PGDHIM SEM 2 ASSIGNMENT 1

 

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Post Graduate Diploma in Health Insurance Management (PGDHIM)

 

3^rd SET OF ASSIGNMENT

 

PRN No.:_________________                                                                  

Student Name:____________

 

Answer the following questions:

Course 4: Health Insurance Claims Management

 

Question. What is Third Party Administrator (TPA)? Enlist the role of TPA.                          (5 Marks)

Answer: What is a TPA?

A Third Party Administrator is a body that processes insurance claims admissible under the mediclaim policy. In general,these administrators are independent but can also act as an entity belonging to the insurer/s. These bodies are licensed by Insurance Regulatory IRDAI.

Over the years, the number of

 

 

 

 

Question. What is claims? Why is health claims repudiated?                                                     (5 Marks)

Answer:  An insurance claim is simply a request made concerning an insurance policy. When you make an insurance claim, you have usually suffered some type of loss or your property has sustained damage that is caused by one of the

 

Course 5: Legal Aspects in Health Insurance

 

Question. What are the general guidelines to TPA in respect of services in relation to Health Insurance Policies as per Regulations, 2016.                                                                           (10 Marks)

Answer: Health services by 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

 

Question. Write down the important provisions relating to health insurance products as per IRDAI (Health Insurance) regulations 2016                                                                                       (5 Marks)

Answer: Provisions relating to Health Insurance products, IRDA 2016:

Product Filing Procedure for health insurance products

a. No insurance product of a Life Insurer, General Insurer and Health Insurer under Health Insurance Business and any revision or modification thereon shall be marketed or offered by any insurer unless it is filed with the Authority as per the Product Filing Guidelines and duly disposed of by the Authority as provided therein.

 

Course 6:

Project Synopsis- As a part of continuous assessment                    15 Marks

 

 

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