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Changes made in TPAs Health Norms

Published on July 10, 2019
Current Context: Insurance Regulatory and Development Authority (IRDAI) has introduced changes in the regulation governing TPA (Third-Party Administrators)-Health Services
Changes made in TPAs Health Norms

Changes:

  • The IRDAI has proposed to allow the policyholders to choose the TPA of their choice among the TPAs engaged by the insurers
  • It has also introduced changes in the regulatory provisions
  • TPAs would not be allowed to discuss matters of health services directly to the policyholders or prospects
  • The policyholder will choose the TPAs from the names of the TPAs explicitly provided by the insurers
  • The policyholders will be allowed to change the TPA only at the point of renewal
  • No option will be given to the policyholder if the insurer engages only one TPA

About Third Party Administrator (TPA):

  • A TPA is an organization that administers group insurance policies for an employer. It works in processing claims and determining eligibility and allow the employer and the insurer to communicate information between the two
  • The introduction of TPAs in the health insurance sector was in 2001

Question: 

Q.1 With respect to the changes made by IRDAI in the regulation of TPAs, which is the correct statement?
a. Policyholders can change TPAs any time
b. Policyholder can have many options to choose even If the insurer provides only one TPA
c. TPAs are not allowed to discuss service matters with policyholders
d. Policyholders can choose TPAs apart from insurer’s option
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