While the Star Health DRHP mentions that the share of TPA’s in total health insurance claims paid has reduced over the last few years, the Frost & Sullivan report says that the premiums serviced by TPA’s have grown at a CAGR of ~20% between FY’17 and FY’23 and are further likely to grow by about 24% CAGR for the next few years. The report also highlights that the share of TPA’s in servicing overall premiums is likely to increase from the current 59% to about 65% by FY’28.
The thesis here is that in the last five years, the dependence on TPAs has increased with insurance companies focusing on the primary business of underwriting risks and marketing policies and outsourcing the claims processing function to TPA.
Medi Assist currently works with 27 of the 28 insurance companies in India and 21 of the 28 insurers use their network to process claims.
The Medi Assist management had the below response to a question on how insurance companies are acquiring TPA’s and the potential impact it would have on a company like Med Assist.
“So, even today, whether it was through an acquisition route or built homegrown, every single
insurer that we work with has the TPA capabilities today across the board and all 27 of them.
And we continue to win business based on the core value proposition that we’ve always
articulated in terms of our ability to understand group benefits better, drive superior retention
for the same insurers and bring in technology, expand cashless and more importantly be with a
neutral party. That actually focuses on balancing all the different perspectives that need to be
brought together across the insurers, policyholders and the network. And that’s where we’ve
consistently grown because of our focus on the core value proposition and being neutral.”
The above is one of the key questions that merits a lot of thought.
Bajaj Finserv Health recently acquired Vidal Healthcare Services, a leading healthcare administrator and TPA servicing premium of 5000 crore. What happens in this case going forward?
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Does Bajaj Finserv Health exclusively work with Vidal henceforth? I am guessing not, since the latter manages premiums of 5000 crores. If Vidal is going to work with other insurance providers as well, how comfortable will insurance companies be to work with a TPA which is owned by a competitor?
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If other insurance companies, choose to not work with Vidal, does it not open up a big opportunity for Medi Assist to increase their market share?
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How does Bajaj Finserv Health stay unbiased when it comes to processing claims since they now have vested interests for obvious reasons to not approve them?
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What is the regulator doing in this case to ensure a fair and unbiased claim process?
Would be great to get informed views from people within the industry or otherwise.
Disc: Studying- Not invested yet.
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