What does the Term TPA mean in Health Insurance?

HEALTH INSURANCE


what does the term tpa mean in health insurance

What does TPA mean?

As the name suggests, it is a company/agency/organization that works as an outsourcing entity for an insurance company authorized by IRDA ( Insurance Regulatory Development Authority) to process claims to provide cashless facilities to the policyholders. 

What does TPA in Health Insurance mean?

The ambit of health insurance is more extensive than other insurances like vehicle or travel insurances. Due to the bigger scope, health insurance has ample terminologies that need to be understood before you buy insurance. Health insurance is often perceived with so many complexities, but can be simple if you know one component at a time rather than get overwhelmed by its totality. Not everyone is aware of what TPA means in health insurance. It is a third party entity in health insurance that administers claim settlement of policyholders if they have a cashless policy. 

Below are some points that will help you understand TPA more clearly-

  • It is s a contract between the insurer and the insured during a hospitalization claim.

  • Health insurance company chooses its TPA agency.

  • It eases the claim settlement process by looking after the tasks such as dealing with documents and settling hospital bills.

  • Insurance Regulatory and Development Authority of India (IRDAI) authorizes TPA.

  • One TPA can tie up with multiple health insurance companies.

The Role of TPA in Health Insurance

TPA’s role in health insurance is as essential as health insurance itself. It makes the process easy for policyholders and saves them from helter-skelter in times of crisis. Let’s learn the key role of TPA in health insurance-

  • Connecting source- TPA and policyholder are directly connected when a hospitalization claim has to be filed. It assists the incomplete claim settlement process. Thus, TPA is the connection between the insurance providers and policyholders when it comes to getting coverage.

  • Maintains Records- It is beneficial to maintain crucial records of the policyholder during the hospitalization. TPA maintains a dedicated database to store the records.

  • Claim Settlement- It is an integral part of the cashless claims settlement process. TPA forwards the hospital’s bills to the insurer to process the claim process and offers back-end support to policyholders and insurers.

  • Constant support- It ensures that policyholders get seamless support 24*7 and even during an emergency. Policyholders can easily raise their queries at the counter. 

Benefits of TPA in Health Insurance for Policyholders

Below-mentioned points might have given you a perspective about TPA and its importance in health insurance. Knowing its benefits is also more important. Following are some benefits to help you learn more about TPA-

  • Constant support during hospitalization.

  • Guidance regarding the proper documentation.

  • Prompt and effective Cashless Claims settlement process.

  • They are expertise and have extensive knowledge in the healthcare industry and its regulatory requirements.

  • It enables the insured to avail medical facilities from any network hospitals under TPA without paying the cost of medical bills and rushing for claim settlement.

>>Also read 12 Health Insurance Terms you must know

Takeaway

To summarize, TPA has a relentless role in supporting policyholders in their claim process as they provide round the clock services sitting at your network hospitals. You must always know what TPA means and how its support can empower you to overcome a hazardous situation.

Disclaimer- The above information is for reference purpose only.

 



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