PSU insurers to set up own TPA to vet mediclaims

The four state-owned general insurers will set up a common Third Party Administrator (TPA) as a joint venture to manage health insurance claims, a move that will end the dispute over excessive billing by hospitals.

The four PSU insurers -- National Insurance Company, New India Assurance, Oriental Insurance and United India Insurance -- have invited expressions of interest from companies for forming a joint venture TPA, which would act as a facilitator between insured persons and insurance companies.

"The GIPSA member companies are keen to partner with a suitable entity, which will be offered an equity stake of up to 26 per cent in the joint venture," the General Insurers' (Public Sector) Association of India (GIPSA) said in a public announcement.

The partnership is expected to commence operations by June 30, 2011, said GIPSA, which represents all four public sector general insurance companies.

"The GIPSA member companies are looking to improve the profitability of their health portfolio, along with services to their customers, and the proposed TPA would be a strategic driver in this direction," it said.
    
The proposed TPA joint venture would require an upfront capital investment of Rs 200 crore, subject to business plan agreement and finalisation, apart from regulatory clearances.
    
The yet-to-be-floated consortium would be a JV with either an existing TPA in India or abroad. At present, the FDI cap in the insurance sector is 26 per cent, which means that foreign companies would be able to participate in the TPA joint venture to the same extent as domestic players.
    
With this, foreign general insurers will get an opportunity to access business currently controlled by government-owned insurance companies.
    
The move gains importance amid the ongoing tussle between the PSU insurers and private hospitals.
    
Following the row over excessive billing, the four PSU insurers, with effect from July 1, 2010, took off about 150 hospitals from the list of preferred provider network (PPN) that provide cashless hospitalisation services to policy holders under the mediclaim scheme.
    
Later, the insurers had partially restored the cashless facility for emergency, ICU, cardiac care and trauma cases.
    
As regards the TPAs who are eligible to apply, GIPSA has stipulated that they must have profitable operations for at least three of the last five preceding years.
    
"The applicant should have business experience in one or more areas of health insurance claims management, in markets other than India or India for at least the last five years," it added.
    
Further, the applicant must have handled at least five lakh health insurance claims over the last three years and its parent should have a net worth of Rs 250 crore, it said.