Third Party Administrator License

Understanding Third Party Administrator License

Thinking about offering seamless claims support in the insurance sector? Want to know how to apply for a TPA License online and become a trusted link between insurers and policyholders? A Third Party Administrator License in India empowers a company to operate as an IRDAI authorized service provider, managing claim processing, policy servicing, customer coordination, and backend support for insurance organizations.

By securing a TPA License with Enterslice, companies position themselves as a vital support system in India’s growing health insurance ecosystem, ensuring transparency, accuracy, and a smooth claim experience. The Third Party Administrator (TPA) licensing is governed by specific regulations, primarily the Insurance Regulatory and Development Authority of India (IRDAI) (Third Party Administrators- Health Services) Regulations, 2016.

Apply for your TPA License online and explore opportunities in insurance administration, enhancing service delivery, customer engagement, and operational excellence across India.

What are the Functions of a Third Party Administrator License?

A Third Party Administrator license holder acts as a bridge between the insurance company and the policyholder. Its primary responsibility is to safeguard the interests of both parties while ensuring a smooth insurance claim process. Some of the key functions of a TPA include:

Issuing Policy Documents & ID Cards

TPAs provide ID cards and related documents that policyholders must present at the hospital to avail cashless hospitalization benefits.

Coordinating with Network Hospitals

TPAs maintain agreements with specific hospitals. When the policyholder wishes to access treatment at a network hospital, the TPA must be informed in advance. However, policyholders may still receive treatment in non-network hospitals, based on the policy terms.

Providing Authorization Letters

Before treatment begins, the TPA issues an authorization letter to the hospital confirming coverage and approval for cashless services.

Processing and Transmitting Claims

After hospitalization, the TPA collects all necessary documents, such as hospital bills and medical reports and sends them to the insurance company for claim evaluation and settlement.

Why is a Third Party Administrator License Required?

The third party administrator license is required for the following reasons:

How to get a TPA License in India?

The step-by-step process to get a TPA license in India is as mentioned below:

What are the Documents Required for a Third Party Administrator License?

The list of documents required for a third party administrator license is as follows:

Third Party Administrator License Renewal in India

The third party administrator license renewal in India is as follows:

• The application for renewing a Third Party Administrator License must be submitted to the concerned authority.
• Renewal cannot be applied earlier than 180 days and not later than 30 days before the existing Certificate of Registration expires.
• A non-refundable fee of ₹15,000 plus applicable GST must accompany the renewal application.
• If the application is filed after the prescribed period but before the license expires, a penalty of ₹100 is applicable.
• If the application is submitted after expiry and the applicant proves the delay was due to reasons beyond their control, the authority may accept the application with a penalty of ₹750.
• Upon fulfilling the required criteria, the Third Party Administrator License is renewed for an additional period of three years.

Executive Training Requirements for TPA Registration Online

The executive training requirements for TPA registration online are as follows:

• The Third Party Administrator must appoint a CEO (Chief Executive Officer), CAO (Chief Administrative Officer), or CMO (Chief Medical Officer) who possesses the required educational qualifications and necessary training as prescribed by the authority.
• The appointed executives must take responsibility for managing the overall functions of the Third Party Administrator.
• The appointment of TPA executives and the Board of Directors (BOD) must comply with the authority’s requirements, and such appointments must be reported to the authority within 30 days.
• The CEO, CAO, or CMO must not have any disqualifications under any prevailing law.
• The CEO or CAO must have a recognized Bachelor’s Degree, complete the required Associate Examination or its equivalent, and meet the minimum training requirements set by the authority.

What are the Services Rendered by Third Party Administrator License Holders?

What are the Requirements for Registering TPA License?

The list of requirements for registering TPA license is as follows:

• The applicant must be a registered entity, either as a company or LLP, according to the Companies Act of 2013.
• The name must include “Insurance TPA” in order to reflect the services offered.
• The TPA must only engage in health insurance administration.
• The applicant for TPA must maintain a minimum paid-up share capital of Rs. 4 crores and a working capital of Rs. 1 crore.
• Foreign investment is allowed subject to specific guidelines.
• At least one director must hold an MBBS degree and be registered with the Medical Council of India.
• Directors must not be disqualified under the existing laws.
• The TPA should have sufficient office space and trained staff.
• The TPA should collaborate with hospitals that have the necessary infrastructure.

Why Trust Enterslice for Third Party Administrator License?

With years of expertise in insurance regulatory compliance, Enterslice offers comprehensive support in securing approvals and maintaining ongoing compliance for TPAs in India. Our team ensures a seamless, error-free, and timely TPA license process from application to post-approval services. From getting an insurance repository registration to obtaining a corporate agency license, we leave no stone unturned in helping business owners in the insurance industry.

Here’s why Enterslice should be your trusted partner for obtaining a Third Party Administrator License:

Frequently Asked Questions on TPA Registration Online