Anthropology states that we humans are social creatures. Our ability to think logically and form groups are what differentiates us from other animals. Unlike several creatures that might form small, hierarchical groups, humans have the unique ability to create vast social structures.
This is precisely where the true power of human networking lies – In our ability to communicate abstract ideas, establish trust, and create systems for the mutual benefit of all the parties involved. This network is what enhances our ability to solve problems, build economies, and foster cultures, all of which help advance human civilisation.
Similar to how humans thrive through our complex social networks, health insurance companies have developed their own networks to foster collaboration in the healthcare system.
This process is known as empanelment, and there are different types of empanelled hospitals.
What is Empanelment in health insurance?
Empanelment in health insurance is the process by which insurance companies select and approve hospitals to provide treatment for you as the policyholder. Hospitals that are empanelled with an insurer are part of that insurer’s network of hospitals that offer cashless treatment to policyholders.
Just as human networking helps build trust and mutual benefit, insurance companies form an alliance with empanelled hospitals, enabling policyholders to receive seamless, cashless medical treatment.
This collaboration between insurers and hospitals ensures that you can access quality healthcare without the administrative burdens that often come with hospitalisation expenses. However, this collaboration is not just limited to one insurer and hospital, as scaling this network would be cumbersome. Insurers get together and form alliances. One such alliance is GIPSA.
Heads Up: It takes an average person up to 5 hours to read & analyse a policy and 10 hours or more to compare different plans and make a decision.
This is why we propose a better alternative - taking a 30-minute FREE consultation with Ditto’s certified advisors. We have a spam-free guarantee, and we’ll never push you to buy a plan. Don’t delay this - we have limited slots every day, so book a quick call here before they run out.
What is GIPSA (General Insurance Public Sector Association) in Health Insurance?
GIPSA is an association formed by four PSU insurance companies – New India Assurance, Oriental Insurance, United India, and National Insurance Company. It stands for General Insurance Public Sector Association.
The main goal of GIPSA is to control and manage healthcare costs while ensuring quality healthcare services for policyholders. The companies in this association negotiate standardised rates with hospitals across the country for as many medical procedures as possible. This ensures that hospitals do not overcharge for services and that policyholders receive cost-effective care.
Through the hospitals that agree to GIPSA guidelines, a Preferred Provider Network (PPN) of hospitals is established.
What is PPN (Preferred Provider Network) in health insurance?
While GIPSA is the association that sets the standard rates for treatments among hospitals, PPN refers to the actual network of hospitals that offer these treatments at the agreed-upon rates. Hospitals that are part of the PPN agree to the predefined rates for treatments set by the insurance companies under GIPSA.
If you are insured under a health policy with a company that is part of the GIPSA framework, opting for treatment at a PPN hospital ensures that you can avail yourself of the benefits of cashless hospitalisation and standardised treatment costs. However, it is important to note that the PPN hospitalisation benefits apply only to specific procedures and treatments pre-approved under the agreement between insurers and hospitals.
What is the Difference Between GIPSA & PPN in Health Insurance?
Here’s a brief overview of GIPSA & PPN:
- GIPSA focuses on regulating and negotiating prices for treatments between insurers and hospitals.
- Whereas PPN is the list of hospitals that agree to provide these treatments at the regulated rates.
Therefore, GIPSA is more of a governing body, while PPN is the implementation of the agreements set by GIPSA.
Health Insurers with the Highest Network Hospitals & their Top Policies
Several health insurers in India have extensive networks of empanelled hospitals under their PPN or general agreements. For insurers, network hospitals are beneficial as they meet certain standards of care and follow specific pricing guidelines. For policyholders, they offer the convenience of cashless treatments, standardised rates, and superior healthcare.
Here are some of the top policies with insurers with a strong network of hospitals:
Things to Keep in Mind About GIPSA, PPN, and Empanelment in Health Insurance
- Standardised Costs: Thanks to the predefined rates negotiated by GIPSA, anyone admitted to the hospital can benefit from standardised pricing at PPN hospitals. This reduces the likelihood of being overcharged for treatments.
- Cashless Treatment: With empanelled hospitals in the PPN network, policyholders can avail of cashless hospitalisation without needing to pay upfront and wait for reimbursement later.
- Reliable Network: Empanelment ensures that only trusted hospitals that meet specific standards are included in the network, giving you peace of mind when it comes to superior health care. However, always check whether your preferred hospital is part of your insurer’s PPN network. This can help you avoid out-of-pocket expenses should you get hospitalised there.
- Limited Choices: At the same time, PPN hospitals are part of a limited network, so if your preferred hospital isn’t empanelled, you may not be able to avail of the benefits of these standardised rates and cashless treatment.
- Specific Treatments Covered: Not all procedures may be covered under GIPSA or PPN agreements. Be sure to check the list of treatments and surgeries included.
Why Talk to Ditto for Your Health Insurance?
At Ditto, we’ve assisted over 3,00,000 customers with choosing the right insurance policy. Why customers like Srinivas below love us:
✅No-Spam & No Salesmen
✅Rated 4.9/5 on Google Reviews by 5,000+ happy customers
✅Backed by Zerodha
✅100% Free Consultation
You can book a FREE consultation. Slots are running out, so make sure you book a call now!
Conclusion
Understanding terms like GIPSA, PPN, and Empanelment can make a significant difference when it comes to comparing and selecting a good health insurance policy. Choosing a policy with an extensive hospital network and transparent treatment costs ensures hassle-free hospitalisation and minimal out-of-pocket expenses.
Before purchasing a policy, always check whether your preferred hospitals are part of the PPN network and whether they offer cashless facilities.
If you still need help with personalised, spam-free health insurance advice, you can always contact us at Ditto Insurance. We don’t just sell insurance. We help you understand it.
