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ICICI Lombard Expert Blog

This Is How IRDAI Is Planning to Offer You More Freedom Regarding Health Insurance

July 09 2019

The Insurance Regulatory and Development Authority of India (IRDAI) has brought about multiple changes related to the third-party administrator (TPA) for health insurance policies. The policyholders can now choose the TPAs of their own choice regarding their health plans.

policyholder health insurance

Health insurance policyholders may get the option to choose TPAs

From administering services to settling claims, TPAs provide a wide range of services to the policyholders in the health insurance segment. They play the role of a facilitator and act as an important link between the insurance company they represent and the network hospitals.

With an aim to increase the competition amongst the TPAs, IRDAI has put forth a proposal to allow policyholders to choose their TPAs from those engaged by the insurance company. If a particular insurance company engages only one TPA, then it does not need to offer an option to the policyholder. Further, the insurer will allow the policyholder to change the TPA only at the time of policy renewal.

It is important to note that TPAs are not given the right to promote their business by providing health services directly to the policyholders or prospective health insurance buyers. Rather, at the time of the sale of a policy, the insurance provider needs to explicitly provide the list of TPAs from which the customer can choose from.

The IRDAI has also proposed a rise in the fees it levies on TPAs, which has remained unchanged since 2001 – when the concept of TPAs was introduced in the health insurance sector. The authority has proposed to hike the non-refundable processing fee to Rs. 1 lakh from Rs. 20,000, the registration fee for new applicants to Rs. 2 lakh from Rs. 30,000, and the renewal application fee to Rs. 1.5 lakh from Rs. 15,000.

*Source: The Hindu

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