Health Insurance Third-Party Administrator
Health insurance third-party administrators’ (TPAs) contribution to the insurance sector is unprecedented. They have, in fact, transformed the way insurance products are being promoted, sold, and processed. From solicitation to claim settlement, these professionals play an instrumental role a fostering a harmonized connection between insurers and policyholders. They can cater to a number of endevours, including claim processing, cashless services, etc on the insurer’s behalf, adding to the convenience and growth. If you are planning to act as a TPA, the approval from Insurance Regulatory and Development Authority of India (IRDAI) is a must. Read on to discover the legal aspects of becoming a certified TPA in India.
What is a Health Insurance Third Party Administrator?
A health insurance third party administrator refers to an IRDAI-approved organization that facilitates given services on the insurer’s behalf while staying aligned with IRDAI operational compliances.
- Claim processing
- Risk assessment
- Assisting clients in understanding policy benefits and implications
- Cashless services
- Resolving claim hassles, if any
All TPAs are bound to comply with IRDAI norms in their entirety, ensuring compliance and reliability.
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Understanding Roles of Health Insurance ThirdParty Administrator
TPAs provide various services, including:
- Claim Servicing: Managing claims for cashless as well as reimbursement processes as per their health insurance policies.
- Hospitalization Claims: Handling hospitalization claims when it comes to personal accident and domestic travel policies.
- Pre-Insurance Medical Examinations: Helping insured with medical checkups during the underwriting process.
- Foreign Travel Policies: Overseeing health-related matters for policies spanning medical treatment overseas.
- Incoming Policyholders: Servicing overseas health policies for policyholders traveling to India.
Who Can Become Health Insurance Third Party Administrator?
Becoming a health insurance third party administrator is a matter of complying with the following norms. Here is a brief breakdown of the same:
1. Company Formation:
An applicant firm must have a share capital and operate under the Companies Act 2013. The firm’s object should revolve around rendering health services.
2. Naming Standards:
The name of the applicant firm should have terms viz. “Insurance TPA”, reflecting the nature of business
3. Financial Requirements:
The presence of Paid-up equity share capital worth ₹4 crores is paramount.
4. Foreign Investment Compliance:
Adherence to government rules and IRDAI norms concerning foreign investments is vital before applying for IRDAI’s approval
Step-by-Step Guide to Becoming Health Insurance Third Party Administrator
Navigating the IRDAI compliance for a health insurance third party administrator can be overwhelming. Focus on adhering to given steps when it comes to registration.
1. Initial Registration on IRDAI BAP Portal
Visit the IRDAI BAP portal and complete the registration process. Use the valid credentials to complete this step as it can avoid any technical or login hiccups.
2. Submit Application Online
Post login, get access to the application form wherein you must enter all the details as asked. Once done, upload the mandatory paperwork and submit the prescribed fee of Rs 1,00,000.
3. Document Verification
IRDAI shall vet the submitted documents and application to identify possible non-conformity. Any error or misleading information shall not be entertained and thus lead to rejection. It is vital to note that the authority might ask for some additional documents to support the inspection process. Timely submission of these documents is paramount to avoid any delay.
4. Approval and Payment
Once approved, pay a registration fee worth Rs 2 lakhs to secure the registration certificate.
Fee Structure for TPA Registration
| Payment Category | Amount Payable (₹) |
| Processing Fee (Non-refundable) | ₹1,00,000 |
| Registration Fee (Valid for 3 years) | ₹2,00,000 |
| Renewal Fee (Every 3 years) | ₹1,50,000 |
Adviso’s Role in Securing TPA Approval
Adviso specializes in IRDAI approvals and several key licenses that are compliance-intensive. Here’s why Adviso’s support can be a game-changer when applying for TPA registration:
- End-to-End Assistance: From scouting applicable compliances to application submission, Adviso offers all-encompassing support, ensuring you have quality support every step of the way.
- Compliance Checks: Adviso ensures that your firm adheres to what’s mandatory, be it a matter of structure, operations, or finances.
- Expert Guidance: Adviso’s fosters a team of seasoned professionals well-versed in IRDAI norms. Their support can be of great help when it comes to compliance adherence.
- Timely Follow-ups: With robust liaisoning, Adviso ensures comprehensive tracking of your application after submission, helping you make timely decisions.
With Adviso by your side, you can expect seamless application processing with zero scopes of rejection, ensuring timely and hassle-free registration grants.
FAQs
Q1. What is the primary role of a health insurance third party administrator?
A health insurance third party administrator caters to a number of endeavors such as claims processing, cashless services, and processing of health insurance policies.
Q2. Can any company become a TPA?
No, only companies registered under the Companies Act, 2013, with an object revolving around health services and ample financial backing, can apply.
Q3. What are the fees involved in registering as a TPA?
The processing fee is ₹1,00,000, the registration fee is ₹2,00,000 (valid for three years), and the renewal fee is ₹1,50,000 every three years.
Q4. How can Adviso help with TPA registration?
Adviso provides end-to-end assistance, compliance checks, and expert guidance to streamline the IRDAI registration process.
Q5. What documents are required for TPA registration?
The required documents may vary but generally include incorporation certificates, financial statements, and other regulatory compliance records.
Conclusion
Registering as a health insurance third party administrator is a bold step toward inclusiveness and authority. While being compliance-intensive, becoming a TPA presents a firm with endless growth opportunities thanks to the ever-evolving insurance sector. Adherence to IRDAI norms is paramount when it comes to securing IRDAI approval for TPA. Thus, pay extra attention to every detail in the guide before you go all cylinder firing. In case of any confusion or legal quandaries, feel free to connect with Adviso- your trusted compliance partner.
Also Read: IRDAI Health Insurance Regulations: A Comprehensive Guide
