What Is GIPSA & How Does It Work?

What Makes GIPSA Different From Others?

This group insurance companies has a particular price band with limited cashless services. The services are solely for limited hospitals which accept these companies' price bands and join their own PPN. As of now, this decision has impacted around 5.48 crore health insurance policyholders.

Case Scenario

According to a statement by Karmayogi Pratishthan, Gaurang Damani, the founder of an NGO. Public interest litigation was filed against the GIPSA decision in the High Court, Bombay. When policyholders go to the hospitals for treatment, they have to pay a certain amount without any cashless group insurance facility. This may be disallowed eventually partially or fully by third-party administrators on certain grounds.

How Does GIPSA Work?

GIPSA provides coverage for common illnesses such as kidney stones, cataracts, appendicitis, hysterectomy, angioplasty, etc. As mentioned above, the network hospitals of GIPSA will provide treatment coverage under the price band decided by GIPSA.

Few Relevant Points for Policyholders

Here are a few points that a policyholder should know:

• Policyholders can avail of cashless mediclaim services in the PPN network approved by GIPSA.
• PPN network hospitals have to charge as per the agreed package rates. If any hospital overcharges, the policyholder can raise a grievance with the insurance company.
• The insurer will reimburse as per the GIPSA rate if the policyholder raises a claim for reimbursement for a treatment done in a PPN network hospital.
• If a policyholder raises a reimbursement claim for a treatment done in a non-PPN network hospital, the insurance company will reimburse the amount as per the customary clause. The insurance company will calculate the amount as per the service and prevailing cost within the geographic area.

Benefits of GIPSA

Here are some of the benefits of GIPSA:

• All four insurers have negotiated a special package rate with many hospitals across 12 cities for several medical procedures.
• The list of cities: Ahemdabad, Chandigarh, Delhi, Chennai, Mumbai, Hyderabad, Indore, Kolkata, Coimbatore, Bangalore, Jaipur and Pune.
• GIPSA’s purpose is to have standard packages and charges for certain medical procedures to save customers from being charged more which would ensure better utilization of the sum insured amount.
• Medical procedures such as Kidney transplant, total knee replacement, CABG, Liver transplant, Dialysis, etc. are generally covered. There are more than 550 hospitals enrolled with GIPSA.

Conclusion

If you live in one of the 12 cities mentioned above and want to get yourself covered under a cost-effective group health insurance policy then you can purchase the health insurance plan from any of the 4 insurance companies mentioned above. You can look for a suitable group insurance policy online and learn about the coverage, terms and conditions in detail.