third party administrator registration

1. Servicing of claims under health insurance policies (Cashless/Reimbursement).
2. Servicing of claims for Hospitalization cover, if any, under Personal Accident Policy and domestic travel policy.
3. Pre-insurance medical examinations in connection with underwriting of health insurance policies.
4. Health services matters of foreign travel policies and health policies issued by Indian insurers covering medical treatment or hospitalization outside India
5. Servicing of health services matters of travel or health or medical insurance policies issued by foreign insurers for policyholders who are travelling to India

3. Who is eligible to obtain registration as a Third Party Administrator (TPA)?

Only a company with a share capital and registered under the Companies Act, 2013 (18 of 2013) as amended from time to time, can function as a TPA. The main and sole object of the TPA, on being registered with the Authority, shall be to exclusively carry on business of providing health services. A TPA shall not engage itself in any other business.

Note: - Every TPA and applicant seeking registration as TPA from the Authority shall have the words ‘Insurance TPA’ in its name to reflect that it is engaged or proposes to engage in the business of TPA for rendering health services.

4. What is the minimum capital and working capital requirement to obtain registration as a Third Party Administrator (TPA)?

A TPA shall maintain minimum paid up equity share capital of not less than rupees four crores(4cr) and shall maintain a working capital of not less than rupees one crore(1cr).

5. What is the application fee for obtaining registration as a Third Party Administrator (TPA)?

The application for registration shall be submitted online to the Authority, accompanied by a non-refundable processing fee of Rs. 1,00,000/- and other taxes as may be applicable.

6. Is there any additional registration fee payable after the approval of the TPA application?

After the IRDAI approves the application for registration as a Third Party Administrator (TPA), the applicant is required to pay an additional registration fee of ₹200000, plus applicable taxes. This payment must be made within the period specified by the Authority, and before the issuance of the Certificate of Registration. The fee is payable in the manner prescribed by IRDAI.

7. What is the validity period of registration granted to a Third Party Administrator (TPA)?

The Certificate of Registration granted by the Insurance Regulatory and Development Authority of India (IRDAI) to a Third Party Administrator (TPA) is valid for a period of three (3) years from the date of its issuance, unless it is revoked, suspended, or cancelled earlier by the Authority in accordance with the regulations.

8. What are the conditions for the grant of a Certificate of Registration as a Third Party Administrator (TPA)?

As per Regulation 8 of the IRDAI (Third Party Administrators – Health Services) Regulations, 2016, while examining an application for the grant of a Certificate of Registration, the Authority shall take into account all matters relevant to carrying out the business of a TPA.

1. The applicant has the words “Insurance TPA” in its name.
2. The applicant has complied with the minimum capital requirements.
3. The promoters of the applicant have the financial strength to carry out the business of TPA
4. At least one of the Directors of the TPA holds a minimum qualification of MBBS, with valid registration from the Medical Council of India or any State Medical Council, and is entitled to practice medicine within its jurisdiction.
5. The applicant or its promoters or its directors are not suffering from any disqualifications mentioned under Section 42D of the Insurance Act, 1938
6. The applicant has the necessary infrastructure, such as adequate office space, equipment, and trained manpower to effectively discharge its functions.
7. The applicant has employed at least one person who possesses the qualifications and experience specified under Regulation 11 of these Regulations.
8. The Chief Executive Officer (CEO) or Chief Administrative Officer (CAO) and the Chief Medical Officer (CMO) fulfill the fit and proper criteria as per Regulation 11.
9. i. The applicant has sufficient reach with network hospitals and information technology capability.
10. The applicant has necessary in-house medical expertise, in addition to the requirement of at least one Director having medical qualification.
11. The applicant satisfies any other requirements that the Authority may consider necessary for granting the Certificate of Registration.

A third party administrator plays a key role in managing health insurance claims and policy services on behalf of insurance companies. To operate legally, entities must complete third party administrator registration and obtain an IRDAI third party administrator license. The process of TPA registration IRDAI ensures regulatory compliance, transparency, and efficient claim management, allowing organizations to function as authorized service providers within the insurance ecosystem.