Is It Beneficial to Have a TPA in Health Insurance?

What do you know about TPA in health insurance? Hardly anything, right? Don't worry; here, in this blog, you will learn about TPA, its roles, and its benefits in brief.

What is TPA in health insurance?

The third-party administrator is the full form of TPA. You can come across this term several times in the health insurance sector. Do you know why? It is because TPAs play an essential role in processing and settling your health insurance.

This third-party administrator maintains the link between the first party (insurer) and the second party (insured). They are qualified and specialise in offering administrative services.

Roles and responsibilities of third-party administrators

Now that you got to know about what is TPA in health insurance, it is also essential to know their roles and responsibilities.

24*7 assistance

The best and primary role of TPAs is to support you 24*7. The third-party administrator's department consists of reliable support services that help insurance seekers 365 days a year with 24*7 assistance.

You can seek help from the TPAs via text messaging or IVRs. A toll-free number on your health card is mentioned; calling on this number can let you connect with third-party administrators.

Issuing of Health card

In the health insurance industry, you, as an insured, must have a health card. But do you know what a health card is? A health card is an ID card with which you can seek health care services all around the country.

One of the significant responsibilities of a third-party administrator can be traced at the very beginning of the whole process. Once you choose your ideal insurance company and plan, they forward your information to the TPAs, who later utilise it in issuing your health card.

Cashless claim settlement

If you want to seek treatment in a network hospital, then it is essential to inform the TPA and the insurer at least four to five days before the planned treatment. Not only this, but you need to fill out a pre-authorisation form to seek the best services and get them covered under your insurance plan. If it's an emergency case, then you get a time of nearly 24 hours within the hospitalisation to inform the authorities.

Informing the third-party administrator and insurer on time is quite essential because then they can analyse whether it's under your coverage or not, how much the cost of health care solutions can be covered, etc.

Reimbursement claim settlement

Don't worry; you can also seek treatment at a hospital not in your network. In the case of seeking treatment at a non-network hospital, the insurance company allows reimbursement. Now you might be thinking that in this whole process, what is the role of a third-party administrator, right? So, the role of TPAs is to practice investigation regarding the claim and analyse whether the request and documents are legitimate.

Wide range of tie-ups

Do you know another significant role played by TPAs is to create tie-up with several hospitals around the country? TPAs build tie-ups and relationships with hospitals to let you enjoy a wide range of network hospital services.

In the era of cashless claim settlement, wider tie-ups have become more important for the insurers and insured as well. Third-party administrator health insurance continuously tries to increase their network so that policyholders can enjoy cashless claim settlement benefits in different parts of the country.

Benefits of TPAs

After analysing the roles and responsibilities of the third-party administrator, the following are a few benefits people can enjoy.

  1. The TPAs offer 24*7 customer support throughout the health insurance period.
  2. Third-party administrators can offer you guidance regarding the claim settlement procedure and documentation as well.
  3. The TPAs let you issue the health card, which is very useful throughout your policy period.
  4. Third-party administrators can offer efficient and prompt claim settlement.
  5. You can enjoy receiving treatment under various schemes of the government.


Yes, TPAs are very helpful in medical insurance. Above, you can find a few benefits of the same.

If you are planning to buy health insurance, then visit the website of LivLong. This health care company doesn't only offer various insurance policies; instead, it also offers facilities like easy purchasing of health insurance, easy claim settlement, etc.

Posted in Business News on February 24 at 01:30 PM

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