Concept of Third party Administrators
The Concept of Third party Administrators Focus Health Insurance TPA Private Limited has been introduced by IRDA (Insurance
Regulatory and Development Authority) for the benefit of insured and the insurer.
The insurer would get the benefit of transparent hassled free and better services
and insurers to be benefited by the reduction of administrative costs, better claim
management resulting in bringing down the claim cost with batter services to the
TPA maintains insured‘s database by issuing unique identification photo id card
and would manage all the claims in the post policy period. TPA’s are required to
run 24 hours toll free numbers accessible from any location in India. They would
employ trained personals and doctors who are conversant with the claim procedures
as well as insurance policies terms and condition.
The policy holder would have the choice of availing treatment in the best of hospitals
selected by him out of all the empanelled hospitals list and avail the hassle free
treatment .this can be done in case of Emergency by providing photo ID card to get
admission in the hospital. The hospital sends the necessary details along with ID
card to TPA to get the cashless facility. At the time of discharge the bill is settled
by TPA as per the terms and conditions of the mediclaim policy and one has to pay
only for those services, items which are not covered under the policy or if the
bill exceeds the benefit (sum insured), thus providing cashless treatment to the
insured .The insured has no worry for arrangement of money in emergency cases.