Section 20(8) in Insurance Regulatory and Development Authority of India (Third Party Administrators - Health Services) Regulations, 2016
(8)Any change in a TPA by the insurer shall be communicated to all the policyholders thirty days before giving effect to the change.a. The contact details like helpline numbers, addresses etc. of a new TPA shall be immediately made available to all the policyholders in case of change of TPA.b. The insurer shall take over all the data in respect of the policies serviced by the earlier TPA and make sure that the same is transferred seamlessly to the newly assigned TPA, if any. It shall be ensured that no inconvenience or hardship is caused to the policyholder as a result of the change. In this regard, inter alia the following aspects shall be taken into consideration;i. Status of cases where pre-authorization has already been issued by existing TPA.ii. Status of cases where claim documents have been submitted to the existing TPA for processing.iii. Status of claims where processing has been completed by the existing TPA and payment is pending with the insurer.
