What Is a TPA in Health Insurance? Role & Claim Process

What is a TPA (Third Party Administrator) in Health Insurance?

A TPA (Third Party Administrator) is a company licensed by IRDAI that processes health insurance claims on behalf of insurance companies. TPAs handle the day-to-day claim operations: issuing health cards/e-cards, processing cashless pre-authorization requests, coordinating between hospitals and insurers, reviewing reimbursement claims, and managing network hospital relationships. TPAs recommend claim decisions - the insurer makes the final call on approvals, denials, and settlement amounts.

There are 17 TPAs registered with IRDAI, listed below with their registration numbers (IRDAI, List of Third Party Administrators as on 18 February 2026). For cashless treatment the timelines that bind are the insurer's, not the TPA's: under the IRDAI Master Circular on Health Insurance Business (29 May 2024) a cashless authorisation is due within 1 hour of the request and final authorisation within 3 hours of the discharge request. A TPA processing on the insurer's behalf does not extend those clocks. Several large insurers – Star Health, HDFC ERGO and Niva Bupa among them – process claims in-house instead, so your policy may have no TPA at all. Your health card or policy schedule says which applies to you.

Back to: Health Insurance Claims Guide

Quick checklist

• Goal: understand who processes your claims and how to communicate effectively.
• Avoid: blaming the TPA for policy exclusions (they follow insurer instructions).
• Prefer: keeping your TPA ID/health card details handy and knowing the escalation path.
• Claims-first: always get claim decisions in writing with specific clause references.

What does a TPA do?

Key point: TPAs recommend claim decisions, but the final authority is the insurer. If you dispute a TPA decision, escalate to the insurer.

TPA vs In-house claim processing

Trend: Many large insurers are moving to in-house processing for better control and speed. Check your policy documents for TPA details.

Every IRDAI-registered TPA in India (2026)

All 17, with their IRDAI registration numbers and the date their certificate of registration runs to. Registrations last three years from issue or renewal unless suspended or cancelled.

Source: IRDAI, List of Third Party Administrators as on 18 February 2026.

A closer look at the four largest

We have written up the four TPAs we are asked about most, each with its IRDAI registration, what it does and does not decide, and the escalation path when a claim stalls:

• Medi Assist – registration 003, and the entity Raksha merged into
• FHPL (Family Health Plan) – registration 013
• Vidal Health – registration 016, formerly TTK Healthcare
• Paramount – registration 006

Three TPAs you may be searching for under an old name

Names change, and the old ones stay in people's heads and in old policy documents:

• Raksha TPA no longer exists as a separate company. Raksha Health Insurance TPA Private Limited merged into Medi Assist with effect from 1 January 2025 (IRDAI). If your card says Raksha, your claims are handled by Medi Assist.
• Safeway TPA is now Health Assist Insurance TPA (registration 026), same registration, new name.
• East West Assist is now Volo Health Insurance TPA (registration 018).

If the name on your health card is not in the table above, check these three first before assuming the TPA has been deregistered.

Which TPA handles your policy?

We do not publish a TPA-to-insurer table, and you should be wary of sites that do. The assignment is set per policy, not per insurer: the same insurer can use different TPAs for different products, regions and corporate accounts, and can change TPA at renewal. A table that looks authoritative is usually out of date.

Three places carry the answer for your policy, in order of reliability:

1. Your health card or e-card – the TPA's name and helpline are printed on it, and this is what the hospital desk actually reads.
2. Your policy schedule or welcome letter – names the TPA and its claim address.
3. The insurer's helpline – ask for the TPA and the TPA claim number against your policy number.

How cashless claims work with a TPA

You (patient)
    ↓ Present e-card at network hospital
Hospital TPA desk
    ↓ Submit pre-auth request + documents
TPA
    ↓ Verify policy, check coverage, review documents
    ↓ Approve/deny/request more info
Hospital
    ↓ Proceed with treatment (if approved)
    ↓ Submit final bill at discharge
TPA
    ↓ Review final amount, apply deductions
    ↓ Authorize payment
Insurer
    ↓ Pays hospital directly
You
    → Pay non-payables/co-pay/deductibles at discharge

Detailed steps: Cashless Claim Checklist

Common TPA-related issues and solutions

TPA contact information: where to find it

Your TPA details are on:

• Health card / E-card (TPA name + helpline)
• Policy welcome letter
• Policy document (claims section)
• Insurer website (claim assistance page)

Keep saved: TPA helpline, email, and your policy/member ID.

What TPAs CANNOT do

• Change policy terms: TPAs follow insurer instructions
• Override exclusions: If something is excluded, TPA cannot approve it
• Make final claim decisions: Insurer has final authority
• Add/remove network hospitals arbitrarily: Controlled by agreements with insurers

When to escalate beyond TPA

Always escalate in writing and keep reference numbers.

TPA vs insurer: who to contact when

FAQs

Does TPA pay my hospital bills?

No. TPAs process and recommend claims. The insurer pays the hospital. TPAs facilitate the paperwork and approval process.

Why does my insurer use a TPA instead of processing claims directly?

TPAs provide specialized infrastructure for claim processing, network hospital management, and 24/7 support. It's often more efficient than insurers building these capabilities in-house.

Can I choose my TPA?

No. The insurer assigns a TPA based on their agreements. However, if you face persistent issues, you can request the insurer to review.

What if the TPA denies my cashless claim?

Get the denial in writing with specific policy clause references. You can appeal to the insurer directly-TPA decisions are recommendations, not final verdicts.

Is TPA service free?

For policyholders, yes. TPAs are paid by insurers, not by you. Their services are part of your policy.

How do I know which TPA handles my policy?

Check your health card/e-card, policy welcome letter, or call your insurer's customer care.

Can I file a complaint against a TPA?

Yes. First escalate to the insurer. If unresolved, approach IRDAI Ombudsman. TPAs are regulated by IRDAI.

What's the difference between TPA and insurer customer care?

TPA handles claim-related queries (pre-auth, cashless, claim status). Insurer handles policy-related matters (renewal, coverage changes, grievances).

Are in-house claim settlements better than TPA?

Not necessarily. Quality depends on the specific insurer/TPA. In-house may be faster for some insurers; good TPAs provide efficient service too. Focus on claim settlement ratio and reviews.

Related Guides

• Pillar: Health Insurance Claims Guide
• Related: Cashless Claim Checklist
• Related: Pre-auth Denied: What to Do
• Related: Cashless Network Hospitals
• Cross-cluster: Insurer Grievance Process

Disclaimer: TPA assignments and processes may vary by insurer and policy. Always verify your TPA details from your policy documents.

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