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IRDA asks insurers for guidelines to TPAs

The IRDA has advised all insurers to ensure that detailed guidelines are prepared and given to the respective TPA as per its regulation

August 16, 2013 3:18 IST | India Infoline News Service
The Insurance Regulatory and Development Authority (IRDA) has asked all general insurers to send detailed guidelines to third party administrators (TPAs) for payment of claim settlements related to health insurance.

'TPA may handle claims, admissions and recommend to the insurer for the payment of the claim settlement, provided a detailed guideline is prescribed by the insurer to the TPA for claims assessments and admissions in terms of capacity requirements, internal control requirements, claim assessment and admissions procedure requirements etc under the agreement,' the IRDA said in a circular on Wednesday.

However, TPAs are not allowed for claim settlements and rejections with respect to health insurance policies.

“Every insurer utilising third party administrators is advised to send a specific confirmation to this effect to the Authority on or before September 30, 2013,” IRDA said.

The insurance regulator has advised all the insurers to ensure that detailed guidelines are prepared and given to the respective TPA as per its regulation.


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