Section 3(1) in Insurance Regulatory and Development Authority of India (Third Party Administrators - Health Services) Regulations, 2016
(1)A TPA may render the following services to an insurer under an agreement in connection with health insurance business:a. 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.b. servicing of claims for Hospitalization cover, if any, under Personal Accident Policy and domestic travel policy.c. 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 alsod. health services matters of foreign travel policies and health policies issued by Indian insurers covering medical treatment or hospitalization outside Indiae. servicing of health services matters of [travel or health or medical insurance] [Substituted 'foreign travel' by Notification F. No. IRDAI/Reg/15/166/2019, dated 3.12.2019 (w.e.f. 14.3.2016).] 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.f. 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.
