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.
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