Third party administrator (TPA)

An individual or firm hired by an employer to handle claims processing, pay providers, and manage other functions related to the operation of health insurance. The TPA is not the policyholder or the insurer.

Types of health care provider arrangements

♦ Exclusive providers – Enrollees must go to providers associated with the plan for all

non-emergency care in order for the costs to be covered.

♦ Any providers – Enrollees may go to providers of their choice with no cost incentives

to use a particular subset of providers.

♦ Mixture of providers – Enrollees may go to any provider but there is a cost incentive

to use a particular subset of providers.