What Is a TPA in Health Insurance? Full Form, Role and Claims
TPA stands for Third Party Administrator: a company licensed by IRDAI to handle health insurance claims for an insurer. The TPA issues your health card, takes the hospital's cashless request and checks the bills, but the insurer decides the claim and pays it. IRDAI's list as on 18 February 2026 has 17 registered TPAs.
Written by Harsh SoniReviewed by Shadab SayeedUpdated nyvo insurance Services LLP, IRDAI Corporate Agent (Composite) CA1085Salaried advisors, no commission-based ranking
What this video covers (11 chapters)
- 0:04Health insurance claim process explained
- 0:12Planned vs emergency hospitalisation
- 0:21Planned hospitalisation and cashless claims
- 0:43Emergency hospitalisation and cashless claims
- 1:06Cashless vs reimbursement claims
- 1:14What to do if your claim is rejected
- 1:19Get the rejection reason in writing
- 1:27How to escalate a rejected claim
- 1:32Bima Bharosa grievance process
- 1:47Insurance Ombudsman
- 2:02Why an insurance advisor matters
What is the full form of TPA in health insurance?
TPA stands for Third Party Administrator. In health insurance, a TPA is a company licensed by IRDAI that handles claims on an insurer's behalf: it issues the health card, receives the hospital's cashless request, checks the documents against the policy and recommends what to pay. The insurer makes the final decision and pays the money, and your contract stays with the insurer.
A TPA works for the insurer that hired it and is paid by that insurer, not by you. One TPA can serve several insurers, each through its own claim desk, which is why the number on your health card matters more than the TPA's general line. Every TPA needs an IRDAI registration, and IRDAI publishes the list.
| TPA at a glance | The fact | Source |
|---|---|---|
| Full form | Third Party Administrator | IRDAI |
| Registered TPAs | 17, each with its own IRDAI registration number | IRDAI List of TPAs as on 18 February 2026 |
| Registration runs | Three years from issue or renewal | Same list |
| Who decides your claim | The insurer. No claim can be rejected without the insurer's Product Management Committee or its Claims Review Committee approving it | IRDAI Master Circular on Health Insurance Business, 29 May 2024, para 17(a) |
| Cashless decision | Within 1 hour of the request | Same circular, para 15(b) |
| Final approval at discharge | Within 3 hours of the hospital's request | Same circular, para 16(a) |
| Reimbursement | Settled within 15 days of submitting the claim | IRDAI Master Circular on Protection of Policyholders' Interests, 5 September 2024 |
| Who pays the TPA | The insurer. TPA fees cannot depend on the claim ratio of the policies it serves | Health master circular, Part B, performance monitoring of TPAs |
| Cost to you | Nothing |
Not every policy has a TPA. Some insurers settle claims with their own team: Star Health, for one, says on its claims page that its in-house claim settlement team processes claims (read 24 October 2026). Your health card or policy schedule tells you whether a TPA is involved.
What does a TPA do in a health insurance claim?
The TPA does the paperwork side of a claim. In order:
| Job | What it means for you |
|---|---|
| Issues the health card or e-card | The ID the hospital insurance desk asks for at admission |
| Takes the cashless request | The hospital sends the pre-authorisation to the TPA, which checks it against your policy |
| Collects documents | Under IRDAI's rules the insurer and TPA collect the documents from the hospital; you should not be asked to fetch them (Master Circular on Health Insurance Business, 29 May 2024, para 17(c)) |
| Checks the final bill | Applies room-rent limits, co-pay, sub-limits and non-payable items, then recommends the amount |
| Processes reimbursement | Reviews the bills you submit when you paid the hospital yourself |
| Keeps a hospital network | Many TPAs list network hospitals for the insurers they serve |
What a TPA cannot do: change your policy terms, approve something the policy excludes, or make the final call on a claim. When a TPA says no, the decision is still the insurer's to defend.
How does a cashless claim work when there is a TPA?
