GIPSA, PPN and Empanelment in Health Insurance - Explained

What is GIPSA? General Insurance Public Sector Association, popularly known as GIPSA, comprises 4 public sector general insurance companies...

What is GIPSA?

General Insurance Public Sector Association, popularly known as GIPSA, comprises 4 public sector general insurance companies namely,

The New India Assurance Company Ltd.,

National Insurance Company Ltd.,

United India Insurance Company Ltd. and

The Oriental Insurance Company

It covers 80% of the country’s cashless insurance market, as per Paramount Health. It provides cashless claims services in registered hospitals for insurance holders. They have comparatively reduced prices from hospitals across India for common issues such as kidney stones, angioplasty, hysterectomy etc.

What is PPN?

GIPSA provides cashless services in hospitals that accept their policies and prices and join the Preferred Provider Network (PPN). It requires hospitals to accept GIPSA rules and work on standardized rates. Those who accept this fall under the GIPSA umbrella and can be called PPN.

This is done so that health insurance becomes cost-effective for the general public. The insurance holders will not be charged more than what is due, diminishing the scope of higher chargeable amounts. Experts have opined that in the long run, higher customer premiums will be paid. GIPSA will greatly reduce costs for customers as well as companies.

Hospitals that come under GIPSA are required to charge their customers on the basis of standardization of rates only. If any insurance-holder faces higher rates through PPN, they can raise their grievance with their insurance company. In addition to that, reimbursement claims, if asked, can be done only as per the GIPSA rate in a PPN hospital. But, if reimbursement is claimed for a non-PPN hospital, then the reimbursement will be done according to the insurance company only.

The main idea behind the advent of GIPSA is to provide a safety net to insurance takers. Very often, hospitals might charge more than the actual amount, therefore to protect the customers from paying more, GIPSA ensures standardized rates for basic medical procedures. The special package rates are applicable in 12 cities and around 500 hospitals till now.  

Click here to access the list of GIPSA preferred cashless hospitals

What is GIPSA empanelment?

Getting GIPSA empanelled means getting into the PPN of the Public Insurers. Hospitals can fill and submit GIPSA empanelment forms from the public insurers along with the documents asked by them. You can find the form and the list of documents required in the website of the insurance companies. Once you get accepted, you will also be on the list of the hospital networks.

Also read: What is TPA and its role?

Priyal Singh

Co-founder & CEO

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