Health Insurance
What is a TPA in health insurance — and why it matters during an emergency
📅 Updated May 2026⏱ 5 min read✍️ InsureIQ Research
The short answer
TPA stands for Third Party Administrator. They are the company that approves your cashless hospitalisation on behalf of your insurer. Save your TPA name and helpline number in your phone right now — before you ever need it. During a midnight emergency, you will not have time to search.
What a TPA does — in plain language
When you buy health insurance, your insurer handles the money. The TPA handles the paperwork and approvals.
When you need cashless hospitalisation, the hospital calls your TPA — not your insurance company. The TPA checks your coverage, verifies the treatment, and approves the cashless payment to the hospital. If the TPA does not approve, you pay out of pocket and claim reimbursement later.
⚠️ Most people only discover their TPA exists when they are lying in a hospital at midnight. Find your TPA name and helpline number right now — before you need it. It is on your health insurance card or policy document.
How to find your TPA details
1
Check your health insurance card — TPA name and helpline is printed on the back.
2
Check your policy document — TPA details are on page 1 or 2.
3
Check the insurer's website — search "[insurer name] TPA contact".
4
Call your insurer's customer care and ask "Who is my TPA and what is their helpline?"
5
Save the TPA number in your phone labelled "Health Insurance TPA". Do it today.
Major TPAs in India and their helplines
Medi Assist India
Helpline: 1800-425-9449 · mediassistindia.com · Works with: HDFC Ergo, Bajaj Allianz, Royal Sundaram
MD India Healthcare
Helpline: 1800-2099-800 · mdindia.co.in · Works with: Star Health, United India, Oriental
Vidal Health (formerly Heritage)
Helpline: 1800-425-4033 · vidalhealth.com · Works with: New India, National Insurance
Paramount Health Services
Helpline: 022-6715-4444 · paramounthealthservices.com · Works with: Various insurers
Genins India
Helpline: 1800-102-3366 · geninsindia.com · Works with: National Insurance, United India
Note: Many insurers now manage claims in-house without a TPA. Niva Bupa, Care Health, and Aditya Birla Health handle most claims directly.
What happens during cashless hospitalisation
1
You arrive at an empanelled hospital. The hospital must be in your insurer's network for cashless treatment.
2
Go to the hospital's insurance helpdesk — most hospitals have a dedicated desk. Show your health insurance card and Aadhaar.
3
The hospital sends a pre-authorisation request to your TPA with diagnosis and estimated treatment cost.
4
The TPA reviews the request and sends approval or rejection within 30–60 minutes for planned procedures, faster for emergencies.
5
If approved — the hospital bills the TPA directly. You pay only the non-covered portion — co-pay, room rent excess, non-medical items.
6
At discharge — sign the final claim form. The hospital settles with the TPA after you leave.
What to do if cashless is denied
🔴 A TPA rejection is not final. You have multiple escalation paths. Many rejections are overturned when properly challenged.
1
Get the rejection reason in writing from the TPA — ask for an email or written letter. "Not covered" is not an acceptable reason without specifics.
2
If treatment is urgent — proceed with self-payment and file for reimbursement. Do not delay treatment waiting for TPA approval.
3
File a written complaint with your insurance company's grievance cell. They must respond within 15 days under IRDAI rules.
4
If unresolved — escalate to IRDAI Bima Bharosa: call 155255 or visit bimabharosa.irdai.gov.in. File online — free, no lawyer needed.
5
For amounts above Rs.20 lakh — approach the Insurance Ombudsman in your city. Decisions are binding on the insurer.
Store your TPA details in InsureIQ
Upload your policy and InsureIQ extracts your TPA name, helpline, and claim process automatically. Available offline when you need it most.
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Frequently asked questions
My insurer says they don't use a TPA. Is that possible? +
Yes. Several major insurers now manage claims directly without a TPA — Niva Bupa, Care Health, Aditya Birla Health, and Star Health (partially). In this case, contact your insurer's claims helpline directly instead of a TPA number. The process is the same.
Can I change my TPA? +
Generally no. Your TPA is assigned by your insurer and changes only when the insurer changes its TPA partner. When you port your policy to a new insurer, the new insurer's TPA applies.
What documents do I need for cashless hospitalisation? +
Health insurance card, Aadhaar card, doctor's prescription recommending hospitalisation, any pre-test reports relevant to the condition. For planned procedures, bring these to the pre-admission desk at least 48 hours before admission if possible.
How long does reimbursement take after TPA rejection? +
Under IRDAI rules, insurers must settle reimbursement claims within 30 days of receiving all documents. If delayed beyond 30 days, you are entitled to interest on the claim amount. File a complaint with IRDAI Bima Bharosa if the deadline is missed.