Monday, May 13, 2024
Choose your TPA
Irdai has allowed policyholders to choose a TPA of their choice while buying or renewing a health insurance coverage plan.Under the Insurance Regulatory and Development Authority of India (Third Party Administrators - Health Services) (Amendment) Regulations, 2019, Irdai has asked health insurance companies to provide a host of TPAs to policyholders at point of sales. Buyers will decide a TPA according to their need.But policyholders are only allowed to change a TPA of their choice at the time of renewal. The insurer will limit the number of TPAs based on product and geographical location of the policyholders.
1) "The policyholder can choose a TPA of their choice from amongs the TPAs engaged by the insurer," said the regulator.
2) The policyholder can only choose TPA from the names provided by the health insurers at the time of buying the policy or renewing the policy.
3) If a policyholder does not choose any of the TPAs provided by the insurance company, the insurer will have the right to allot a TPA of its choice.
4) The policyholder shall have no right to seek dispensing of the services of the TPA and request the insurer to undertake rendering the health service directly, said Irdai.
5) If a TPA service is terminated during health coverage, the insurer must allow the policyholder to choose an alternate TPA.
6) If the insurer engages the services of only one TPA, no option will be provided to the policyholders.
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