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 group health insurance policy is issued by any of these insurers, GIPSA's negotiated hospital rates and network arrangements may affect your cashless hospitalisation experience and the amount payable for certain treatments.
Why Was GIPSA Created?
GIPSA was created to help control hospital treatment costs and reduce billing disputes for policyholders of its four member insurers. It does this by negotiating standard treatment rates with network hospitals.
The aims are simple:
Standardise treatment rates across participating hospitals
Reduce wide variations in hospital charges for the same procedures
Make cashless claim settlements faster and more predictable
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).
If you are covered by one of these insurers and receive treatment at 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.
Once empanelled, the hospital can provide cashless treatment at GIPSA package rates to policyholders of the four member insurers.
Does GIPSA Apply to Private Health Insurers?
No. GIPSA applies only to India's four public-sector general insurers. Instead, private insurers maintain their own network hospitals and manage cashless claims through their own claims teams or third-party administrators (TPAs). While the cashless claim process is broadly similar, 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: Covered procedures are billed at pre-negotiated rates based on the city and the policyholder's eligible room category.
Cashless treatment requires pre-authorisation: Show your policy or e-card, let the hospital get approval from the insurer or TPA, and the insurer settles the bill according to the applicable package rate.
GIPSA applies only to four public-sector undertaking (PSU) general insurers: Private and standalone health insurers have their own hospital networks and cashless claim processes.
Frequently asked questions
GIPSA package rates can help reduce the amount you pay for covered treatments.
About the authors
Neviya Laishram
Written by · Senior Editor
Nitesh Kapur
Reviewed by · Senior Director – Underwriting & Claims, ACKO Group Health Insurance
