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What is a TPA?
A TPA (third-party administrator) is an independent organization that assists policyholders in processing their insurance claims. TPA Insurance bridges the gap between the insurance company and the policyholder.
What is TPA in Health Insurance?
A third-party administrator acts as a point of contact between the health insurance company and its policyholders. They help to develop the insurers' hospital network and take care of the policyholders' hospital bills and other medical expenses.
Types of TPA Insurance Plans in the UAE
Health Insurance TPA
This plan provides assistance related to health insurance policies. This includes services such as claims management, managing the relationship with healthcare providers, and maintaining the hospital network.
Motor Insurance TPA
This insurance plan supports all your motor insurance claims. It includes services like claims processing, verification & assessment of damages, and coordinating with motor garages & workshops.
Travel Insurance TPA
A travel insurance TPA offers services related to travel insurance policies. This includes managing claims, verifying & reimbursing claims related to medical emergencies, lost baggage, trip cancellations, etc.
Property Insurance TPA
This plan provides assistance to process property insurance claims. They support policyholders in filing claims, assessing property damages, handling their repairs or replacements, and settlement of claims.
Liability Insurance TPA
A liability insurance TPA provides support in respect of liability insurance policies. This includes claims such as general liability, professional liability, and product liability. They support the filing, verification, negotiation, and settlement of liability insurance claims.
The availability and features of TPA insurance plans may vary among insurance companies in the UAE. It is recommended to review the policy terms, coverage, and services provided by the TPA and confirm that they meet your specific requirements.
Role of TPA in Health Insurance
Smooth Processing & Settlement of Claims
The key responsibility of a TPA is to verify, process, and then settle the medical claims raised by policyholders. The claims are settled either on a cashless basis or on a reimbursement basis. A TPA verifies all the documents submitted in favor of the claim. It can also ask the policyholders or hospitals to provide additional details if required.
Issuing Health Cards to the Policyholders
A health card validates the issuance of the policy to the insured. It is an authorized document containing the details of the policy and the policyholder. This card has to be presented to the hospital at the time of admission to initiate the processing of claims.
Building a Strong Hospital Network
A third-party administrator helps insurance companies to build a wide network of hospitals. It plays a key role in enlisting the best hospitals that can provide cashless treatments and negotiates the pricing of healthcare services.
Maintaining Proper Records
A health insurance TPA is also responsible for maintaining the details of the policyholders and their claims. This helps to ease the burden of preserving voluminous records by the insurance companies for future reference.
TPAs have full-fledged support teams to provide assistance to the policyholders on any matter related to their medical insurance claims. Most TPAs have a 24X7 helpline facility for the benefit of the policyholders.
Other Value-Added Services
Many of the TPAs provide certain value-added services like specialists’ consultations, wellness programs, ambulance services, etc
Benefits of a TPA in Health Insurance
The hospital admission procedure becomes smooth & seamless through a TPA.
A TPA facilitates quick and direct settlement of cashless claims without troubling the policyholder. The process is streamlined due to the standardization of the claims procedure.
A TPA ensures that the claims documents submitted to the insurer are in order.
TPAs render round-the-clock customer service to assist the policyholders in claims settlement and other queries.
TPAs help insurance companies to eliminate fake and inflated claims. They also support the insurers in efficiently managing a large number of claims.
How Does a TPA Help the Policyholders?
The primary responsibility of a health insurance TPA is to process and settle medical claims. So it acts as an intermediary between the insurer and the insured. TPAs provide continuous support to the policyholders during the entire period of hospitalization.
Policyholders can avail of a cashless facility if they choose a network hospital for medical treatments. The TPAs carefully check and verify the claims documents and bills. If the claim is admissible, the bills are paid directly to the hospital. TPA services are very helpful during medical emergencies as policyholders need not struggle to arrange funds.
But the policyholders will have to file a claim for reimbursement if they choose a hospital outside the insurer's network. Here, the insured need to pay the bills at the hospital and then get reimbursed by the insurer.
How to Choose a TPA Insurance Plan In UAE?
Assess Your Needs
You must clearly know the type of insurance coverage that you need, such as health insurance, property insurance, liability insurance, etc. Please evaluate your requirements in terms of the policy coverage amount, benefits, and premiums payable.
Compare Insurance Providers
You must only select licensed players with a distinguished track record in the industry. Check their plan options, ratings & reviews, and financials before you zero in on a TPA insurance plan.
Features & Benefits
Study the features and benefits of a TPA insurance plan in detail before you buy. Choose a plan that meets your specific requirements. Know the exclusions and the scope of coverage.
Check the TPA’s competency and efficiency in processing your claims. Fast and easy settlement of claims is essential in respect of TPA insurance.
Select a plan that provides optimal insurance coverage and also fits your budget. It should provide comprehensive coverage at a reasonable price.
Frequently Asked Questions on TPA Insurance
A health card issued by a TPA ensures that the policyholders and their family members get cashless treatment at any of the network hospitals. So they need not pay their medical bills at the hospital and later claim reimbursement from the insurance company.
A network hospital in health insurance TPA is a hospital that is empaneled to provide a cashless treatment facility to the policyholder. These hospitals have an agreement with the insurance company/TPA for providing this facility.
No. You need not pay any money to the TPA for their services. You only pay the premium to the insurer to buy a health insurance policy.
The third-party administrator (TPA) is hired by the health insurance company for assistance in claims verification, processing, and settlement.
No. It’s not necessary for every health insurance company to have a TPA. Many companies do have their own in-house claims management team.
Disclaimer: The TPA insurance policy or plan may have limitations, exclusions, and other terms & conditions that may affect coverage. It is important to carefully review the policy wording before making any decision.