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Third Party Administrators

Insurance industry in India has seen lot of changes since the opening of the sector for private participation. Industry has witnessed entry of a plethora of companies and is to witness many more to foray. There has been a lot of innovation both on the products front and also on service front. Innovation on the service front include providing call centre facilities, providing personalized financial planning tools and the best thing to happen on the service front is introduction of third party administrators.

Third party administrators are the new breed of intermediaries in the sector, introduction of whom will benefit both the insured and the insurer. While the insured is benefited by better service, insurers are benefited by reduction in their administrative costs. But the questions in everybody's mind are - what does a TPA do? Who can be a TPA? What is his source of revenue? How does he benefit the insured? To find answers for all these and many more read onů.

Introduction of Third party administrators comes as a succor to the insurance companies which have been searching for ways and means to get their management expenses in line with the specifications laid down by IRDA. Insurers can now outsource their administrative activities, including settlement of claims, to Third party administrators, who offer such services at a cost. It may be noted that TPAs are remunerated by the insurers and so policy holders should welcome such a move since they receive enhanced facilities at no extra cost. Once the policy has been issued, all the records will be passed on to the TPA and all the correspondence of the insured will be with the TPA.

To put in short, the job of the TPA's is to maintain databases of policyholders and issue them identity cards with unique identification numbers and handle all the post policy issues including claim settlements. In terms of infrastructure, the TPA's run a 24-hour toll-free number, which can be accessed from anywhere in the country. And they will have full-time medical practitioners under their employment who will immediately take a decision on whether the ailment is covered under the policy.

TPA license can be granted to any company registered under the companies Act 1956. IRDA, which licenses and regulates these TPAs, has specified stiff entry norms some of which include a minimum capital requirement of 1 Crore, capping the foreign equity at 26% etc. License is usually granted for a period of 3 years. For complete details of TPA regulation issued by IRDA, Please click on the following link:

Third party administrators regulations

Presently TPA licenses are issued to render health services. It is hoped that effectively this will lead to cash less hospitalisation services. In contrast to earlier scenario where the insured is reimbursed all the hospitalisation expenses, in the present scenario TPA would tieup with the hospitals and all the hospitalisation services would be on cash less basis. Below is an overview of the activities of TPA

To offer their services TPAs, after getting license have to forge alliances with insurers. To this extent TPAs have no role to play if they are not empanelled by Insurers. As discussed earlier TPAs will be remunerated by insurers and remuneration shall be fixed on a mutually agreeable terms. However IRDA has laid down a maximum ceiling on the commission that can be given to a TPA, which presently stands at 15% of premium amount. TPAs shall also have to tie-up with hospitals, which offer hospitalisation services. Further each TPA may tie-up with any number of insurers and like wise each insurer can empanel any number of TPAs.

The above relates to roles and activities of a TPA in case of medical insurance policies. However, in the days to come, TPA services may well be extended, but not limited, to the following:


