The four PSU insurers — National Insurance Company, New India Assurance, Oriental Insurance and United India Insurance — had invited expressions of interest from companies for forming a joint venture TPA. “The deadline for EoI has been extended to September 24, from September 3 earlier,” General Insurers Public Sector Association (GIPSA) Chief Executive A K Singhal told PTI.

The partnership is expected to commence operations by June 30, 2011. TPAs are firms to which insurers outsource servicing of health claims. After the insurance companies issue the policy, almost all the back office work, including networking with healthcare providers, are undertaken by TPAs. In return, they get around five per cent of the premium as fees.

Following the row over excessive billing, the four PSU insurers, with effect from July 1, 2010, took off about 150 hospitals from the list of preferred provider network (PPN) that provide cashless hospitalisation services to policy holders under the mediclaim scheme.

While the insurance regulator expressed hope that the row would be resolved soon, hospitals do not seem sharing the same optimism, with Max India Chairman Analjit Singh saying there is currently “zero consensus” on the issue.

Currently, there are 27 TPAs registered with insurance regulator Irda. The health insurance segment generated over Rs 7,000 crore of premium last year, of which about 70 per cent was generated by the four state-owned insurers.
Industry insiders say that the requirements in the EoI have stated that the TPA should have a networth of Rs 250 crore, which is very high.

Regulatory norms

Also, the current regulatory norms do not allow one person to hold two TPA licences. It is still not clear whether Irda would allow companies to continue with their existing TPAs even after they enter into a partnership with GIPSA. The TPAs are also concerned that since the PSU insurers are the major players in the health insurance sector, most of the business would now come to the new JV TPA. Thereby leaving only the private sector insurance companies for the TPAs.

Among private insurers, ICICI Lombard and Bajaj Allianz General Insurance, which account for 80 per cent of the health business, have their own health administration divisions.