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| Concept
of Third Party Administrator |
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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. |
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| 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. |
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| 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
shall be well aware whether the treatment
is covered under his policy conditions or
not. If covered, they can seek cashless facility
at any of the 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 benefits not covered under policy conditions.
Thus, with a complete CASHLESS TREATMENT,
the Individual need not run around for arranging
cash for paying for the hospital expenses. |
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