Health insurance TPA to begin operations from next fiscal

After it becomes operational, 8-10% of claims now being handled by external agencies will be processed by the new body

Health Insurance TPA of India, a joint venture by public sector insurance companies to manage in-house health claims, will begin operations soon.

After it becomes operational,  8-10 per cent of claims now being handled by external agencies will be processed by the new body. Health Insurance TPA launched operations on a pilot basis in October in Delhi.

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The company was allotted one office each by National Insurance Company, New India Assurance Company, Oriental Insurance Company and United India Insurance Company. The objective is to reduce the turnaround time for claims.

External TPAs will also continue to service claims for the insurers.

Both cashless as well as reimbursement claims will be processed via this TPA. Further, HI TPA would provide the pre-authorisation to the insured member for availing treatment on cashless basis at Network hospital. The TPA is even coming out with a mobile application for ease of process in the near future.

For cashless claim, a member has to just show the card at the hospital after which the hospital fills the pre-authorisation request & sends it to HI TPA. The TPA will then review it and approval is granted. For reimbursement claims, the insured member has to inform the HI TPA/Insurer within 24 hours of hospitalisation. The very first member ID card was issued to a policyholder of National Insurance. 

The new entity will not only provide pre-authorisation service and process claims, it would also provide network empanelment, verification and investigation, and pre-policy health check-up. Apart from this, they are in the process of establishing provider network under tripartite agreements between Insurer-Provider and TPA for extension of cashless facility to member customers. If required, HI TPA will also carry out spot verification of cashless cases and investigation of reimbursement claims as need be.

Health Insurance TPA is a joint venture of public sector non-life insurance companies – National Insurance Company, New India Assurance Company, United Insurance Company, Oriental Insurance Company, and General Insurance Corporation of India. The first four have 23.75% stake each in the new company while GIC has 5% stake.

The internal TPA was set up to prohibit large-scale leakages while settling insurance claims in the health segment. Insurers expect the new body to speed up the claims settlement process and reduce the claims ratio of insurance firms. This move is also expected to reduce costs for insurers, who pay a commission to TPAs for processing the claims.

It was incorporated on August 14, 2013 with two key objectives - to enhance customer experience and to bring in greater efficiency in health insurance claims processing. Health Insurance TPA is headquartered in New Delhi and is looking to develop its footprint/branches in different cities in due course.