What is GIPSA?
The General Insurance Public Sector Association (GIPSA) is a group made up of four public sector insurance companies which covers 80% of the country’s cashless insurance market. The association listed hospitals for fixed closed packages for specific surgeries in specific rooms.
The four public sector insurance companies are:
- National Insurance Co Ltd.
- New India Assurance Company Ltd.
- Oriental Insurance Co Ltd.
- United India Insurance Co Ltd.
To standardize and economize treatment cost of common diseases which affects general public. For example, Angioplasty is very common hence treatment cost has been standardized.
How does it Work?
The association introduced PPN (Preferred Provider Network), a cashless network of hospitals. These hospitals provide cashless treatment under the price band decided by GIPSA. This makes the network friendly to the policyholder as healthcare costs are restrained and as a result, insurance companies charge a lower premium. Cataracts, appendicitis, kidney stones, hysterectomy, angioplasty, etc., are some of the common illnesses covered.
Health Insurance Claims in Network Hospitals
You can avail cashless mediclaim services only in GIPSA approved PPN hospitals. In simple words, if you show your health card to the PPN hospital, then the hospital will not charge you.
If you have taken treatment from any PPN hospital and it overcharges, then you can contact your insurance company for grievances.
Health Insurance Claims in Non-Network Hospitals
A non-network hospital does not have a tie-up with the insurer, therefore cashless procedures are not possible in non-network hospital. However, you can still reimburse the claim amount as per the GIPSA approved rates.
However, the medical policy holders are confused. They are not aware that claims will be approved as per the approved budget. Insured would need to pay any amount in excess to budget. Some policyholders opted for alternative medical treatments which are not only advanced, but also expensive. As a result, GIPSA does not approve such medical treatments. Some policyholders also presume that 80% of medical expenses will be reimbursed but claim is reimbursed for less than 60%. Therefore, policyholders have grievances related to rate disparity.
So it is advisable that we check the GIPSA rates and approved procedures before going for treatment.
Click here to know the widespread implications of GIPSA for health insurance policyholders
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