To,

All TPAs


A query is being raised by several Third Party Administrators-Health services and other agencies whether TPAs can enter into agreements with entities other than insurance companies for servicing their healthcare schemes.

It is hereby clarified that if the task undertaken by the TPA Company is to undertake servicing of non insurance healthcare schemes promoted, sponsored or approved by Central or State Governments, the IRDA has no objection to the TPAs undertaking that function.

Since TPAs also undertake claims processing on behalf of insurers it should, however, be ensured that there is no conflict of interest between the work undertaken on behalf of the Central and State Governments and the work taken up on behalf of the Insurance Companies. It is also further clarified that the working capital requirements for attending to the work relating to the Central and State Governments shall be worked out separately and brought in additionally so as to ensure that the processing of claims on behalf of the Insurance Companies is in no way impaired.

The IRDA will not be responsible for administrative or financial transactions between the TPAs and the Central or State Governments. It, however, reserves its right to take appropriate action against the TPAs for serious acts of omission and commission brought to its notice by the Central or State Governments.

(C. S. Rao)
Chairman