How does the GIPSA package work?

Overview: How the GIPSA Package Works 

• GIPSA stands for General Insurance Public Sector Association, a collaboration between four major public-sector insurers in India: New India Assurance, National Insurance, United India Insurance, and Oriental Insurance . 

• It offers cashless mediclaim services for standard treatments (like cataract removal, kidney stones, appendectomy, angioplasty, etc.) through a curated Preferred Provider Network (PPN) of hospitals that agree to pre-negotiated package rates . 

Key Points for Policyholders: 

• Cashless claims only at GIPSA-empaneled hospitals. 

• Hospitals must bill strictly as per agreed package rates—overcharging can be disputed . 

• For reimbursement claims in PPN hospitals, settlements are based on these package rates . 
• Reimbursement from non-PPN hospitals follows the insurer’s standard “reasonable and customary” criteria, based on local market rates. 

Wider Benefits: 

• Covers standard procedures at ~550+ empaneled hospitals across 12 major Indian cities . 

• Lower negotiated costs from large public insurers mean potentially reduced premiums and better utilization of your insured sum . 

GIPSA stands for General Insurance Public Sector Association. An association of the four public sector general insurance companies, namely, manages the GIPSA Insurance package.

1. The New India Assurance Company Ltd,
2. National Insurance Company Ltd,
3. United India Insurance Company Ltd, &
4. The Oriental Insurance Company

General Insurance Public Sector Association packages (GIPSA Insurance package) cover commonly occurring ailments like cataracts, kidney stones, hysterectomy, appendicitis, angioplasty, etc. GIPSA has limited cashless mediclaim services available to policyholders of the above public sector general insurance companies to hospitals that honor GIPSA suggested rates for treatment packages. Hospitals that accept GIPSA rates join their preferred provider network list commonly referred to as PPN. This helps the insurers rationalize the settlement of health insurance claims.

Inline is a few points that are relevant to policyholders –

1. You can only avail cashless mediclaim services within the GIPSA approved PPN network.
2. The authorities instruct PPN Hospitals to strictly charge as per the agreed package rates for treatments. In case any hospital overcharges or denies admission to the patient due to GIPSA rates, the policyholder should immediately raise a grievance with the insurance company.
3. In case a policyholder files for reimbursement claim for treatment done in a PPN network hospital, the insurer will reimburse only as per the GIPSA rate.
4. In case a policyholder files for reimbursement claim for treatment done in a non-PPN network hospital, the insurer will reimburse as per reasonable and customary clause. That is, general prevailing cost of that service within your geographic area, which is calculated by your insurance company.

FAQs:  

1. What does GIPSA mean?
   GIPSA is the General Insurance Public Sector Association, formed by four government-owned insurance companies to standardize and streamline health insurance claims and rates .

2. What treatments are covered under GIPSA?
   It includes common procedures like cataract surgery, kidney stone removal, hysterectomy, angioplasty, appendicitis operations, dialysis, joint replacements, and more .

3. What is a PPN hospital?
   A PPN (Preferred Provider Network) hospital is one that has agreed to GIPSA’s package rates and offers cashless services to policyholders of member insurers .

4. Can I avail of cashless treatment outside a GIPSA hospital?
   No—cashless facility is limited to PPN hospitals. If treated at a non-GIPSA hospital, you can claim reimbursement based on usual insurer guidelines .

5. What if a GIPSA hospital overcharges?
   If the hospital exceeds the package rate, you can file a grievance with your insurer or TPA. They must settle claims as per the agreed GIPSA rate .

6. Where is GIPSA available?
   Coverage is available in about 12 major Indian cities, including Delhi, Mumbai, Bangalore, Chennai, Kolkata, Hyderabad, Ahmedabad, Chandigarh, Jaipur, Pune, Indore, and Coimbatore .

7. Why is GIPSA beneficial?

• Ensures standardized treatment costs across hospitals. 

• Offers streamlined, predictable cashless claims. 

• Leverages negotiated bargaining power for lower costs than private insurers.