TPA Documents
TPAs play a key role in simplifying hassles pertaining to claims of health insurance products. From claim processing to pre-insurance medical examinations, Third-Party Administrator (TPA) caters to a range of tasks that ease the blow for insurers. To operate as a TPA, one must fulfill the multitude of compliances enacted by the apex regulator viz. Insurance Regulatory and Development Authority of India (IRDAI). Arranging TPA documents and following registration procedures are among the standard requirements that need to be met mandatorily. This article sheds light on various aspects of TPA registration, including eligibility, fees, and documents. Read on to solidify your understanding of this registration so that you can proceed with legalities easily.
Who is a TPA?
A Third-Party Administrator (TPA) is an IRDAI-registered entity that for a fee or commission provides a range of health-related services on behalf of the insurer. These services include pre-insurance medical examinations, claim servicing, hospitalization, etc. TPAs’ operations are framed as per the Insurance Regulatory and Development Authority of India (Third Party Administrators- Health Services) Regulations, 2016, ensuring transparency and good corporate governance.
Health Services Provided by TPAs
TPAs render a slew of health-related services. These include:
- Claims Servicing: Under this, TPAs ensure seamless claim processing as per the health insurance policies, be it reimbursement-based or cashless.
- Hospitalization Cover Claims: TPAs also cater to claims concerning hospitalization under personal accident or domestic travel policies.
- Pre-Insurance Medical Examinations: TPAs ensure hassle-free medical check-ups for underwriting health insurance policies.
- Foreign Travel Policies: Addressing health service concerns for overseas travel policies issued by the Indian insurers.
- Travel or Medical Insurance for Foreign Insurers: Resolving critical matters concerning matters relating to policies issued by overseas insurers to individuals coming to India.
By ensuring hassle-free services, TPAs benefit both insurers and policyholders. From easing the blow for individuals seeking hassle-free claim processing or hospitalization to streamlining insurers’ operations, TPAs reinforce a fertile ground for the health insurance sector for augmented growth.
Essential TPA Documents for Registration
The success of a TPA registration process heavily depends on the accuracy of the documents as they help reinforce the firm’s and individuals’ legitimacy. In general, the following TPA documents come into play when applying for IRDAI approval.
- Certificate of Incorporation: It is a vital document as it confirms that an entity is registered under the Companies Act, 2013.
- Memorandum and Articles of Association (MOA & AOA): These documents are referred to as founding documents that outline various aspects of the firm, including objective, rules, obligations, management hierarchy, directorship, share disbursement, capital, etc.
- Board Resolution: A resolution passed by the board of directors (BOD), confirming to apply for TPA registration.
- Shareholding Pattern: Details about the firm’s shareholding structure to ensure adherence to financial requirements.
- Audited Financial Statements: Audited balance sheets and profit and loss statements for the last three years, illustrating profitability with zero deficit.
- Net Worth Certificate: A certificate issued by the CA, confirming the firm’s net worth complies with the minimum threshold of Rs 1 crore.
- Details of Directors and Key Management Personnel:
- Names, qualifications, and experience of the company’s directors and officers.
- PAN and Aadhaar copies of the directors for verification.
- Foreign Investment Documents (if applicable): Details pertaining to the overseas investment in the company as well as the compliance with the regulatory body’s norms.
- Proof of Paid-Up Capital: Bank statements and key financial dossiers illustrating a paid-up equity share capital worth Rs 4 crores.
- Health Services Agreement: Draft agreement outlining the services proposed to be provided by the TPA to insurers.
- Declaration of Compliance: A signed declaration illustrating compliance with the IRDAI’s operational norms and guidelines.
The accuracy of these TPA documents will define how quickly and seamlessly one will receive the IRDAI approval.
Requirements for Registering as a TPA
Once you have curated the required TPA documents, it is time to comprehend the registration requisites set forth by the IRDAI. Some frontline registration norms include:
- Corporate Entity: Companies with registration under the Companies Act, 2013 are only the fit to apply for this registration.
- Exclusive Business Activity: The company’s sole object revolves around facilitating health services as a TPA. Engagement with any other businesses is not permissible.
- Naming Requirement: The company’s name should reflect the terms viz. ‘Insurance TPA’, reinforcing the focus on health services.
- Financial Requirements:
- Paid-Up Capital: A minimum paid-up equity share capital should not be less than ₹4 crores.
- Net Worth: The net worth should not be less than 1 crore at any time during the registration period.
- Foreign Investment Compliance: Fulfillment of investment norms and IRDAI guidelines is paramount to stay compliant before and after registration.
Application Process Concerning TPA Registration
The common steps involved in TPA registration are as follows:
Step 1: Head to the IRDAI’s BAP Portal to register with the authority. Use the valid credentials for this purpose.
Step 2: Explore the TPA options available on the main menu.
Step 3: Open the prescribed application and fill it out with valid information.
Step 4: Upload the mandatory TPA documents in a format recommended by the authority.
Step 5: Pay the non-refundable processing fee of ₹1,00,000/- plus applicable taxes.
Step 6: IRDAI shall vet the dossiers for compliance and accuracy and based on the assessment grant their approval. The grant of approval shall invite a payment of a registration fee of ₹2,00,000/- plus applicable taxes, upon which the Certificate of Registration is granted.
Fee Structure
The fees associated with TPA registration are as follows:
| Payment Category | Amount Payable (₹) |
| Processing Fee | 1,00,000/- |
| Registration Fee (3 years) | 2,00,000/- |
| Renewal Fee (Once in 3 years) | 1,50,000/- |
Renewal of TPA Registration
Once registered, a TPA registration shall stay valid for three years. The renewal of the registration is paramount upon the completion of this tenure. The renewal shall be provided only after the submission of the prescribed application, applicable documents, and a fee amounting to Rs 1,50,000/- plus applicable taxes.
Conclusion
Registering as a Third-Party Administrator requires a deliberate approach involving a careful drill down of compliances and documents. From eligibility criteria and management requisites to financial requirements, one has to keep a tab on every aspect when applying for IRDAI approval.
If adhering to these requirements seems daunting, connect with a professional firm like Adviso, a pioneer in legal consultancy services. With over a decade of experience, Adviso takes pride in simplifying legalities for clients so that they can focus on things that matter.
Also Read: IRDAI Corporate Governance Guidelines: A Comprehensive Overview
