What Is GIPSA & How Does It Work?

GIPSA's full form is the General Insurance Public Sector Association, which is a group of four general insurance companies. The group includes National Insurance Co Ltd., Oriental Insurance Co Ltd., New India Assurance Company Ltd., and United India Insurance Co Ltd.

These companies cover around 80% of the country’s cashless insurance market; they have specific price bands for surgeries or treatments in specific rooms. The services are only for limited hospitals in 12 cities which accept these companies’ price bands and join their own PPN (Preferred Provider Network).

GIPSA policies provide coverage against common illnesses like cataracts, kidney stones, appendicitis, and angioplasty. The network hospitals of these GIPSA companies will provide treatment coverage under the price band decided by GIPSA.

Some Points To Remember for GIPSA Insurance Holders

• Policyholders can avail benefits of cashless insurance in GIPSA-approved PPN hospitals.

• PPN hospitals are required to adhere strictly to the agreed-upon rates. If any hospital exceeds these rates, policyholders have the option to file a grievance with their insurance company.

• Additionally, if a policyholder submits a reimbursement claim for treatment received at a PPN hospital, the insurance provider will reimburse them according to the GIPSA rate. If the policyholder submits a reimbursement claim for treatment at a PPN hospital, the insurance provider will apply the GIPSA rate for reimbursement.

• Suppose the policyholder raises a reimbursement claim for treatment in a non-PPN hospital. In that case, the insurance company will reimburse the amount according to the customary clause. The cost is calculated according to the service prevailing rate within the geographic area.

• GIPSA companies encourage cooperation and coordination in the insurance sector. It helps the member organisations work effectively and efficiently by sharing information, resources, and knowledge.

• GIPSA works to provide standard packages and charges for particular medical procedures, saving customers from being overcharged and ensuring better utilisation of the sum insured amount.

• It acts as the representative of its members and engages with industry stakeholders and authorities to advocate favourable policies and regulations.

• GIPSA works to develop its members' skills and knowledge through skill-development workshops, seminars, training, and teachings. It also enhances the cultural development of professionals.

• It takes initiatives related to infrastructure, adoption of new technology, etc. that can help the member reduce costs and improve profits.

• GIPSA has a vast network of hospitals, and medical procedures like liver transplants, kidney transplants, CABG, dialysis etc, are usually covered under them.

Uniformity and standardised practice are necessary in every industry. GIPSA is the organisation that maintains them in the cashless insurance industry. It helps policyholders get the best medical services at reasonable costs and ensures that the insurance company also profits adequately.

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What is the GIPSA rate?

It is the negotiated rates or tariff structure with the hospitals that 4 large insurance PSUs have.

What is the GIPSA PPN declaration form?

It is the form stating the information of the patients at the network hospitals. It contains their details like name, address, age, insurance policy details, etc.

What is the GIPSA exam?

Every year, GIPSA conducts an all-India competitive exam to promote officers of GIPSA member companies in scales 1, 2, 3, and 4 to the higher cadre.