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| | | What is TPA? | | TPA stands for Third Party Administrator. A TPA is a specialized health service provider rendering variety of services like networking with hospitals, arranging for hospitalization and claim processing and settlement. The concept of TPA has been introduced by the IRDA (Insurance Regulatory and Development Authority of India) for the benefit of both the insured and the insurer. While the insured is benefited by quicker & better health service, insurers are benefited by reduction in their administrative costs, fraudulent claims and ultimately bringing down the claim ratios. An insurance company can have more than one TPA and a TPA can serve more than one insurance company. | | top |
| | | What are the scope of services of TPAs? | The scope of services of TPAs include:
 | Maintain database of policyholders |
| Issue of identity card to all policyholders |
| Provide ambulance service |
| Provide information to policyholders about hospitals. |
| Check various investigations |
| Provide Cashless service |
| Process claims |
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| | | Who can become a TPA? | According to the Insurance Regulatory Development Authority (IRDA) regulation,
| A company with a share capital and registered under the Companies Act, 1956 can function as a TPA. |
| The minimum paid up capital of the company shall be in equity shares amounting to Rs 1 crore. The working capital should not be less than Rs 1 crore at any point of time. |
| At least one of the directors of the TPA shall be a qualified medical doctor registered with the Medical Council of India. |
| The aggregate holdings of equity shares by a foreign company shall not exceed 26% of the paid up equity capital of a TPA. |
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