Only three of the 10 qualifying TPAs who bid for the Gipsa tenders won country-wide empanelment for Mediclaim processing services, it is reliably learnt.
After negotiations with the lowest bidders, Gipsa decided on a TPA fee of 5.5 per cent in the north and south zones and 5.4 per cent in the east and west zones. The move could have a major impact on health insurance, since the public sector players are the only large-scale providers of this product. They have already raised insurance rates in January.
The low fee rates could mean a lower consequential increase in premia for policy-holders. It was expected that companies may resort to another hefty hike with the entry of TPAs.
There are 19 TPAs who have been licensed by the Insurance Regulatory and Development Authority (Irda), and all had been invited by Gipsa to put in technical and financial bids. The tenders were opened on Wednesday.
Two corporate-backed TPAs TTK Healthcare Services and Apollos Family Health Plan as well as one stand-alone TPA, E Meditek Solutions, made it to the all-India grade. This will enable all three to enter into agreements with any or all four general insurers in the public sector in any of the four zones.
Others who have qualified include:Medicare (north, east and south zones); Parekh Health (north, west and south); MediAssist (west and south); MD India Healthcare (west); Ican Health Services (north, west and south); Medicare Foundation (north, west and south); and Med Save Health Care (north, west and east).
Interestingly, Paramount Health Services, one of the older and larger players in the TPA arena who has been servicing corporate clients for some of the PSUs during the unregulated regime, was among those who failed to qualify.
The eligibility criteria laid down by Gipsa included: at least one years experience; a medical practitioner on its permanent rolls; a presence in each state capital of the zone it bids for and at least in one more location in that state; a tie-up with at least five hospitals in each state capital of the zone and two in another location elsewhere in the state; a hotline in each office and at least one toll-free number and; at least one claims administrator in each office.
Industry officials said the TPAs would be expected to enter into agreements with individual insurers now and file the pacts with Irda before formally undertaking operations. Irda regulations bar TPAs from marketing insurance, in this case Mediclaim policies. However, they would be allowed to assist in claim processing, cashless hospitalisation and 24-hour call centre services on behalf of the companies. Industry sources said Kolkata-based PSU, National Insurance, was pushing most aggressively for using TPA services in the personal lines in Mediclaim.
However, they felt it could be a month or more before such services get under way, initially addressing corporate clients alone since that was a segment easier to administer and one that was used to dealing with TPAs even before they were brought under Irda purview.