Vidal Health Insurance TPA

Employers seeking to deliver employee health benefits that are structured differently from the typical group medical cover are reaching out to Vidal Health to support them on multiple aspects of the programme. These can include benefits design, setting up of preferred provider networks, technology platforms and benefits administration. Since many employers are accustomed to insurance brokers playing a key role in their benefits management, Vidal Health actively engages with brokers to accomplish this and deliver meaningful outcomes to employers.

As insurers (and their employer/government clients) start to include coverage for outpatient services, there is a need to provide their members with access to preferred physicians networks based on a structured/rigorous credentialing mechanism. Vidal Health is empanelling a large number of physicians across specialties and empowering them with tools to make them ready for third-party payments. Insurer’s members can be provided access to such physician networks.

Based on its expertise in data capture as well as extraction of insights from large volumes of transaction data. Owing to this, it has made solid investments in analytics talent and developed the expertise to assist insurers to design and implement their own reporting and analytics projects, either on a consulting approach or a completely out-sourced approach.

Whether transitioning an existing customer account or on-boarding a new account, insurers find Vidal Health technology platforms the perfect way to enroll members—be it by the hundreds or by the millions. On large government contracts, Vidal Health has frequently helped its insurer clients on-board more than a million members from the most remote locations. That too within a short time frame. Large employers transitioning to new insurance relationships also find this capability of Vidal Health of great value. Click here to visit

Owing to the massive scale of its operations (35 million members, 1 million hospitalisation claims every year, 800 thousand pre-authorisation requests for these hospitalisations from an empanelled network of over 7000 hospitals) Vidal Health heavily invests in technology to deliver a superior experience to all its stakeholders. Over the years, these investments have resulted in the evolution of a world-class proprietary technology platform that can be licensed for use by insurers, healthcare administrators (including third-party administrators), hospitals and health systems, and pharma companies for deployment across their businesses.

For its insurer clients, Vidal Health can empanel and contract with hospitals as required by the insurer (and/or its employer/government clients) based on precise specifications relating to access. Vidal Health already enjoys a direct relationship with over 7000 hospitals across India. Also, if a preferred network is required, it can accomplish that set up very quickly. Click here to visit

Other than insurance companies, Vidal Health is among a handful of health services management companies that have invested in building expertise in actuarial and underwriting skills. The Vidal Health actuarial team is already assisting insurance companies globally on matters such as pricing and new product designs; it’s also consulting on analytics and process improvement.

Members of insurance companies often need help to identify the right doctor(s) to diagnose and treat their medical condition. Being able to access the right doctor at the right time can often result in significant savings by avoiding unnecessary visits to multiple doctors and any subsequent repeated spending on diagnostics. Vidal Health has invested in processes and technology platforms that enable convenient access to a credentialed network of empanelled doctors to members and their families.

In addition to the convenience of not having to carry cash while in the hospital to settle the hospital bill, the bigger advantage of credit billing/cashless hospitalisation is that it allows Vidal Health to review the final hospital bill for accuracy. Considering that hospitalisation is a rare occurrence in the lives of most individuals, making sense of a hospital bill is not something they might be equipped to deal with. Vidal Health processes over 1 million hospital bills every year. This provides an assurance to members that they are paying the right amount for their treatments. Click here to visit

When Vidal Health first offered the e-claims platform to its network hospitals, it set up help desks in hospitals with high volumes of insured members to support them take advantage of the technology platforms. Vidal Health continues to provide this support by setting up hospital help desks at the behest of an insurer or employer or government client from time to time. This makes it easier for members to avail themselves of the benefits under their policies. These help desks are staffed with resources who use technology extensively and are connected via telephone and internet to the Vidal Health back-end to offer a speedy response to the members.

Most individuals are unequipped to deal with the complexity and costs involved in medical treatments. When selection of the hospital is added into the mix, it gets even more confusing. Whether one is paying out-of-pocket or is receiving benefits from an insurance policy (employer-provided or direct-purchased), it is always helpful if expert advice is on hand. It helps determine whether a particular treatment is required, will it deliver expected outcomes, which is the right hospital for the procedure and how to manage costs (of hospitalisation etc.) Using its network of empanelled top medical specialists as well as extensive data available from its hospital relationships, Vidal Health can hand-hold individuals as they make their decisions in extremely critical situations for themselves or their families. A strong culture of empathy within the organisation ensures that the individual is given personalised attention.

Vidal Health was the first third-party administrator to provide its empanelled hospitals with access to an e-claims platform that allowed pre-authorisation requests and final claims to be submitted online. This allowed turnaround times for pre-authorisations approvals to drop drastically benefiting members tremendously. It has continued building on similar innovations to make it easier for members whether they seek cashless hospitalisation or re-imbursement of a hospital bill they may have already paid. In areas outside India, Vidal Health processes on the fly cashless requests for outpatient services like doctor consultation, prescription filling at a pharmacy, diagnostics etc. which makes it convenient for members, helping them avoid having to fill out forms for reimbursement of medical spending. Click here to visit

Employers are taking a lot of interest in helping their employees stay healthy. While the underlying objectives could vary from employee engagement to productivity increase or even an attempt to reduce illness and therefore hospitalisation (and therefore claims pay-outs), preventive health and well-being programmes are being seen as a compelling way to accomplish those objectives. These programmes could include health screenings, risk assessments, on-site activities, on-site health centres, counselling and many more. Over the last few years, Vidal Health has delivered such programmes to a large number of employers (most of who have spent top dollar on such programmes) which has resulted in over a hundred thousand participants and yielded some amazing insights into the health status of the workforce. This has in turn enabled these employers to strengthen their benefits programmes to deliver greater benefits.

Individuals are being recommended a wide range of medical/health services, many of which might be delivered outside a hospital. For example, in a clinical setting like a doctor’s office or a diagnostics lab, in the individuals’ homes, or over the internet. Services could include doctor consultations, lab investigations, expensive pharma therapies, counselling, preventive and well-being services etc. More often than not, individuals will pay for such services out-of-pocket (at this time most insurance policies do not include these services for coverage, though a few might be able to get this reimbursed from the insurance company since their policies might cover these services) and will therefore seek convenient access to these services. Vidal Health aggregates a wide variety of services available across the country from credentialed service providers on a web portal where individuals can discover, purchase and schedule appointments for the services.

In addition to investing heavily in technology to deliver a superior stakeholder experience, Vidal Health believes that healthcare often requires high-touch. This is why it has a full service call centre, staffed with over 100 executives drawn from various backgrounds, including clinical. In addition to receiving in-bound calls from members on a variety of concerns like eligibility, claims status, customer satisfaction etc., the call centre also provides disease-specific support, toll-free support for specific clients and processes as well as out-bound calling if required. Click here to visit