What is GIPSA?
GIPSA stands for the General Insurance Public Sector Association. It is an association of India's four public sector general insurance companies. Established in 2001, its member insurance companies are:
- The New India Assurance Co. Ltd.
- National Insurance Co. Ltd.
- United India Insurance Co. Ltd.
- The Oriental Insurance Co. Ltd.
If your health insurance policy is from one of these insurers, GIPSA's hospital network and agreed treatment rates may affect where you can get cashless treatment and how much you pay for certain procedures.
Why Was GIPSA Created?
GIPSA was established to simplify the claims process for health insurance. Unlike hospitals that charge different prices for the same type of care, GIPSA helps establish fixed rates for treatments at network hospitals. This benefits both insurers and policyholders.
The primary objectives include:
- Bringing consistency in the cost of treatments at network hospitals.
- Reducing high variations in the cost of treatments at different hospitals.
- Faster cashless claims processing.
When treatment rates are agreed upon in advance, there is less scope for billing disputes during hospitalisation. That helps with cashless (the insurer pays the hospital directly), so it goes through quickly.
How Does GIPSA Work for Group Health Insurance?
GIPSA works by creating a common framework for its four member insurers to offer cashless treatment at agreed prices. Instead of each insurer negotiating separately with hospitals, GIPSA negotiates standard treatment rates with selected hospitals that become part of the GIPSA Preferred Provider Network (PPN).
In case you have group health insurance through any of these insurers and get treatment from a PPN hospital, the hospital sends a cashless pre-authorisation request to your insurer or third-party administrator (TPA). Once approved, the insurer settles the bill directly with the hospital based on the agreed package rate, subject to your policy terms.
What is GIPSA PPN, and What are GIPSA Package Rates?
The GIPSA-PPN is the Preferred Provider Network (a list of hospitals chosen by these four insurers). These hospitals agree to treat policyholders at fixed prices.
Those fixed prices are called package rates (a fixed price that the insurer and hospital agree on for a procedure). Each package covers a specific medical procedure and is based on factors such as the city and the patient's eligible room category.
Package rates cover common planned procedures. Some of the examples include cataract, angioplasty, appendix surgery, kidney stones, and knee replacement. Since the treatment cost is agreed upon in advance, policyholders can expect more predictable hospital bills and a smoother cashless experience at PPN hospitals.
Confirm the network before you get admitted
GIPSA package rates apply only at Preferred Provider Network (PPN) hospitals and only for listed procedures. Before a planned admission, confirm with your insurer or TPA that your chosen hospital is on the current PPN list and that your procedure is covered at the package rate. Non-network hospitals and unlisted items are billed at the hospital's own tariff
How Does a GIPSA Cashless Claim Work Under Group Health Insurance?
A cashless claim works in four steps. Here is the order:
Choose a PPN hospital
Pick a hospital that is part of the GIPSA Preferred Provider Network for your insurer, so the agreed package rates apply.
Show your health card and inform the TPA
Present your cashless health card and let the hospital's insurance desk raise a cashless request with the third-party administrator (TPA).
Get pre-authorisation
The TPA reviews the request against your policy and the GIPSA package rate for the procedure, then approves the cashless amount.
Undergo treatment at the package rate
The listed procedure is billed at the fixed GIPSA package rate rather than the hospital's open tariff.
Insurer settles the bill directly
The insurer or TPA pays the hospital directly for the covered amount. You pay only for items outside the package or policy limits.
How Does a Hospital Join the GIPSA Network?
A hospital becomes part of the GIPSA Preferred Provider Network (PPN) through an empanelment process. The process generally involves the following steps:
The hospital submits an application for empanelment.
The member insurers verify the hospital's infrastructure, facilities, and documentation.
If the hospital meets the required criteria, it is added to the GIPSA PPN network.
The empanelled hospital is allowed to give cashless treatment to the policyholders of the four member insurers at GIPSA package rates.
Does GIPSA Apply to Private Health Insurers?
No. It does not apply to private health insurance companies. Private insurance firms have their own networks of hospitals and process cashless claims through their own claims teams or third-party administrators (TPAs). While there is a similarity in the processing of cashless claims, the hospital network, package rates, and claim procedures are determined by the individual insurer rather than GIPSA.
Key Takeaways
- GIPSA is an association, not an insurance company: It brings together four public-sector general insurers, New India Assurance, National Insurance, United India Insurance, and the Oriental Insurance Company.
- GIPSA PPN hospitals follow agreed package rates: The procedures performed by the hospitals are charged at the negotiated rates depending on the city and the insured's eligible room category.
- The GIPSA PPN applies to only four PSU general insurers: Other private standalone health insurers have their own network of hospitals and process of cashless claims.
Frequently asked questions
GIPSA package rates can help reduce the amount you pay for covered treatments.
If you receive treatment at a hospital that is not part of the GIPSA PPN, you may not be eligible for cashless treatment. In most cases, you will need to pay the hospital bill first and then submit a reimbursement claim to your insurer.
GIPSA supports both planned and emergency hospitalisations, provided the treatment is covered under your policy, and you receive care at a GIPSA PPN hospital.
Find out the name of the company issuing your health insurance plan. In case your health insurance plan is being issued by the New India Assurance Co. Ltd., National Insurance Co. Ltd., United India Insurance Co. Ltd. or the Oriental Insurance Co. Ltd., it follows GIPSA's hospital network and package rate system.
No. GIPSA package rates apply only to specified procedures covered under the GIPSA PPN.
You can check your insurer's website, contact its customer support or TPA for the latest GIPSA PPN hospital list. Since network hospitals may change over time, always confirm the hospital's status before a planned admission.
About the authors
Neviya Laishram
Written by · Senior Editor – Health, Life and Group Health Insurance Content at ACKOWith a journalism background, she brings 9 years of experience in strategising and editing health, life, and group health insurance content. Having written for magazines and digital publications, she combines research and editorial expertise to create credible, useful content for readers.
Nitesh Kapur
Reviewed by · Senior Director – Underwriting & Claims, Group Health Insurance at ACKOWith over 15 years of experience in health insurance underwriting, he has led group health insurance strategy, risk assessment, and policy design. He has held leadership roles at leading insurers, building risk frameworks, evaluating complex health risks, and strengthening underwriting standards.
