Third Party Administration
Pacific Cross International has over 65 years experience providing Third Party Administration services across Asia.
Regulations for Third Party Administration services vary across Asia so please note not all services listed below are available in all locations.
Third Party Administration
Our corporate group of companies are specialists in Asia, managing and developing Health Insurance, Travel Insurance and Personal Accident Insurance - We have operating entities in Hong Kong, Thailand, Indonesia, Philippines, Vietnam and Cambodia. Across the group we share our experiences, including but not limited to technology, product development, medical expertise and medical provider networks.
Our core competencies in this field can be divided into four key areas:
- Product Development - Benefit Design, Pricing & Documentation
- Risk Assessment & Underwriting
- Claim Adjudication
- Training and Marketing
Product Development - Benefit Design, Pricing & Documentation
On behalf of an Insurance company, Pacific Cross develops the insurance Schedule of Benefits, policy wording, premium structure, and the required documentation associated with legally issuing a product to a customer in Asia. The policy and documents are issued on behalf of an Insurance Company, on their letterhead and in a manner consistent with the proper administrative procedures.
Risk Assessment & Underwriting
Pacific Cross consults on Underwriting. The selling agent submits a completed application and medical declaration to the insurance company and based on what is desired we perform the underwriting or we can liaise with the underwriting department of the Insurance Company and propose an offer of coverage, following internationally accepted underwriting rules and procedures we review the medical / lifestyle information to determine the risk associated with issuing a health insurance policy to the customer. Based on the findings of our Underwriter, an offer is made – at this point the premium may be adjusted based on the information (medical and lifestyle) submitted. The product brochures list the accepted price for a normal healthy person based on their age, should a client differ from this profile (have pre-existing illnesses) then the price can change.
Pacific Cross consults on Claim settlement. Pacific Cross has established a network of medical service providers and work with them to implement the policy benefits and rules, thus processing the claim reimbursement for the clients. Once a client has used either a clinic or hospital they will submit the required information and necessary invoices to the insurance company in order to be reimbursed. The insurance company then passes this information to us for review, and following an international claim adjudication rules we review this information, compare it to the policy wording, the schedule of benefits, and determine the qualification of the claim. In some cases we will liaise with the medical service provider and in some case we deny the claim based on the policy rules. We have doctors in Vietnam, Philippines, Hong Kong, and Thailand and as necessary we use them for medical interpretations. Once the claim is approved we communicate the acceptance to the insurance company and the claim is settled with the client.
Training and Marketing
We consult on administration and training for the successful sale and distribution of Health and travel insurance. The selling agent needs to understand the details of the policy in order to ensure the client and the benefits sold operate successfully and the product does not jeopardize the client / company relationship. Pacific Cross have done this with life and non insurance company clients successfully for over 35years in Asia.