Third Party Administrators or TPAs strengthen the infrastructure of the health insurance industry, which has to meet the needs of millions of policyholders. Today many people are opting for a health insurance cover, as medical care costs are rising. Due to this, the number of claims being filed has also gone up. To deal with this high volume of claims, insurers turn to TPAs for assistance.
What is a Third Party Administrator?
A Third Party Administrator is a company that deals with claims filed by policyholders. When people are in the midst of medical emergencies and making claims, these agencies process them on behalf of the insurers.
What services do TPAs offer?
Other than acting as an intermediary between insurers and the insured to settle claims, some other services that a Third Party Administrator render are:
- Cashless transactions
- Offering the insured a list of network hospitals
- Claims tracking
- Value-added services like consulting specialists, access to medicines, making hospital beds available, ambulance services etc.
- Organizing wellness programmes and therapies to help you recuperate
- Disbursement of the sum insured and collecting premiums
- Helplines that work 24*7 to address your queries regarding health insurance
Why do Insurers and Policyholders Need Third Party Administrators?
TPAs benefit both the policyholder as well as the insurance providers in the following ways:
- They process claims quickly which is crucial because during a medical scare every minute counts. Moreover, they take care of all bill payments.
- TPAs are meticulous investigators. Moreover, as per the IRDAI mandate, they have their own team of medical and legal experts who can sniff out a fraudulent medical claim.
- They minimize paperwork and unnecessary expenses.
Which Third Party Administrators Are The Best India?
Although there are plenty of TPAs present in the health insurance sector, Medi Assist is India’s largest TPA, committed to delivering informed healthcare decisions to a billion lives, connected by cutting-edge technology, partnerships and human touch. Through our strong portfolio of group companies, we make a rich continuum of healthcare services available on our award-winning platform, MediBuddy.
Along with offering health benefits administration services such as cashless claims management, reimbursements, pharmacy benefits, and planned hospitalization, we also enable cashless outpatient services.
TPAs are irreplaceable when it comes to forming a bridge between the two parties- the insurer and the insured. So, their services are invaluable to both.
Before jumping into what a MediClinic is, it’s important to understand why it’s needed in the first place.
You see, you’re a part of the ‘rat race’ generation, whether you like it or not — better jobs, fierce competition, power, money. The frantic pace usually gets the better of your health as you don’t get the necessary time. Moreover, unhealthy lifestyle and poor nutrition fan the flames of illnesses.
Of course, you can always go see the doctor, but frequent visits might be a hurdle (considering your company’s leave policy and personal errands). This is where MediClinic comes in the picture by offering medical convenience right at your office premises.
Now, What is a MediClinic?
MediClinic is your Occupational Health Centre which not only administers medical services but also improves employee productivity while optimizing the costs of medical care.
For instance, employees can access the information pertaining to such walk-ins which can be accessed directly from the MediBuddy portal or app.
As for the corporate HRs, the MediClinic data management tool helps them draw valuable insights from the data provided via MIS reports, electronic health records and trend analysis for common ailments people suffer from.
Based on the data gathered, ailments can be grouped under various categories and the HR can then decide the type of wellness service that needs to be provided for the company’s employees.
MediClinic also employs the MediClinic Software which allows our personnel to capture valuable data such as walk-in details and medicines prescribed to the patient. Employees can also access the information pertaining to these walk-ins on MediBuddy which can be accessed either from the portal or app.
What are the Additional Services of the MediClinic?
Here’s a breakdown of all the health services available at the MediClinic.
