Scheme, insurance or TPA: what changes for you
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हिन्दी में पढ़ेंQuick answer
A government scheme, a private insurer and a TPA are three kinds of payer on HealAssist. What changes for you: which card you are asked for, and whether published package rates exist — only schemes have them. What does not change: the coverage request, the document upload and the statuses are the same for all three.
People arrive at HealAssist holding one of three things: a scheme card, an insurance policy, or a TPA card. The journey that follows is more alike than different — but the two places where it differs are the two that decide what you pay.
What actually differs
| What | Government scheme | Insurer or TPA |
|---|---|---|
| Published rates | Package rates per procedure, shown on HealAssist | None published — your price comes from a quote |
| What you are asked for | Your scheme card and identity documents | Your policy document or TPA card |
| Who settles with the hospital | The scheme, where the hospital is empanelled for cashless | The insurer, through the TPA, where pre-authorisation is approved |
What is identical underneath
The coverage request is one request whichever payer you name. The same form, the same document upload, the same statuses as it moves along. HealAssist did not build three products — it built one, and pointed it at three kinds of payer.
That is worth knowing, because it means the advice does not change: attach a clear document, keep your own copy, and let your HealAssistant do the chasing.
What if I have both an insurer and a TPA?
That is normal, and the coverage check in your HealAssist account lets you name both together. The insurer holds your cover; the TPA runs the claim. Naming both is the most complete answer you can give.
A government scheme is a different route, and the form asks you to pick one. If you think you might be eligible under both a scheme and a policy, say so to your HealAssistant rather than trying to submit both.
Which payer questions
Related articles
TPAs and insurers: who is who
A TPA is not your insurer. What the difference means for your cashless claim, and why HealAssist lists TPAs as their own category.
How government scheme rates work on HealAssist
What the package rate on a HealAssist government scheme page means, where it comes from, and why you must confirm the current rate with the hospital before treatment.
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