You (patient)
↓ Show your health card at the hospital insurance desk
Hospital
↓ Sends the pre-authorisation request
TPA
↓ Checks cover, waiting periods and limits; asks for anything missing
Insurer
↓ Decides within 1 hour of the request (IRDAI)
Hospital
↓ Treats you; sends the final bill at discharge
TPA
↓ Checks the bill and recommends the amount
Insurer
↓ Final approval within 3 hours of the discharge request; pays the hospital
You
→ Pay only the non-payable items, co-pay or deductible
The clocks belong to the insurer. A TPA in the middle does not give the insurer extra time. If the final approval at discharge runs past three hours, any extra amount the hospital charges for the delay is borne by the insurer (Master Circular on Health Insurance Business, 29 May 2024, para 16(b)). The full routine, with what to carry, is in our cashless claim checklist.
Which TPAs are registered with IRDAI?
All 17, from IRDAI's own list. A registration runs three years from issue or renewal unless suspended or cancelled.
| TPA | IRDAI reg. no. | Certificate valid to, as listed |
|---|---|---|
| Medi Assist Insurance TPA | 003 | 20 Mar 2026 |
| MDIndia Health Insurance TPA | 005 | 20 Mar 2026 |
| Paramount Health Services & Insurance TPA | 006 | 20 Mar 2026 |
| Heritage Health Insurance TPA | 008 | 20 Mar 2026 |
| Family Health Plan Insurance TPA (FHPL) | 013 | 20 Mar 2026 |
| Vidal Health Insurance TPA | 016 | 15 May 2026 |
| Volo Health Insurance TPA | 018 | 15 May 2026 |
| Medsave Health Insurance TPA | 019 | 14 May 2026 |
| Genins India Insurance TPA | 020 | 10 Jun 2026 |
| Health India Insurance TPA Services | 022 | 17 Nov 2026 |
| Good Health Insurance TPA | 023 | 26 Jan 2027 |
| Park Mediclaim Insurance TPA | 025 | 27 Sep 2028 |
| Health Assist Insurance TPA | 026 | 19 Jul 2026 |
| Ericson Insurance TPA | 035 | 17 Dec 2027 |
| Health Insurance TPA of India | 036 | 5 Jun 2026 |
| Link-K Insurance TPA | 038 | 19 Sep 2026 |
| AKNA Health Insurance TPA | 039 | 8 Oct 2026 |
Source: IRDAI, List of Third Party Administrators as on 18 February 2026. When we checked IRDAI's site on 24 October 2026 this was still the current list, so several of the validity dates shown have passed without a newer list being published. A passed date on this list does not by itself mean a TPA has stopped operating.
Two names people mix up: Health India Insurance TPA Services (registration 022) and Health Insurance TPA of India (registration 036) are different companies. So is Paramount, which is neither.
A closer look at four of them
We have written up the four TPAs we are asked about most, each with its IRDAI registration, the toll-free numbers IRDAI lists for it, and the route when a claim stalls:
- Medi Assist TPA: registration 003, and the company Raksha merged into
- FHPL (Family Health Plan) TPA: registration 013
- Vidal Health TPA: registration 016, formerly TTK Healthcare
- Paramount TPA: registration 006
Three TPAs you may know by an old name
- Raksha TPA no longer exists as a separate company. Raksha Health Insurance TPA merged into Medi Assist with effect from 1 January 2025 (IRDAI). A card that says Raksha is handled by Medi Assist.
- Safeway TPA is now Health Assist Insurance TPA (registration 026).
- East West Assist is now Volo Health Insurance TPA (registration 018).
Which TPA handles my policy?
The one printed on your health card. We do not publish a TPA-to-insurer table, and be wary of sites that do: the same insurer can use different TPAs for different products, regions and corporate accounts, and can change TPA at renewal. United India Insurance, for example, publishes a region-wise list of which TPA services its retail policies, which tells you the allocation is by region, not by insurer.
Three places carry the answer for your own policy, most reliable first:
- Your health card or e-card. The TPA's name, your TPA ID and the claim desk number are printed on it, and it is what the hospital reads.
- Your policy schedule or welcome letter. Names the TPA and its claim address.
- Your insurer's helpline. Ask for the TPA and the TPA claim number against your policy number.
What should I do when a TPA delays or refuses a claim?
