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TPAs and Insurance

Health Insurance has become an integral part of our lives. Specially in India it is very important in the absence of any social health related safety net.

Third Party Administrators are known as TPA’s.  They administer the health insurance for the insurance companies.  They will issue a health insurance identity card to the insurance holder. They enter into an MOU with the various hospitals in the country to provide service to their insured clients.   

The Suraj Eye Institute is recognised by and has MOU’s with the following TPA’s and insurance companies.

  1. MD India.
  2. Medi Assist
  3. Paramount Health Care
  4. Apollo DKV
  5. Genins
  6. Heritage
  7. E Meditek
  8. Family Health Plan
  9. Alankit Healthcare
  10. Cholamandalam
  11. Star Health Insurance
  12. Paramount.

As an insured person, you may approach  us if you  are registered with any of the above TPA and in some instances even if you are registered with other TPA’s.  

You will generally be entitled to undergoing medical treatment and surgery without paying to the hospital. The hospital will then recover the payment from the insurance companies and TPA’s.

To enable this process, when you are diagnosed with a particular ailment, your details with a request for authorisation to treat you will be sent to the TPA. They will then issue a letter authorising your treatment.

Sometimes the response in the presence of proper documents, including current and policy papers is very fast.  At othe times there may be some delay.

Following the authorisation, you will be entitled to undergo treatment on a ‘Cashless’ basis. In addition if you choose a package which is not acceptable to the TPA, they will cover part of the costs and the remaining part of the cost may be paid by you.

If  authorisation is not received in a timely manner, you may still undergo surgery on a payment basis.  You will later be able to claim it from your insurance company.