The Need for TPA Entities to Process Claims in Health Insurance

Health insurance
Image source - Moneycontrol

It has been seen that before CY2000, the health insurance industry that is present in the country was said to be confined to a few basic insurance plans. With this liberalization particularly in this section by the government, the galaxy of the private insurance companies has entered the arena as well as they have revolutionized the entire industry along with the innovative plans as well as operational methods.

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These methods are said to be helping a large population of the citizens who have been keen to grab the opportunity. It has ushered in an era of customized health insurance protection which is backed by this excellent service.

Health insurance is said to be the contract that exists between you with an insurance company. The company will be bearing all the expenses in the hospital in this event of future medical emergencies that includes accidents. These things happened against a premium for a fixed tenure which is generally a year, and it is required to get renewed every year.

It has been seen that there are different types of health insurance plans like individual health insurance, group insurance plan as well as family floater insurance plans. This type of health plans which have been many variants that you need to analyze about the needs which help in buying a plan.

In the case of a medical emergency, you can get something yourself in the hospital as an in-patient. If you have covered this under the health insurance, then the expenses are said to be borne by the insurance company. There are said to be two methods of payment which are said to be few exceptional features that are available in some policies. They are cashless transactions as well as reimbursement.

Currently, the high penetration, the diversity of health insurance plans along with the complexities of rendering the service is said to be the consistently high quality that is necessitated the need for the professional organizations that is capable of managing the myriad operations of all the health insurance industry.  All the third party administrations are said to be outsourcing the entities that will hold the license which will be issued by the IRDA to provide the management solutions to the industry. They are now able to act as the intermediaries in the system.

The TPA concept has introduced by the IRDA in the year 2001.


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