Go to the insurer. A TPA recommends; the insurer decides and is the party your contract is with.
| Problem | What to do |
|---|---|
| No cashless decision within an hour | Call the claim desk on your health card with the request reference, then the insurer. The one-hour limit binds the insurer |
| Cashless refused | Get the refusal in writing with the policy clause it relies on. IRDAI requires a rejection to cite the specific terms (Master Circular, 29 May 2024, para 17(b)) |
| Hospital says "the TPA is not responding" | Call the TPA yourself, note the reference number, and tell the insurer |
| Reimbursement stuck past 15 days | Write to the insurer's grievance cell, quoting the 15-day rule (Master Circular, 5 September 2024) |
| Asked to fetch documents from the hospital | Point out that the insurer and TPA collect them from the hospital under IRDAI's rules |
| Grievance not resolved in 14 days | Escalate to IRDAI's Bima Bharosa portal, then to the Insurance Ombudsman |
The Ombudsman complaint is made against the insurer, not the TPA. If you are choosing an insurer and want to see how often its customers end up complaining, the claim settlement ratio of every health insurer sits next to each one's complaint figure.
FAQs
What is the full form of TPA?
TPA stands for Third Party Administrator. In Indian health insurance, a TPA is a company licensed by IRDAI to process claims for insurers: it issues health cards, handles cashless requests from hospitals and checks bills. The insurer, not the TPA, decides the claim and pays it. IRDAI listed 17 registered TPAs as on 18 February 2026.
Does the TPA pay my hospital bill?
No. The insurer pays. The TPA checks the bill against your policy and recommends the amount, and the insurer approves and pays the hospital, or pays you on a reimbursement claim. That is also why a dispute over the amount goes to the insurer.
Can I choose my TPA?
No. The insurer appoints the TPA, and it can change the TPA at renewal without your policy changing. If you have persistent trouble with a TPA, complain to the insurer in writing. Under IRDAI's health master circular, insurers must monitor their TPAs on service and can claw back TPA fees based on customer feedback, passing that amount to the customer.
What if the TPA denies my cashless claim?
Ask for the denial in writing with the policy clause, and take it up with the insurer, which makes the final call. If treatment cannot wait, pay the hospital and file for reimbursement with the same papers; a cashless refusal is not a claim rejection. Our cashless pre-authorisation denied playbook covers the first hour.
Is a TPA's service free?
Yes. The insurer pays the TPA, and IRDAI's health master circular bars TPA fees from depending on the claim ratio of the policies it handles. You pay nothing for the TPA's service.
How do I find my TPA's customer care number?
Use the number on your health card. A TPA runs a separate claim desk for each insurer it serves, so a general helpline may not reach the team handling your policy. Each of our TPA pages also lists the toll-free numbers IRDAI publishes for that TPA, such as Medi Assist's.
Is in-house claim settlement better than a TPA?
Not by rule. IRDAI's clocks, one hour for cashless and 15 days for reimbursement, apply to the insurer either way. What differs is the insurer, so compare insurers on how many complaints they draw per 10,000 claims, which separates them far more than the settlement ratio does. Our complaint ratio table ranks every health insurer.
Can I complain about a TPA to the Insurance Ombudsman?
Not directly. The Ombudsman complaint goes against the insurer whose policy it is, after the insurer has had a month to answer your written complaint. The insurer is accountable for its TPA's handling of your claim.
Related guides
Sources
- IRDAI, List of Third Party Administrators as on 18 February 2026: irdai.gov.in/list-of-tpas, read 24 October 2026
- IRDAI, Master Circular on Health Insurance Business, IRDAI/HLT/CIR/PRO/84/5/2024, 29 May 2024: irdai.gov.in, read 24 October 2026
- IRDAI, Master Circular on Protection of Policyholders' Interests, IRDAI/PP&GR/CIR/MISC/117/9/2024, 5 September 2024: irdai.gov.in, read 24 October 2026
- Star Health, claims page: starhealth.in/claims, read 24 October 2026
- United India Insurance, claim forms and region-wise servicing TPA list: uiic.co.in, read 24 October 2026
16+ years in financial services. Former investment banker at Bank of America, Kotak Investment Banking, and SBICaps, and ex-CFO of slice. Founder of nyvo and Principal Officer – IRDAI Certified.
