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FAQs on TPA Concept

What is TPA?

Third Party Administration (TPA) is a service given to a Mediclaim policyholder by providing cashless facility for all hospitalizations that come under the scope of
his/herMediclaim policy

What are the benefits of TPA to a policyholder?

The policy holder will have full freedom to choose the hospitals from our Empanelled Network and utilise the services as per his choice · For every Hospitalisation,
the policyholder will be well aware whether the treatment he is to undergo is covered under his policy or not. If covered,then he can seek cashless facility, not
having to pay a singlerupee at any of GITPL Network hospitals. During the time of Emergency Hospitalisation, the policy holder or relative can flash the Photo ID Card
of thepolicyholder and gain admission into any of our network hospitals.

Priority treatment at hospital is given without any payment to be made at the time of admission so also at the time of discharge. Thus, a completeCASHLESS TREATMENTis available to Policy Holders. The Policy Holders also do not run around for arranging cash for paying for the hospital expenses.

What are the facilities offered by a TPA?

i. A 24 X 7 assistance to all policy holders.
ii. Assistance in providing Ambulance Services during Emergency
iii. Assuring a Priority and Quality Treatment at Network Hospitals.
iv. Ensuring solutions to all queries at any time related to Hospital Networks, etc.
v. Guidance available for Health Check-ups, etc.
vi. Speedy claim settlement in case the policy holder has been treated from a non-network hospital
vii. Various kind of MIS/reports as per IRDA and Insurance Company requirements.

What do you mean by Network /Non-network Hospitalisation?

A Hospital, which has an agreement with GITPL for providing Cashless treatment, is referred to as a 'Network Hospital'. Cashless facility is provided ONLY at the
networkhospitals. In case of any Non-network hospitals policyholder will have to pay for the treatment and later claim(Reimbursement) as per normal procedure.

What should I do for getting the TPA services?

If you are a Mediclaim policyholder from any of the public or private sector insurance companies, get the ID Card from the identified TPA. Please also collect list of networkhospitals, state wise and do’s and don’ts from TPA for cashless benefits. Try GITPL Services and feel the difference.

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