What is Third-Party Administrator (TPA) in Health Insurance? - Ditto

Health Insurance Glossary

Third-party administrators, also known as TPAs, are organizations that work in between the policyholder and the insurer. Because these organisations are not parties to the insurance contract, they are referred to as third parties. Insurers select these TPAs. Sometimes a single TPA works with different insurers.

The insurance regulator, IRDAI, regulates third-party administrators, who must follow its rules and guidelines. These third-party administrators provide services such as claim settlement, record keeping, etc.

Some insurers have also begun to have in-house claim settlement rather than relying on third party insurers, which simplifies the claim process.

So, before buying a health insurance policy, one should look at the claim settlement mechanism of the insurer and decide whether to go with an insurer that has a TPA or an in-house claim settlement team, along with all other insurance features.

For more details check out Third-Party Administrator (TPA) article

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A

Accident Accumulation Period Acute Care Add-on Covers Age Limit Agent Ambulance Cover Annual Renewal Date Any One Illness Automatic Restoration AYUSH Treatment

B

Beneficiary Benefit Blacklisted Hospitals Broker

C

Cancer Insurance Cashless Claims/Treatment Cashless Facility/Hospitalization Certificate of Insurance Claim Claim Settlement Claim Settlement Ratio Co-insurance Co-Pay or Copayment Comorbidities/Pre-Existing Diseases Complimentary Health Check-ups Convalescence Benefit Critical Illness Cumulative/No-Claim Bonus

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Eligibility Emergency Care Exclusions

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Family Floater Policy First Diagnosis Free Look Period

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Grace Period Group Health Insurance

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Health Insurance Tax Benefits Hospitalization

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Illness Individual Health Insurance Inpatient Care Insurer IRDAI

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Lapse Long-Term Care Policy

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Maternity Expenses

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Network Provider/Hospital No Claim Bonus (NCB)Nominee Non-Network Provider/Hospital

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Out-Patient Department (OPD)/Treatment

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Senior Citizen Health Insurance Specific Illness Waiting Period Sub-Limit Sum Insured

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Third-Party Administrator (TPA)

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