GIPSA & PPN in Health Insurance: Role, Benefits & Full Form

In health insurance, GIPSA (General Insurance Public Sector Association) and PPN (Preferred Provider Network) work together to offer policyholders cashless treatment at network hospitals. This system, established by GIPSA, ensures standardized medical rates and simplifies the claims process for patients. Let's explore their roles, benefits, and full forms.

What is GIPSA?

GIPSA full form stands for General Insurance Public Sector Association, is a regulatory body in India that oversees public sector general insurance companies. Established in 1986, GIPSA aims to promote collaboration and uniformity among its member insurers, which include major entities:

1. The New India Assurance Company Ltd.,

2. National Insurance Company Ltd.,

3. United India Insurance Company Ltd. and

4. The Oriental Insurance Company

The association focuses on standardizing policies, improving operational efficiency, and enhancing the overall performance of the public sector general insurance industry in India.

What is GIPSA PPN?

GIPSA PPN full form stands for General Insurance Public Sector Association - Preferred Provider Network.  It refers to a network of hospitals that accept cashless treatment for policyholders insured by the four GIPSA companies at pre-negotiated rates. These hospitals agree to give the GIPSA-defined package rates for specific medical procedures, ensuring cost control and streamlined claim settlements.

Points to remember

• Not all hospitals are part of the GIPSA PPN. You can check with your insurer or the hospital.
• While GIPSA PPN offers cashless treatment, the network might be limited compared to other insurance providers.
• Choosing a hospital outside the PPN might still be covered by your plan, but you'll likely need to pay upfront and then claim reimbursement later.

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Benefits of GIPSA in Health Insurance

The GIPSA (General Insurance Public Sector Association) offers various benefits to both insurers and policyholders, including cost control, standardized claim processes, and access to a wide network of hospitals. 

• All four insurance companies have come to an agreement with numerous hospitals in 12 cities to offer a special package rate for various medical procedures. 
• The cities included in this agreement are Ahmedabad, Chandigarh, Delhi, Chennai, Mumbai, Hyderabad, Indore, Kolkata, Coimbatore, Bangalore, Jaipur, and Pune.
• The goal of GIPSA is to establish standardized packages and charges for specific medical procedures to prevent customers from being overcharged, ultimately allowing for better utilization of their insured amounts. 
• Common procedures covered under this agreement include Kidney transplant, total knee replacement, CABG, Liver transplant, and Dialysis. GIPSA currently has over 550 hospitals participating in this program.

How Does GIPSA Work?

GIPSA (General Insurance Public Sector Association) works through a network of hospitals called the Preferred Provider Network (PPN). 

Here's how it works:

• Four Public Insurers: GIPSA comprises four major public sector insurance companies: National Insurance, New India Assurance, Oriental Insurance, and United India Insurance.
• PPN Hospitals: These companies negotiate rates with hospitals that agree to join their PPN. These hospitals agree to abide by the negotiated package prices for specific procedures.
• Policyholder Benefits: If you have a health insurance policy from one of these four companies and choose treatment at a PPN hospital, you can avail of cashless services. This means the hospital will directly bill the insurance company within the pre-determined package price.
• Claim Settlement: The insurance company pays the hospital directly as per the agreed-upon package, and you're only responsible for any co-pays or deductibles mentioned in your policy.
• Reimbursement Claims: If you choose a hospital outside the PPN, you'll need to pay the hospital directly and then file a reimbursement claim with your insurance company.
• Package Coverage: GIPSA typically covers standardized packages for common procedures like cataracts, appendicitis, and knee replacements.
• Cost Control: By negotiating rates and offering cashless settlements, GIPSA aims to keep healthcare costs under control, potentially leading to lower premiums for policyholders.

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What is GIPSA Empanelment?

Being GIPSA-empaneled grants access to the Preferred Provider Network (PPN) of public insurers. Hospitals must complete and submit GIPSA empanelment forms to public insurers, along with the requested documents. These forms and document requirements can be found on the insurance companies' websites. Once approved, hospitals will be included in the hospital networks.

Pointers to Remember Before Opting for GIPSA Services

Here are the pointers to remember before opting for GIPSA services such as cashless claim services, reimbursement claim services, etc.

• Cashless claim services are only available in hospitals that are approved by GIPSA in their Preferred Provider Network (PPN).

• If you want to seek reimbursement for medical treatment received at a PPN hospital, the insurance company will provide reimbursement based on the standard GIPSA rates.

• Alternatively, if you want to submit a claim for the cost of a treatment received at a non-PPN hospital, the insurance provider will reimburse you under the reasonable and customary clause. In this case, the reimbursement will be based on the average cost of the service in a specific area determined by the insurer.

• All PPN hospitals are required to adhere to standardized rates when billing patients. If a hospital overcharges or refuses admission to a patient, you have the right to file a complaint with the insurer promptly.

Conclusion 

The General Insurance Public Sector Association (GIPSA) in health insurance aims to enhance accessibility and affordability. By collaboration among public sector insurers, it strives to streamline processes, reduce costs, and improve customer satisfaction. This collaborative approach holds potential for creating a more efficient and inclusive health insurance landscape. If you want to buy the best health insurance plans with great customer support, contact “Our Experts” now.