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Network Hospitals and TPAs

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17 May, 2021 by  Jani

While trying to buy a new health insurance plan, I was looking at the network hospitals of various insurers for particular cities.

But network hospital link in some companies like Royal Sundaram and SBI General are providing a list of TPAs instead of a list of hospitals like other providers.


So my question is, do these companies like Royal Sundaram and SBI General will ask me to choose a TPA while buying a plan and the corresponding network will be applicable? Or all the network hospitals of all the TPAs listed on their websites will be applicable?

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18 May, 2021

Dear Jani

There are two arrangements of claim handling .

1. Direct where insurance company handle all claim directly and builds a network of hospitals .

2. TPA where insurance company do not deal directly with customer and all.customer contact is through TPA . TPA develop their hospital network .


So each TPA has its network hospital and you are entitled to the network as per list of one allotted TPA only .


Shailesh

Insurance Samadhan

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18 May, 2021
Jani
Thanks Shailesh for clarification. I just have a follow up question regarding TPA allotment. For example, SBI General has a list of 7 TPAs on their website when I try to search network hospital list. So will I be asked to select a TPA while buying a plan from them or SBI will assign me a TPA of their choice?
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18 May, 2021

Dear Jani,


As per IRDAI ( regulator ), customer can choose TPA as per their need provider the insurance company has an arrangement with TPA.


So, In short, you will be provided an option to choose TPA at the time of purchasing a policy. However, policyholders are only allowed to change TPA at the time of renewal

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18 May, 2021
Jani
Thanks Nimesh for clarification.
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18 May, 2021
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