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TPAs
(Introduction)

Third Party Administrators (TPAs) are corporate entities that provide technical and administrative services as required and may be defined by the Agency. (such as registration etc.). Civil society organizations such as Non-Governmental Organizations include: Labour Unions, Nonprofit Organizations, Churches, Community Based Organizations (CBOs) and Faith Based Organizations (FBOs) etc shall participate in the State Social Health Insurance Scheme (SSHIS) as Third Party Administrators (TPAs). As Third Party Administrators, CSOs and Corporate bodies shall be responsible for the day to day management of SSHIS, and they shall provide both initial and on-going technical support to the management of the SSHIS.
TPA
TPAs shall be accredited by TSCHIA. Any group of persons or organizations with technical capacity may be legible to form a company public or private and apply for accreditation as TPA. It is expected that such organizations are required to meet the following criteria:

ELIGIBILITY

  • Register with the Corporate Affairs Commission (CAC). Original Certificate of Incorporation and Incorporated Trustees Form shall be sighted and verified.
  • Complete the prescribed TSCHIA application forms, providing the following information:-
  • Composition of the Trustees.
  • Possess necessary staff and infrastructure including computerization.
  • Pay the stipulated registration fees for guidelines and other sundries.
  • (E) Maintain current accounts with TSCHIA-accredited banks.
  • Evidence of registration with relevant professional/occupational bodies (where applicable).
  • Evidence of at least three (3) years experience in implementing health related community development activities including monitoring and evaluation (M&E) in relevant areas.
  • Good administrative and management structure shall include the following key departments: (i) Finance and Accounts. (ii) Admin/Human Resources. (iii) Health Services. (iv) Information Technology (vi) Minimum working capital of N1 Million as may be prescribed from time to time by TSCHIA. (vii) Re-insurance with an TSCHIA. accredited insurance company. Note: The Agency shall not accredit any TPA if it is not in the public interest or in the interest of prospective enrollees.

Procedure for Accreditation

  • Each application for accreditation as TPA shall be signed by authorized representatives of the applicants, and shall be in a form prescribed by the Agency. The prescribed fees and the following shall accompany such application: (A) Basic registration documents, such as the Certificate of registration and other relevant documents (B) A copy of the byelaws, rules and regulations and such other documents regulating the conduct of the internal affairs of the TPA. (C) The names, addresses and official positions of the persons who shall be responsible for the conduct of the affairs of the TPA.
  • The Agency shall, accept or reject the application of a TPA.
  • The registration fee payable by any TPA to the Scheme is non refundable and as prescribed by the Agency from time to time in line with TSCHIA guidelines.
  • The Agency shall issue a certificate of Accreditation to every successful TPA.

Rules and Regulations

  • TSCHIA may use its own staff or appointed agents to visit any TPA and assess its structure and performance.
  • The accreditation of the TPA shall be for a period of two (2) years and its subject to renewal subsequently.
  • Upon accreditation, each Third Party Administrator shall open a bank account with any bank from the list of TSCHIA-accredited banks and inform the TSCHIA¬† accordingly.
  • Accreditation of any TPA shall be cancelled if the accreditation is based on fraudulent misrepresentation, the organization ceases to exist, or is unable to maintain the financial conditions stipulated by the TSCHIA.
  • Upon accreditation, TPA shall sign Memoranda of Understanding with the TSCHIA.
  • TSCHIA shall carry out periodic evaluation exercises for accredited TPA and assess their level of performance and efficiency.

Registration of Enrollees

Registration of enrollees could be by TPAs. Each programme shall have a clearly defined procedure for registering enrollees as well as a form of identification (ID cards shall be issued by TSCHIA at a cost) to assist in the identification of enrollees.

Remuneration of TPAs

As much as voluntary work is encouraged, TPAs shall be entitled to administrative charge to be determined by TSCHIA.

Annual Activity Report

The accounting year shall be from 1st January to 31st December of every year. Activity reports MUST be sent to TSCHIA quarterly.

Exit from the Agency

TPAs wishing to exit from participation in the Agency shall give three (3) months written notice to the Agency of its intention.