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Health Insurance Third Party Administrator (TPA) of India — set up to exclusively manage health claims of public general insurers — is set to begin operations on July 1.
Senior officials involved in its operations said the company was setting up software processes and hiring personnel. In its first year, it would have about 100 employees. Public general insurers have also deputed people to help with the launch
“In the first year, we shall do 15-20 per cent of the business from the four public general insurers. This will be scaled up, depending on the how the TPA takes shape,” an official said.
While the TPA launch is on July 1, testing of systems would begin much earlier. Last year, the TPA got its licence from the Insurance Regulatory and Development Authority of India (Irdai). TPA licences are valid for three years from the date of issue or renewal.
The TPA had earlier run into trouble after the Competition Commission of India (CCI) had ordered an investigation by the CCI director-general, into alleged anti-competitive practices of General Insurers’ (Public Sector) Association of India.
This common TPA to process health claims has National Insurance Company, New India Assurance Company, United Insurance Company, Oriental Insurance Company and General Insurance Corporation of India as stakeholders.
The first four have 23.75 per cent stake each and GIC has five per cent. This TPA will look into health claims and handle claims received by these public general insurers.
It has been set up to prohibit large-scale leakages, while settling insurance claims in the health segment. Further, it is intended to process claims of public general insurers in-house, rather than handling by an external agency.
Health Insurance TPA shall provide end-to-end ‘health services’. This would include member enrolment, call centre, customer service and grievance management, pre-authorisation and claims processing.
Further, it would also be involved in provider network empanelment, verification and investigation, pre-policy health check-up and facilitate customer awareness and wellness programmes.
Health insurance loss ratios range from 95 to 100 per cent, depending on the size of the company. Loss ratios refer to the ratio between premiums collected and claims paid. However, with stiff competition in group health portfolio with aggressive discounts given to retain customers, the losses have been on the rise.
An external TPA handling claims will add to the costs, hence public general insurers went in for a common TPA. However, till it is operationalised, losses are expected to continue.
The company shall provide services to support all types of health insurance policies sold by insurance companies in India. This includes individual, family floater, group covers, mass schemes, indemnity and fixed benefit.
Those in the sector said this common TPA was expected to hasten the claim-settlement process, as well as reduce the claims ratio of insurance companies. This move is expected to reduce costs for these insurance companies, which pay a commission of approximately six per cent of premiums to TPAs to settle claims.
Senior officials involved in its operations said the company was setting up software processes and hiring personnel. In its first year, it would have about 100 employees. Public general insurers have also deputed people to help with the launch
“In the first year, we shall do 15-20 per cent of the business from the four public general insurers. This will be scaled up, depending on the how the TPA takes shape,” an official said.
While the TPA launch is on July 1, testing of systems would begin much earlier. Last year, the TPA got its licence from the Insurance Regulatory and Development Authority of India (Irdai). TPA licences are valid for three years from the date of issue or renewal.
The TPA had earlier run into trouble after the Competition Commission of India (CCI) had ordered an investigation by the CCI director-general, into alleged anti-competitive practices of General Insurers’ (Public Sector) Association of India.
This common TPA to process health claims has National Insurance Company, New India Assurance Company, United Insurance Company, Oriental Insurance Company and General Insurance Corporation of India as stakeholders.
The first four have 23.75 per cent stake each and GIC has five per cent. This TPA will look into health claims and handle claims received by these public general insurers.
It has been set up to prohibit large-scale leakages, while settling insurance claims in the health segment. Further, it is intended to process claims of public general insurers in-house, rather than handling by an external agency.
Health Insurance TPA shall provide end-to-end ‘health services’. This would include member enrolment, call centre, customer service and grievance management, pre-authorisation and claims processing.
Further, it would also be involved in provider network empanelment, verification and investigation, pre-policy health check-up and facilitate customer awareness and wellness programmes.
Health insurance loss ratios range from 95 to 100 per cent, depending on the size of the company. Loss ratios refer to the ratio between premiums collected and claims paid. However, with stiff competition in group health portfolio with aggressive discounts given to retain customers, the losses have been on the rise.
An external TPA handling claims will add to the costs, hence public general insurers went in for a common TPA. However, till it is operationalised, losses are expected to continue.
The company shall provide services to support all types of health insurance policies sold by insurance companies in India. This includes individual, family floater, group covers, mass schemes, indemnity and fixed benefit.
Those in the sector said this common TPA was expected to hasten the claim-settlement process, as well as reduce the claims ratio of insurance companies. This move is expected to reduce costs for these insurance companies, which pay a commission of approximately six per cent of premiums to TPAs to settle claims.
