Author: Vinod N

MD India is a Third Party Administrator (TPA) that settles health insurance claims on behalf of insurance companies. Private insurance companies, however, typically have their own in-house claim settlement teams. As a result, for the majority of their health insurance business, they do not rely on TPAs. In some Group Mediclaim Policies, corporations which are buying health insurance for their employees may specifically request the services of a TPA instead of the insurance company for claims settlement. Therefore, in private insurance, TPAs are generally engaged mainly for corporate health insurance business. On the other hand, public sector general insurance companies,…

This article discusses in detail the insurance coverage for balloon sinuplasty. Is it considered a conventional or advanced treatment? Does your policy place any limits on its coverage? I have addressed all these issues here in this article. Balloon sinuplasty is used to treat chronic sinus problems that have persisted for some time and have not responded to conventional treatments. As the name suggests, an inflated balloon is used to keep the sinus passage open, allowing for better drainage and airflow. Is balloon sinuplasty covered by insurance? Balloon sinuplasty is considered an advanced treatment by the insurance regulator. The insurance…

The Master Circular on Health Insurance Business is undoubtedly a customer-centric move by IRDAI, addressing key pain points from the policyholder’s perspective. The reduction in the moratorium period, extension of free Look Period, coverage during grace period etc are set to positively impact both the health insurance industry and customers.

GIPSA stands for the General Insurance Public Sector Association, a group of four public sector general insurance companies. These companies are National Insurance, Oriental Insurance, United India Insurance, and New India Assurance. These insurers have empaneled a number of hospitals across India, referred to as the Preferred Provider Network (PPN). Apart from the PPN package rates for surgical procedures, hospitals also agree to offer discounts on their cash rates (treatment costs for patients without insurance) to policyholders of these insurance companies.

It is always better to disclose all information related to your medical conditions and lifestyle upfront to the insurance company before buying a health insurance policy. Otherwise, you may end up paying premiums for years only to have your claim rejected or your policy canceled in the future.

Treatment costs under private health insurance are significantly higher compared to Ayushman Bharat. Health insurance companies pay hospitals more, while Ayushman Bharat offers package rates that are relatively low. This often leads private hospitals to prefer insured patients over Ayushman Bharat beneficiaries.

It’s not a good idea to hide a pre-existing disease/condition. You might pay premiums for years, only to have your policy cancelled later for not being upfront.

New India Assurance is the largest general insurance company in the India. New India offers a wide range of health insurance products and one of their key health insurance product is the New India Yuva Bharat Health Policy, which is specifically designed to meet the needs of young Indians. As the name of policy suggests the policy is specifically designed for young people therefore you can buy this policy in a specific age group – 18 to 45 Years. Here I have reviewed this policy terms in detail, highlighting its benefits and drawbacks. Positive features of Yuva Bharat Health Policy …

A TPA, or Third Party Administrator, is an independent organization that works on behalf of insurance companies. It’s not directly part of the insurance company but serves as an intermediary. In this article, we’ll explore what an insurance TPA is, their roles and functions in health insurance, the total number of TPAs approved by the IRDAI (the insurance regulator), and the pros and cons of choosing a health insurance policy with a TPA. Whether you already have or are considering a health insurance policy with a TPA, this article will help clear up any confusion and guide you in selecting…

On December 28, 2023, the insurance regulator IRDAI granted a health insurance license to Narayana Health Insurance Limited. This makes Narayana Health Insurance the sixth company to operate in the standalone health insurance segment. However, Narayana Health Insurance stands out from the rest because it is the first health insurance company that can leverage its extensive hospital network. Unlike other insurance companies that need to develop a cashless network to serve policyholders, Narayana Health Insurance already has this advantage. On July 30, 2024 Narayana Health Insurance launched its first affordable health insurance plan ‘ADITI’. in this article we will review…