- Primary Care/ First Aid: General physician, paramedic or nursing support, and specialists (Gynaecologist)
- Emergency Care/Medivac: Basic life support by medical staff including Advanced Cardiac Life Support (ACLS)
- Pharmacy Services/Medicines: OTC medicines, medicines for emergency care, and MediBuddy pharmacy services where you can buy your medicines online, and in a cashless format (if your policy covers it)
- Equipment: Provisions for Automated External Defibrillator (AED) and additional necessary equipment
- Lifestyle Management: Wellness intervention programs and fitness rewards on the Mobiefit app
- Additional Services: Lab Tests where a phlebotomist deployed by Medi Assist facilitates the collection of samples for the tests prescribed by the doctor
Summarizing 6 Capabilities of The MediClinic
Some may say that MediClinic is just the OHC being rebranded. That’s true, but not entirely. You see, MediClinic brings a lot more to the table. Here are 6:
Medical Manpower Management
- Deployment and management of Physicians/Paramedics across locations including recruitment, replacement, roster
- Periodic Training of the medical manpower
- Deployment and Management of Ambulances (BLS/ACLS) across locations
- Stabilisation on-site and evacuation of the employee in case of emergency to the nearest hospital for immediate care
Bio-Medical Waste Management (BMW)
- BMW management across sites as per BMW norms with government-authorised vendors
Inventory of Medicines and Equipment
- Manage inventory of common and emergency medicines at the OHCs
- Manage deployment and calibration of medical equipment, including AED
Technology Infrastructure, Data Management, and Analytics
- Deployment of MediClinic data management application across locations
- MediClinic data management application for clinical data capture and analysis
- Converting analytics into meaningful interventions such as personalized wellness sessions, health weeks, vaccination programs, workplace evaluation and more
Account Management and Administration Structure
- Dedicated Account Management Team
- Local administration structure to manage OHCs
- Periodic review
- Make the services Predictable, Reliable & Transparent
Put your health first, even when at work. At MediClinic, you can book health checks, lab tests, medicines, doctor consultations and more, with just a few clicks.
Today, you will find millennials investing in a plethora of schemes to expand their wealth. But, the one investment plan that they often overlook is health insurance plans, which they think doesn’t multiply their wealth. But, what they often fail to consider is how this financial instrument can prevent their wealth from eroding.
How will a health insurance plan help you save money?
This is the main reason why people buy a medical policy in the first place. When you have a health insurance plan, you have to pay some or none at all — depending on the policy terms and conditions — for the following:
- Pre and post hospitalization charges
- Doctor’s and nurse’s fees
- Cost of running tests to diagnose your illness
- Cost of therapy, medicines, surgery, prosthetics etc.
- Room rent
Most health insurance policies offer maternity benefits like pre and postnatal care of both the mother and the child, cost of delivering the baby, tests run on the baby to determine if it is healthy etc.
Out Patient Department Charges
Even if you do not need hospitalization and you only need to consult a doctor at the Out Patient Department, your health insurance policy will cover the expenses.
Most people do not go for a health check-up unless the symptoms of an illness compel them to because check-ups are expensive. Health insurance policies make provisions for pre-emptive check-ups. Don’t ignore check-ups as they can detect illnesses at the onset and allow you to begin treatment at the earliest. A head start on the treatment always increases your chances of staging a full recovery and that too within a shorter duration.
Who doesn’t want respite from taxes? With health insurance policies, you are entitled to tax benefits under Section 80D. The sum insured that your insurer pays is not considered as an income. That is why no taxes apply.
Daily Hospital Cash Allowance
This feature takes care of your day-to-day expenses when you are hospitalized.
Organ transplants are immensely expensive and very difficult to afford unless you invest in a health insurance policy, which covers the cost of transplant and aftercare.
Critical Illness Plans
If you invest in these plans, which cover some grave debilitating diseases like stroke, cancer, kidney failure, you can receive a substantial payment if you ever come down with the specified ailments. The insurance payout can actually help you sustain yourself during trying circumstances.
To find out if you are at risk of contracting a critical ailment, you can talk to a doctor through MediBuddy’s E-consult.
Why should Millennials invest in Health Insurance?
Millennials are young and healthy and hence they believe they are immune to ailments. However, if you look closely, you will see that the life of a millennial is one of anxiety, stress, and worry. This, coupled with a sedentary lifestyle and junk food, makes them prone to a number of chronic disorders.
To make matters worse, we live in times when pollution levels have gone up drastically. This rise in pollution levels is one of the major reasons behind the increasing number of severe heart and lung ailments.
Simultaneously, health care services have also become expensive. So, even a brief stint in the hospital can chip away at your savings. Having a health insurance policy in such circumstances will help cushion your finances.
Moreover, if you buy a policy while you are young, you will have to pay a lower premium. This is because according to insurers, young people carry less risk as opposed to older people when it comes to their health.
Then there is the waiting period – the mandatory period you have to wait before the benefits of a policy kick in. Because a person’s health is directly proportional to their age in most cases, a young person can easily get through the waiting period compared to an older person.
Health Insurance policy vs. a Group Insurance Plan
If you are employed in an organization, most likely you will be included in the company’s insurance plan for employees – the group insurance plan. This plan not only caters to your health care needs but also covers your family. This is why many millennials feel that they do not have to invest in a separate health insurance policy if they already have a group insurance policy.
But remember, the benefits apply only as long as you are employed with that firm. If you resign, retire, or are let off, you will have to fall back on an individual health insurance plan.