Licensed TPAs in India
Company Contact Person/ Address Telephone No.
Dawn Services Pvt. Ltd.
(Licence No. 001)
Dr. R. Suresh Kumar
Managing Director & CEO
Plot No. 37,
Santoshima Colony,
Westmarredpally,
Secunderabad 500026.
27808810
27808809
Fax.: 040-7801813
Parekh Health Management (Pvt.) Ltd.
(Licence No. 002)
Mr. Nimish R. Parekh,
Chief Executive Officer,
The Forum, 2nd Floor,
Raghuvanshi Mills Compound, 11/12,Senapati Bapat Marg,
Mahalakshmi
Mumbai - 400 013
4611022/3/4
Fax: 022-4611021
Medi Assist India Pvt. Ltd. (Licence No. 003) Mr. Ganesh Subramaniam
Director
4/1, Devaiah Court,
1st Floor, 22nd Cross,
Jayanagar, 3rd Block,
Bangalore - 560 011
6538790/91/92
Guardian Health Management Pvt. Ltd.
(Licence No. 004)
Dr. Olinda Timms
Managing Director & CEO
Ground Floor, KSCMF Bldg. No. 8,
Cunningham Road,
Bangalore - 560 052
2204643
2265744
MD India Healthcare Services (Pvt.) Ltd.
(Licence No. 005)
Mr. Brij Sharma
Chief Executive Officer
261/2/7, Silver Oak Park,
Baner Road, Pune - 411 045.
020-7292040 - 43
Paramount Health Services Pvt. Ltd.
(Licence No. 006)
Dr. Nayan Shah,
Managing Director
81, Barodawala Mansion,
Dr. Annie Besant Road,
Worli Naka,Mumbai - 400 018
Tel.: 022-4620800
Fax.: 022-24985507/08
E Meditek Solutions Ltd.
(Licence No. 007)
Mr. Gopal Verma
Managing Director
B-231 C, Greater Kailash Part - I
New Delhi - 110 048.
Tel.: 011-26430885,
26430884
Fax.: 011-26430886
Heritage Health Services Pvt. Ltd.(Licence No. 008) Mr. S. K. Bajoria
Director
McLeod House,
3, Netaji Subhash Road,
Kolkata - 700 001.
Tel.: 033-22482411
Universal Medi-Aid Services Ltd.(Licence No. 009) Mr. G. P. Sureka
Chief Executive Officer
1104, Akashdeep,
26A, Barakhamba Road,
New Delhi - 110001
Tel.: 011-51515197-99
Medicare Foundation Pvt. Ltd. (Licence No. 010) Mr. Akshay Jain
Chief Executive Officer
1120, Housing Board Colony
Porvorim, Alto Betim,
Goa - 403 521
414006
Tower Insurance Services Pvt. Ltd.
(Licence No. 011)
Ms. M S Mahindra,
Chairman
519 Maker Chamber V,
Nariman Point,
Mumbai - 400 021.
22844364/56338492
Medicare TPA Services (I) Pvt. Ltd.
(Licence No. 012)
Brig D J Ghoshal (Rtd)
Director
Flat No 10, Paul Mansions
6, Bishop Lefroy Road,
Kolkata - 700 020.
033-2873385
Family Health Plan Ltd.(Licence No. 013) Mr. A.P.V. Reddy
Chief Executive Officer
34, Sai Enclave,
1st Avenue
Road No. 12, Banjara Hills
Hyderabad - 500 034..
23371167
55510102
ICAN Health Services Pvt. Ltd.(Licence No. 014) Mr. Thomas Mathew
Executive Director
A-9/2, Meera Nagar,
Koregaon Park
Pune - 411 001..
Tel.:020-4001171,2,3
M/s. Raksha TPA Pvt. Ltd.
(Licence No. 015)
Ms. Ritu Nanda
Director
A-1, Friends Colony (E)
New Delhi - 110065
6821618
6447603
M/s TTK Healthcare Services Private Limited
(Licence No. 016)
Shri Girish Rao
Executive Director
202, II Floor, Raheja Chambers,
No. 12, Museum Road,
Bangalore - 560 001.
51155030
M/s Anyuta Medinet Healthcare Pvt. Ltd.
(Licence No. 017)
Dr.N. Ravindra Shetty
Director
65, Lavelle Road,
4th Cross,
Bangalore - 560 001.
2214766
2210205
M/s East West Assist Pvt. Ltd. (Licence No. 018) Dr. N P S Chawla
Managing Director
37, Prithviraj Road,
New Delhi - 110 011.
4699229
4623738
M/s. Med Save Health Care (Licence No. 019) Mr.Rajan Subramaniam
Chief Executive Officer
B-11/99 Mohan Co-operative Industrial Estate,
Badarpur,
New Delhi -110044.
26611061-66
M/S Genins India Ltd.
(Licence No. 020)
Mr. Rakesh Kapoor
Managing Director
41, Arun Vihar
Sector - 37,
NOIDA - 201 303
4430329/139
Alankit Healthcare Pvt. Ltd. (Licence No. 021) Mr. Alok Kumar Aggarwal
Director
234, DDA Office Complex
Jhandewalan Extension
New Delhi - 110055
23540641
23614186
M/s. Bhaichand Amoluk Insurance
Services Private Ltd.
(Licence No. 022)
Commercial Union House, 2nd Floor,
9, Wallace Street Fort
Mumbai - 400 001
022-22077212
22077213
Good Healthplan Limited
(Licence No. 023)
Mr. M. Venkateswarlu,
Chief Executive Officer
Flat No. S-2, 6-3-903/3/2,
Vasavi Ville Apartments,
Rajbhavan Road,
Somajiguda,
Hyderabad - 500 082
040 - 3312163


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