Tpas To Seek Floor Fees Of 25% Of Premium
Third-party administrators (TPAs) will demand a 25 per cent base-floor commission of premiums from insurance companies for services rendered.
In addition, the TPAs have suggested a revolving fund of Rs 1 to 2 crore or more to act as a claim pool limit to be set up by insurance companies for settlement of claims. This is with a view that TPAs funds are not at stake.
This was the collective stand taken by the TPAs during a meeting on Sunday afternoon to chalk out their strategy, ahead of their meeting with the Insurance Regulatory and Development Authority (IRDA) on Monday morning.
It was mutually agreed among the TPAs that marketing of health products ought to be allowed and left to the discretion of insurance companies.
The state insurers had been against TPAs selling managed-care products fearing a collusion, and the possibility of claims ratios mounting.
The TPAs have, however, repeatedly stated that the high claim ratios have to do with the issuance of floater and group policies by insurers.
At the meeting with the IRDA, the TPAs propose to press for a 70 per cent hike in premiums on loss-making portfolio. It was also mutually agreed that the base capital of TPAs be kept at Rs 1 crore.
TPAs have also called for the need to set parameters for accepting hospitals as part of the TPA network, and thereby black-list those, which fail to meet the same. These views will be put forth to the IRDA tomorrow.
The regulator has called for a meeting of TPAs and non-life insurance companies, prior to finalising the TPA regulations.
While IRDA member H O Sonig said that there was no real agenda, the regulator had earlier in the month written letters to 14 TPAs, inviting them to deliberate on broad-basing their functions, as well as finalising the capital requirements, and parameters with regards to the infrastructural requirements of hospitals and dispensaries.
The draft regulations is likely to undergo a material change in view of revised proposals of insurance companies, stated the IRDA in a letter addressed to TPAs.
The TPAs formed an association headed by the former general manager of General Insurance Corporation of India, G Mahapatra, at present consultant to Apollo Hospital.
Among the other issues discussed during the meeting on Sunday, TPAs propose to inform the IRDA that licensing be awarded first before they actually get into an agreement with insurers.
Further, it was proposed that the CEO of a TPA ought to be supported by a medical expert having passed hospital management course, and an insurance expert having appeared for the licentiate examination conducted by the Insurance Institute of India, and hence need not possess the dual qualifications himself.