🆕Involved participants
List of participants involved and their role in the above mentioned types of disputes
Participant Type | Role | Comments |
Payors (Insurers) | Complainant/Defendant | |
Health Care Providers | Complainant/Defendant | |
Health Insurance Intermediaries - (Licensed) - E.g., Brokers & Corporate Agents | Complainant/Defendant | |
Health Insurance Facilitators (No licence) - E.g., distributors, marketers, facilitators (Includes Master policy holders and institutions that provide coverage through group policies including self insurance schemes) | Complainant/Defendant | |
Third Party Administrators | Complainant/Defendant | |
Arbitrators (Online Dispute Resolution Entities ) | Fast track arbitration process | Multiple entities to be empanelled by the HCX operator |
HCX Switch Operator | Complainant/Defendant Data Provider |
In addition, participants like IRDAI (IGMS system - the existing dispute resolution platform) and insurance ombudsman and grievance redressal system in healthcare being co opted in subsequent phases.
The above list of participants and the list of participants will map with HCX participnt roels mentioned in the Access Control section.
Last updated