GIPSA, PPN and Empanelment in Health Insurance - Explained

What is GIPSA, GIPSA full form, PPN in GIPSA, Points to remember before opting GIPSA services, GIPSA hospitals and GIPSA empanelment

What is GIPSA?

GIPSA full form is General Insurance Public Sector Association and itcomprises 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

This association created a network of hospitals to standardize pricing for certain procedures. This network of hospitals is called PPN. Now, when a policyholder goes to any hospital in the network, the prices will be similar for certain medical procedures like kidney stones, angioplasty, hysterectomy, etc. They have comparatively reduced prices from hospitals across India (12 cities).

This also makes claim process easy for policyholders. If they go to any of the network hospital they can easily get cashless treatment.

Read: Health insurance claim process

What is Preferred Provider Network (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. Across the nation around 550 hospitals have enrolled for GIPSA.

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, thereby 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 customers. 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. This in turn ensures the better utilization of the sum insured in a health insurance policy.

The special package rates are applicable in 12 cities. They are Ahmedabad, Bangalore, Chandigarh, Chennai, Coimbatore, Delhi, Hyderabad, Indore, Jaipur, Kolkata, Mumbai, and Pune.

Read: GIPSA PPN hospitals in India

Pointers to remember before opting for GIPSA services

As policyholders, it is essential to keep these in mind regarding the GIPSA services

  • You can avail cashless claim services only in GIPSA approved Preferred Provider Network (PPN) hospitals.
  • If you wish to avail a reimbursement claim for the treatment done at a PPN hospital then, the insurance company reimburses you according to the standard GIPSA rates.
  • On the other hand, if you wish to file a reimbursement claim for a treatment taken at a non-PPN hospital then, the insurance company reimburses you according to the reasonable and customary clause. This means you will be reimbursed based on the general prevailing cost of the specific service in a particular geographical area (usually calculated by your insurer).
  • All the PPN hospitals must charge you only according to the standardized rates. In case, the hospital charges you more or denies the admission to the patient you can immediately raise a complaint with the insurer.

Read: Mediclaim policy

What is GIPSA empanelment?

Getting GIPSA empaneled 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 on the website of the insurance companies. Once you get accepted, you will also be on the list of the hospital networks.

Read: What is health insurance TPA?

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