TPA in Health Insurance

A health insurance TPA (Third Party Administrator) is an IRDAI-licensed intermediary that helps manage health insurance services, especially claims. The TPA acts as a link between you and your insurance company to coordinate with hospitals, verify policy details and facilitate the claim approvals. This is particularly helpful during cashless hospitalisation, where the TPA makes sure your bills are settled directly with the least hassles.

Here are a few key things to know about TPAs in health insurance:

• According to the new IRDAI rules, **customers can select a TPA** when purchasing or renewing their health insurance plan. 
  

• TPAs **handle documentation**, check policy details and make the claim process smooth.
  

• They are **licensed by IRDAI**, which means they are officially approved and regulated.
  

• They **work with multiple** insurers, so one TPA may serve several insurance companies.
  

Also Read: TPAs in Group Health Insurance

The role of TPA in health insurance is to act as a licensed service intermediary that manages key processes like claim verification, hospital coordination and customer support. A good health insurance TPA can make your entire cashless claims experience faster, smoother and more transparent.

• **Claim Verification:**
  

When a hospital sends your claim, the TPA reviews all bills, documents and forms to verify their authenticity. They may contact the hospital or you directly to ensure details are accurate and prevent fraudulent claims.

• **Claim Settlement:**
  

TPAs coordinate with hospitals to process cashless claims at all authorised hospitals. For reimbursement claims, they verify documents and process refunds within timelines. A good health insurance TPA ensures timely action without delays.

• **Continuous Support:**
  

Most TPAs offer round-the-clock customer support through call centres, chatbots, emails and mobile apps. They help you check claim eligibility, claim status, policy terms and more during hospitalisation or emergencies.

Note: Whether it is about checking your claim status, understanding policy benefits or getting support during hospitalisation, TATA AIG is your main point of contact. While TPAs work behind the scenes to process claims and handle coordination, it is the insurer that guides and updates you throughout the process.

• **Record Keeping:**
  

TPAs also maintain a systematic record of all treatment-related documents, hospital bills and claim forms associated with the policyholder. These records can be accessed whenever needed, whether for future claims, renewals or reference purposes.

• **Delivers the Health Cards:**
  

Although your insurance company issues the health card, the TPA generates and dispatches it to you after policy issuance. It also keeps a record of all the health card data which can be used during claims.

• **Cost Management and Transparency:**
  

TPAs effectively manage healthcare costs by analysing claim trends, negotiating treatment rates with hospitals and identifying areas where costs can be optimised. They may also offer tools and reports that allow policyholders to track usage patterns and make informed decisions.

• **Assists with Pre-Policy Medical Tests:**
  

If your health insurance policy requires a medical test before approval, the TPA helps arrange and coordinate the examination with a diagnostic centre.

• **Supports International Health Claims:**
  

For travel or health insurance policies that cover treatment abroad, the TPA helps with claim processing and coordination for medical services received outside India.

Also Read: Health Insurance Claims Process: Cashless and Reimbursement

In Case of Cashless Treatment

Suppose Rohan has a health insurance policy and needs to undergo surgery. He visits an authorised hospital.

• The hospital shares Rohan’s treatment details and estimated costs with the TPA.
  

• The TPA checks if the treatment is covered under his policy and whether his claim is eligible.
  

• If all is in order, the TPA provides the hospital with pre-authorisation.
  

• Rohan gets treated without paying anything upfront.
  

• The hospital sends the final bill directly to the TPA, which settles it with the insurer.
  

In Case of Reimbursement Treatment

Now, imagine Meera goes to a hospital for emergency treatment

• Meera pays for the treatment out of her pocket.
  

• After discharge, she submits all bills and documents to the TPA.
  

• The TPA verifies the documents and checks her policy coverage.
  

• They forward the approved claim to the insurer.
  

• Once approved, Meera gets the money back via bank transfer or cheque.
  

At TATA AIG, we go a step further to support you during medical emergencies. We have a strong network of hospitals across the country that offer quicker and more streamlined claim processing. We also offer cashless hospitalisation at non-network (but authorised) hospitals with our Cashless Everywhere feature. This ensures that you can get the care you need, even if the hospital is not formally part of our network.

In most cases, policyholders first look for a trusted insurance provider, and that is a smart move. With TATA AIG, you can rest assured knowing that we only work with experienced and IRDAI-approved TPAs.

If you get to choose from a few of our empanelled TPAs and you are unsure which one to go with, here are a few tips to help:

• **Customer Support Quality**: A responsive and helpful TPA can make a huge difference during emergencies. Look for one that is known for good communication and quick assistance.
  

• **Claim Handling Record**: Choose a TPA with a proven track record of processing claims fairly and on time.
  

• **Speed of Service**: Verify whether the TPA is recognised for its fast approvals and minimal documentation back and forth.
  

• **Hospital Coordination**: A TPA with strong hospital coordination can make your entire hospitalisation process smoother and less stressful.
  

Remember, while TATA AIG is your main point of contact, the right TPA can make your claims experience much easier.

IRDAI updates the health insurance TPAs on a regular basis. You can check their details on the official website of the Insurance Regulatory and Development Authority of India (IRDAI) for the year 2025.

Here is the latest licenced health insurance TPA hospital list of TATA AIG:

If you are not satisfied with the services of your current TPA (Third-Party Administrator), you can request a change through TATA AIG. TPAs act as service coordinators, and if there is a delay or issue with service, we can step in to assist.

Here is how you can cancel or switch your TPA:

• [Get in touch](https://www.tataaig.com/contact-us) with us through our Helpline, or you can visit the nearest TATA AIG branch. 
  

• Provide your policy number, personal details and any unique identification number (UID) issued with the TPA card.
  

• Clearly explain why you want to cancel or change the TPA. It could be due to poor service, delays or preference for another TPA.
  

• You will be presented with a list of available TPAs, and you can choose the one that best suits your needs.
  

• Once the switch is approved, make sure you receive a written confirmation or updated documents with the new TPA details.
  

The best TPA for health insurance plays a vital role in making your health insurance journey smooth and hassle-free. From helping with documentation and settling claims to offering 24x7 support and maintaining records, TPAs act as the bridge between you and your insurer.

At TATA AIG, our health insurance plans are designed to offer wide coverage and convenience, whether through our large network of hospitals, easy claim process or added benefits.

You can enhance your policy with our Global/Worldwide Cover to get treatment for covered illnesses even if you choose to get hospitalised abroad. You also enjoy a Cumulative Bonus of 10–50% for every claim-free year, giving you more coverage at no extra premium cost.

Explore our plans today and experience health insurance that is built around your needs - with care, clarity and trust.