Third Party Administrator (TPA) - Need to Strengthen the Pillars of Health Insurance Claims Management

The liberalisation of the Insurance sector and formation of Insurance and Development authority of India in 2000 has completely transformed the Indian Insurance Industry in the last two decades. There are currently 60 registered Insurers (including 7 standalone health Insurers) having physical presence with approximately 22,000 offices throughout the country.

- Dr. Seema Arora

Introduction

The liberalisation of the Insurance sector and formation of Insurance and Development authority of India in 2000 has completely transformed the Indian Insurance Industry in the last two decades. There are currently 60 registered Insurers (including 7 standalone health Insurers) having physical presence with approximately 22,000 offices throughout the country. Further, with technological development the Insurers spread the gospel of Insurance in every nook and corner of the country through online presence. The Health insurance sector witnessed the emergence of the concept of Standalone health insurers and a new set of professional body namely the TPAS (Third Party Administrators) in the last two decade.

Health care and health Insurance awareness has tremendously increased Post-Covid in our country. Health insurance has become the most prominent segment in the insurance space today comprising 38% of the Non-Life Insurance business. Health Insurance Segment reported a growth of 21.32 percent in 2022-23 with the premium amounting to Rs. 97,633 crore (including personal accident) and the sector is further expected to grow significantly in the next few years. During 2022-23, the General and Health insurance companies have covered 55 crore lives under 2.26 crore health insurance policies (excluding policies issued under PA and Travel Insurance). They have settled 2.36 crore number of health insurance claims and paid an amount of Rs. 70,930 crore for the same. The incurred claim ratio for the year 2022-2023 stood at 89%. With the expansion of health insurance business and large number of claims settled by the Insurers, the services provided by the third party administrators have become more significant in building up the trust and reputation of the Insurance Industry.