GIPSA stands for General Insurance Public Sector Association. It is an association of the four public sector general insurance companies, namely :
- The New India Assurance Company Ltd,
- National Insurance Company Ltd,
- United India Insurance CompanyLtd, &
- The Oriental Insurance Company
General Insurance Public Sector Association packages 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 –
- Cashless mediclaim services can only be availed in GIPSA approved PPN network
- PPN Hospitals are instructed to charge strictly as per 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.
- 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.
- 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 – i.e. general prevailing cost of that service within your geographic area, which is calculated by your insurance company.