know the reason behind the TPA cancellation.
- Once your insurance company approves the change of TPA, you can select another TPA from the list.
Difference Between TPAs and Insurance Providers
Third Party Administrators aim to handle different aspects of insurance offered by insurance companies. A few of the examples of TPAs are hassle free and smooth claim process, efficient customer care, and premium payment management. The key role of TPA in health insurance is it bridges the gap between the insurance policy holders’ health and insurance companies. On the other hand, health insurance companies are responsible in offering best health insurance plans to individuals, groups, families, and others. TPAs in health insurance act as the administrative foundation in the health insurance system.
Value-Added Health Services Offered by TPAs
- Ambulance services
- Specialised consultation
- Availability of beds
- 24-hour toll-free helplines
- Lifestyle management
- Wellbeing programmes
- Medicine supplies
- Health facilities
According to experts, providing cashless hospitalization of the insured should be the primary service offered by TPAs. It is important to note that some insurance companies have a separate department which performs the functions of TPA instead of outsourcing it to another entity.
What is the Need for Third Party Administrators?
According to industry observers, TPAs can bring in the following changes:
- Greater efficiency/quality (delivery of services)
- Improved standardisation (procedures and due diligence)
- Increase knowledge base of healthcare services
- New management system
- Greater penetration of health insurance
- Minimize costs/expenditure
- Develop protocols to streamline investigation and avoid unnecessary delays
- Pave way for lower insurance premiums
All the same, there is much discrepancy between the aims and the ground realities of functioning of TPAs. As a result, the jury is still out on the efficacy of TPAs in the growing and complex health insurance sector in the country. The institutionalization of TPAs, therefore, leaves a lot to be desired.
How do TPAs Function?
There are two scenarios on how TPAs function. Given below are the details of the two scenarios:
In Case of Cashless Treatment
- When a policyholder requires a medical treatment, they can visit a hospital which is a part of the network of insurance company.
- The hospital will send the details of the treatment and approximate costs to the TPA. The TPA officials will verify the eligibility of the policyholder and the coverage provided under the insurance policy.
- If everything is right, the TPA will provide the pre authorization to the hospital through which the policyholders can receive treatment without paying any upfront.
- The TPA will then settle the payment with the hospital on behalf of the insurance provider once the hospital bills it directly for the expenses of the care.
In Case of Reimbursement Treatment:
- If a policyholder gets a treatment from a non network hospital, he or she has to pay an upfront cost and then file a reimbursement claim with the insurer.
- The policyholder will have to submit all the required documents as well as bills to the TPA after which the TPA officials will verify the details and process the claim.
- Next, the TPA will send the claim to the insurer for approval as well as reimbursement.
- Once the claim has been approved, the TPA will reimburse the amount either by issuing cheque or by doing direct bank transfer to the bank account of the policyholder.
GST rate of 18% applicable for all financial services effective July 1, 2017.
Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.
FAQs on Third Party Administrators
- Does TPA charge money?
No, TPA does not charge money from policyholders. The policyholders will have to deal with the insurance company directly to get help from TPA.
- Who are the professionals in a TPA team?
The team of TPA comprises of experts like insurance consultants, doctors, IT professionals, and legal experts.
- Can a TPA help to reduce fake claims?
Yes, TPA helps in reducing the fake claims.
- What is the role of a TPA in health insurance?
TPA in health insurance is responsible for doing claim settlement between cashless hospitals and insurance policy holders. Apart from this, it also helps in taking care of value added services like road ambulance, wellness programs, and others.
- Who is responsible for hiring TPA in health insurance?
Health insurance service providers are responsible for hiring TPAs.
- Does the policyholder have to pay money to TPA?
No, the policyholder does not have to pay money to TPA.
- Has involving TPAs reduced fake health insurance claims?
Yes, TPA services have helped health insurance companies in reducing the number of fake claims.
News on Third Party Administrators for Health Insurance
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On 3 May 2025, Jharkhand became the first state to launch a dedicated health insurance scheme for advocates and their families. Launched under the Rajyakarmi Swasthya Beema Yojana, the initiative was unveiled by Chief Minister Hemant Soren in Ranchi. The scheme is aimed at reducing the financial strain of medical expenses for members of the legal profession. On the same occasion, the Chief Minister also announced the state’s plan to establish a top-tier law university in Jharkhand. The proposed institution is expected to enhance legal education and support the development of the state’s legal infrastructure.
Inclusive growth across all social and economic groups was highlighted as a key government goal, with assurance of sustainable policy action. Use of the Guruji Credit Card Yojana for higher education funding was promoted. The launch event saw attendance by top state officials, ministers, and well-known lawyers.
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