M Nagaraja Sarma to head Health Insurance TPA of India

TPA to begin operations from 1 July, 2015

M Nagaraja Sarma will now be heading Health Insurance TPA, taking over from P K Bhagat. Sarma has been associated with its executive team. Bhagat will move to Oriental Insurance. He is expected to retire in four months. Sarma has worked as general manager with Oriental Insurance.

Set up exclusively to manage the health insurance claims of general insurers, Health Insurance TPA will begin operation from July 1. At present, it is ramping up its team. Some of its officials are on deputation from public insurance companies; some have been hired. The initial strength would be 100.

“In the first year, we plan to work on 15-20 per cent of the business from the four public general insurers. This will be scaled up progressively depending on the how the TPA takes shape,” an official said.

Though the official launch is slated on July 1, testing of the systems would begin much earlier than that. Last year, the TPA got its licence from the Insurance Regulatory and Development Authority of India (Irdai). The licence is valid for three years.

The TPA had run into trouble after the Competition Commission of India (CCI) had ordered an investigation by its director-general into alleged anti-competitive practices of General Insurers’ (Public Sector) Association of India and other public sector general insurers. The issue was resolved with the public insurers claiming that the TPA would not be working on all their claims.
 

The common TPA to process health claims has National Insurance Company, New India Assurance Company, United Insurance Company, Oriental Insurance Company and General Insurance Corporation of India as stakeholders. The first four have 23.75 per cent stake each and GIC has 5 per cent.

The TPA will look into health claims and handle claims received by these public general insurers. It has been set up to prohibit large-scale leakages, while settling insurance claims in the health segment. Further, it is intended to process claims of public general insurers in-house, rather than handing them over to an external agency.

Health Insurance TPA will provide end-to-end services. This would include member enrolment, call centre, customer service and grievance management, pre-authorisation and claims processing.  

Health insurance loss ratios range from 95 to 100 per cent, depending on the size of the company. Loss ratios refer to the ratio between premiums collected and claims paid. With stiff competition in group health portfolio and aggressive discounts being given to retain customers, the losses have been on the rise.

An external TPA handling claims will add to the costs, hence public general insurers went in for a common TPA. However, till it is operationalised, losses are expected to continue.

The company shall provide services to support all types of health insurance policies sold by insurance companies in India. This includes individual, family floater, group covers, mass schemes, indemnity, fixed benefit among others.