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Are you planning to provide health insurance claim services in India? Get your Third Party Administrator License with end-to-end support by Enterslice. We assist in documentation, application filing, and approval, making your TPA registration smooth and compliant.
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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.
Indian Insurance TPA Market ($9.29 Billion by 2030)
CAGR Growth of About 5.6% (Anticipated)
Cost-effective Claim Processing in India
Health Insurance Boom due to Increasing Chronic Diseases
Insurance for All by 2047 Vision
Regulatory Body- IRDAI
Become an IRDAI-approved TPA and legally manage health insurance claims and services with ease. Secure your third party administrator license with Enterslice.
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:
TPAs provide ID cards and related documents that policyholders must present at the hospital to avail cashless hospitalization benefits.
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.
Before treatment begins, the TPA issues an authorization letter to the hospital confirming coverage and approval for cashless services.
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.
The third party administrator license is required for the following reasons:
It ensures that the interests of the policyholders are prioritized.
Third Party Administrator License guarantees efficient insurance processing and management of claims.
It provides a framework for protecting policyholder information.
It upholds a standard of diligence and governance in the insurance sector.
The step-by-step process to get a TPA license in India is as mentioned below:
The applicant must submit the application for the grant of a Third Party Administrator License along with all mandatory supporting documents through the prescribed mode to IRDAI.
A non-refundable processing fee of Rs. 1,00,000/- plus applicable GST must be submitted along with the application via a crossed Demand Draft (DD) payable to Insurance Regulatory and Development Authority of India, Hyderabad.
IRDAI may request further documents or information before processing the application. The applicant must provide the requested details within the specified timeline set by the authority.
During the application evaluation period, the applicant cannot change the nature or structure of the business without obtaining prior approval from IRDAI. Any changes must be immediately notified to the authority.
Once the eligibility criteria are satisfied, IRDAI grants the Certificate of Registration. The applicant is required to pay Rs. 30,000/- plus applicable GST as the registration fee.
The TPA company can commence operations within 12 months from the date of issuance of the certificate. The certificate should be displayed publicly with details such as registration number, validity period, and registered & corporate office address.
The list of documents required for a third party administrator license is as follows:
Form TPA -1
Certificate of Registration of the Company or LLP as issued by the ROC
MOA and AOA of the Company or the LLP Agreement
Copy of PAN Card of the Company
Profile of the Directors/Partners of the Company or LLP
Profile of the Principal Officers along with the educational qualification certificates
Brief preview of the contents of the website proposed for the license
Details of the CEO, CAO and CMO
Documents of the Medical officers
Details about the hosting place of the website
Details about the responsible persons for the website’ content
Net worth certificate and shareholding pattern of the company as certified by the Chartered Accountant
Audited financials for the last three years in case of an existing company or as of the latest date in case of a new company
Details of the IT infrastructure available with the applicant
Form for Intimation of appointment or change in Director, Chief Executive Officer, Chief Administrative Officer, or Chief Medical Officer.
The third party administrator license renewal in India is as follows:
Worried about hurdles in the path of getting a third party administrator license?
The executive training requirements for TPA registration online are as follows:
The list of services rendered by third party administrator license holders is as follows:
Managing claims for policyholders through cashless treatment, reimbursement settlements, or both.
Handling claims related to hospital cover, including personal accident and travel-related injuries.
Conducting required medical tests and examinations for insurance claims.
Providing services for coverage of medical expenses incurred during travel abroad.
Managing health claims for policyholders travelling to India under foreign insurance policies, strictly as per the regulations for foreign insurance and non-insurance claims.
A health insurer is permitted to appoint more than one TPA to offer health services to its policyholders.
The list of requirements for registering TPA license is as follows:
At Enterslice, we will help you apply online for TPA license and get IRDA approval. No trial and error, expert-led process.
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:
A network hospital has a formal agreement with a Third Party Administrator (TPA) to provide cashless treatment to policyholders. On the other hand, a non-network hospital does not have any such tie-up, and policyholders must pay bills upfront and seek reimbursement later.
A TPA is appointed by an insurer. The TPA acts as the first point of contact for policyholders, assisting them with hospital bills, approvals, and other medical expense claims.
A TPA license in India allows the administrator to handle sensitive policyholder information such as age, address, and policy details. It builds trust with policyholders and ensures that grievances are regulated and monitored by the Insurance Regulatory and Development Authority of India (IRDAI).
The difference between an Insurance Broker, Web Aggregator, and Third Party Administrator is as follows:
Cashless access means the policyholder does not need to pay hospital bills upfront. This facility is only available at network hospitals that are partnered with the TPA.
The following information must be provided at the time of claim intimation:
No, pre-existing diseases are not covered under the TPA policy. A claim related to such a disease would only be considered after the disease is recorded and occurs during the policy period.
A Third Party Administrator License is required for the following reasons.
The Third Party Administrator (TPA) License is regulated by the Insurance Regulatory and Development Authority of India (IRDAI). The licensing framework is governed under the Insurance Act, 1938, and the Insurance Regulatory and Development Authority Act, 1999. In addition, the operations and responsibilities of TPAs are primarily regulated under the IRDAI (Third Party Administrators Health Services) Regulations, 2016.
A TPA cannot make payments for claims, reject claims, handle service claims other than those related to health insurance, or solicit insurance business directly or indirectly.
A validity for the TPA registration online certificate is granted to the third-party administrator and will be valid for three years. Further, the validity is subject to revocation by the authority or the applicant.
TPA issues Identity Card, authorize treatments, processes claims, and maintains agreements with hospitals.
A TPA must maintain a minimum paid-up capital of Rs. 4 crores and working capital of Rs. 1 Crore.
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