Involved participants

List of participants involved and their role in the above mentioned types of disputes

Participant Type

Role

Comments

Payors (Insurers)

Complainant/Defendant

HCX role: payer

Health Care Providers

Complainant/Defendant

HCX role: provider

Health Insurance Intermediaries - (Licensed) - E.g., Brokers & Corporate Agents

Complainant/Defendant

HCX role: <TBD>

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

HCX role: member.isnp

Third Party Administrators

Complainant/Defendant

HCX role: agency.tpa

Arbitrators (Online Dispute Resolution Entities )

Fast track arbitration process

Multiple entities to be empanelled by the HCX operator (HCX role: To be decided)

HCX Switch Operator

Complainant/Defendant

Data Provider

HCX role: HIE/HIO.HCX

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.

Each participant in the above list will be mapped with HCX participnt roels mentioned in the Access Control section.

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