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ANNUAL REPORT 2011-12
SI.
No.
Name of the TPA
TABLE I.49
TPA INFRASTRUCTURE (Contd.)
No. of Hospitals
Added to the
Network
Total No. of
Hospitals in the
Network
No. of New
Branches
Opened
Manpower
Added Including
Professionals
21 TTK Healthcare TPA 298 5895 1 158
22 Grand Healthcare 731 1268 0 3
23 Paramount Health 1013 4052 3 49
24 Anyuta Medinet NR NR NR NR
25 East West Assist TPA 37 3536 2 19
26 Focus Healthcare NR NR NR NR
27 Sri Gokulam Health NR NR NR NR
28 Spurthi Meditech TPA 2253 2362 0 16
29 Universal Medi-Aid NR NR NR NR
TOTAL 8644 78207 43 3939
NR - Not Received.
TABLE I.50
THIRD PARTY ADMINISTRATORS - CLAIMS DATA*
Year
Claims
Received
during the year
≤ 1
month
Claims Settled (duration wise)
> 1 to ≤ 3
months
> 3 to ≤ 6
months
> 6
months
Claims
Outstanding
2010-11 3641585 2745661
(75.40)
2011-12 3783261 3172461
(83.86)
517069
(14.20)
403615
(10.67)
135808
(3.73)
59183
(1.56)
39859
(1.09)
14055
(0.37)
313013
(8.60)
302547
(8.00)
* Claims data includes claims intimated during the previous years.
Figure in the brackets indicates the ratio (in per cent) of claims settled to the total claims received.
During the year 2011-12, the Authority received 129
complaints, of which 122 were disposed and 7
complaints were outstanding as on 31 st March, 2012.
I.4.6.7 During 2011-12, the TPAs received 37,83,261
claims. Out of these, 83.86 per cent of the claims were
settled within one month of reporting, which is an
improvement when compared to previous years.
Claims settled within one month of reporting was 75.40
per cent in the year 2010-11 and 69.76 per cent in the
year 2009-10.
I.4.7 BUSINESS IN THE RURAL AND SOCIAL
SECTOR
I.4.7.1 The Regulations framed by the Authority on the
obligations of the insurers towards rural and social
sector stipulated targets to be fulfi lled by insurers on
an annual basis. In terms of these regulations, insurers
are required to cover year wise prescribed targets
(i) in terms of number of lives under social obligations;
and (ii) year wise prescribed targets in terms of
percentage of policies to be underwritten and
percentage of total gross premium income written
direct by the life and non-life insurers respectively
under rural obligations. The regulations require
insurers to underwrite business in these segments
based on the year of commencement of their
operations and the applicable targets are linked to the
year of operations of each insurer. For meeting these
obligations, the regulations further provide that, if an
insurance company commences operations in the
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