State Insurers Keep Hospital-Backed Tpas Off Final List

State-owned insurance companies have conscientiously kept out hospital-sponsored third party administrators (TPAs) in the finalisation of TPAs.

The four state insurers, which shortlisted the appointment of TPAs today, have decided against the selection of Escorts-sponsored Raksha and Apollo Hospitals-sponsored Family Health Plan.

Said a senior official from National Insurance Company: "The idea is that the direct beneficiaries (hospitals) ought not to be made in charge of claim settlement on account of vested interests". It might be recalled that prior to the Insurance Regulatory and Development Authority (IRDA) licensing TPAs, the industry had raised objection against hospitals being made TPAs as there would be no control over claims.

 

The four insurance companies have called a meeting of the shortlisted TPAs on Saturday to finalise the terms and conditions of the agreements and the zones in which the TPAs will operate.

Oriental Insurance Company has shortlisted Medicare, Heritage, Medisafe, Paramount Health Services, TTK Pharma and Parekh Healthcare & Management. National Insurance Company has identified Paramount, Heritage, Genins, Mediassit and TTK. United India Insurance Company has selected TTK, Paramount, Ican, Parekh and Medisafe.

The General Insurers' Public Sector Association (Gipsa) had late last month pointed out to the four state insurers that each company ought to at best appoint five TPAs and each TPA can at best have interest in a maximum of two zones.

The first exercise undertaken by Gipsa in June for the empanelment of TPAs went for a toss. This was because only nine of the 20 qualified TPAs had been selected. The industry raised hue and cry as 99 per cent of the Rs 500-600 crore health insurance business is accounted for by the public sector, and with only nine TPAs selected, the rest would have little business to write.

However, considering the four state insurers have appointed almost the same number of TPAs -- less than 10 -- the second round of selection to divide the business among the 20 has equally proved to be futile, said a senior official from a TPA that has not been selected.