Health Services by TPA” means the services specified in Regulation (3) of IRDAI (Third Party Administrators-Health Services) Regulations, 2016. “Third Party Administrators or TPA’’ means any person who is registered under the IRDAI (Third Party Administrators – Health Services) Regulations, 2016 notified by the Authority, and is engaged, for a fee or remuneration by an insurance company, for the purposes of providing health services as defined in those Regulations. 3 which provide Servicing of claims under health insurance policies by way of pre-authorization of cashless treatment or settlement of claims other than cashless claims or both, as per the underlying terms and conditions of the respective policy and within the framework of the guidelines issued by the insurers for settlement of claims.Servicing of claims for Hospitalization cover, if any, under Personal Accident Policy and domestic travel policy.Facilitating carrying out of pre-insurance medical examinations in connection with underwriting of health insurance policies: Provided that a TPA can extend this service for life insurance policies also.Health services matters of foreign travel policies and health policies issued by Indian insurers covering medical treatment or hospitalization outside IndiaServicing of health services matters of foreign travel policies issued by foreign insurers for policyholders who are travelling to India: Provided that such services shall be restricted to the health services required to be attended to during the course of the visit or the stay of the policyholders in India.Servicing of non-insurance healthcare schemes as mentioned in Regulation 22 (3) of these Regulations g. any other services as may be mentioned by the Authority.While performing the services as indicated at Regulation 3 (1) of these regulations, a TPA shall not Directly make payment in respect of claims Reject or repudiate any of the claims directlyHandle or service claims other than hospitalization cover under a personal accident policyProcure or solicit insurance business directly or indirectlyOffer any service directly to the policyholder or insured or to any other person unless such service is in accordance with the terms and conditions of the policy contract and the agreement entered into in terms of these regulations.A TPA can provide health services to more than one insurer. Similarly an insurer may engage more than one TPA for providing health services to its policyholders or claimants.
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Third party beneficiary
A person who is not expressly named in a contract, but who legally still has rights under that contract.
Third party claim
a demand made by a person against a policyholder of another company and any payment that will be made by that company.
Third Party Cover / Third Party Insurance
Insurance cover providing compensation for injury to third parties and/or damage to their property. Generally a synonym for liability Insurance. Liability Insurance always involves three parties, the harmed, the Insurer and the insured charged with causing that harm.
Third Party Fire and Theft
Differs from third party motor only in that it covers damage to the vehicle if caused by fire or theft or attempt at theft. See MOTOR INSURANCE COMPREHENSIVE COVER.
Third party insurance
Synonymous with public liability, it distinguishes cover from a policy covering liability to employees. In aviation insurance the term third party insurance distinguishes general third party cover from legal liability to passengers in the insured’s own aircraft. A captive company in the open market also uses term in connection with the insurance business for parties other than its parent company. Marine third party liability is the primary business of Protection and Indemnity Clubs.
Third party insurance (Liability Insurance)
Another name for liability insurance. It is referred to as third party insurance because it involves the insured, the insurer, and a third party, the person who has been harmed.
Third Party Liability
Liability incurred by the insured to another party but excluding contractual liability.
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The liability that an insured has to a third party.
Third party motor cover
Covers liability for third party injury and property damage, including emergency treatment, and liability for accidents caused by passengers. The policy exceeds the level of cover required under Road Traffic Act compulsory requirements that require cover only in connection with vehicles used on a road or other public place. The normal third party policy is not so restricted.
Third party notice/proceedings
Process by which the defendant in a civil action may obtain a court order to include a third party in the proceedings because he seeks a remedy or indemnity from that party. A retailer faced with a product liability claim might seek to join the manufacturer in the action, perhaps prompted by the insurer in pursuing subrogation rights. This avoids the costs of a separate action. See THIRD PARTY 2.