Insurance

Simplifying the Concept of Network and Non-Network Hospitals Under Health Insurance Plans

Health insurance is by far the most important thing when it comes to safeguarding health. How much ever health lifestyle is adapted, unexpected medical emergencies occur. At these times a backup plan in the form of a medical insurance comes handy.

Health insurance policies come in different types with each of them suited for a specific purpose. While some are generalist in nature, others cater to specific treatments. Depending on the requirements, one can choose to buy, not just one, but multiple insurance plans to avail a 360-degree coverage. However, when selecting a policy, there are certain things to consider; the network hospital facility being one of it.

What are network hospitals?

In some cases, it is observed that patients that are covered by a health insurance policy are charged steeper for the treatment as compared to those who don’t have one. A workaround by insurance companies to tackle such unfair pricing is by on-boarding certain hospitals that are affiliated with it. These hospitals are known as network hospitals. In such hospitals, any treatment sought by the policyholder is directly paid by the insurance company. This way, individual health insurance policyholders need not worry about making upfront payments to the hospital and then following it up with the insurance company to claim a reimbursement. * Standard T&C Apply

Cashless health insurance claims are simpler and swifter since the treatment cost is directly settled by the insurer. This gives policyholders the freedom to seek treatment without the need to arrange money for medical procedures. However, the freedom to select the medical facility is restricted. Thus, opting for an insurance company with a larger network hospital coverage is what policyholders need to keep in mind when selecting a health insurance policy. * Standard T&C Apply

What are non-network hospitals?

A non-network hospital is that which is not a network hospital, i.e. not affiliated to the insurance company. These medical facilities are not on the list of empanelled medical facilities where the insurance company extends its cashless support. Hence, any treatment sought at such non-network hospital will require the policyholder to pay for the treatment at first, which then can be reimbursed from the insurer.

Reimbursement claims are the traditional way how health insurance worked. Here, the policyholders pay for the treatment from their own pocket at first, which is then followed by a reimbursement from the insurance company. For such claim, the policyholder is required to submit medical bills, test reports, hospital bills and other supporting documents that are then verified by the insurer for its validity. Then, subject to the policy terms, a compensation is provided for the expense incurred. * Standard T&C Apply

Summarising difference between network and non-network hospitals

To summarise the differences between network and non-network hospitals, mode of payment and the association are two points that must be looked at.

While the network hospitals are covered with cashless facility, a reimbursement claim is provided for treatments availed at a non-network hospital. Next, the network hospitals are verified by the insurance company and thus are part of the empanelled network of insurer-backed hospitals. On the contrary, non-network hospitals have no association with the insurance company.

These are some pointers that simplify the concept of network and non-network hospitals. While availing treatment at network hospital provides cashless benefits, policyholders can avail treatment at a non-network hospital too. Just that they won’t be settled in a cashless manner.

Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms and conditions, please read sales brochure/policy wording carefully before concluding a sale.

 

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