Your Third Party Administrator: What You Should Know

Third Party Administrator

If you are covered by a health insurance policy, you will be allocated a third party administrator or TPA by your insurance company. However, most people are unaware of who a TPA is or what a TPA does. Here is what you should know about the third party administrator:

• If you are reading this, this means that you have probably been assigned Medi Assist as your TPA for health insurance benefits managed by your organization. As a member of Medi Assist family, you are eligible for hassle-free healthcare insurance claims administration.

• What this really means for you is that, if you or any of your family member is covered under the insurance policy, we handle all the paperwork related to your claims. Wherever possible, we give you the benefit of cashless hospitalization; and we ensure that your claim is settled at the earliest.

• As a member of Medi Assist, you are not only entitled to hassle-free claims, but also several other health benefits.

• However, you should understand that TPAs are not the same as insurance companies.

What does a third party administrator (TPA) do?

A TPA is appointed by your insurance company to process your claims. This means that whenever you raise a claim for hospitalization for yourself or any of your family members covered under the policy, a TPA processes these claims.

What a TPA does not do:

• Decide who is covered and what ailments/procedures are covered under your policy. Your insurance plan dictates these.

• Control your policy terms and conditions. Your insurance policy is developed by your insurance company.

• Decide admissible/non-admissible expenses. Your insurance policy dictates that.

• Approve/disapprove claim without reason. TPAs process claims strictly based on your policy terms and conditions.