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Difference Between Network & Non-Network Hospitals in Health Insurance

By Finserv MARKETS - Mar 16,2019
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Difference Between Network & Non-Network Hospitals In Health Insurance

If you have taken up Health policy, you must have surely come across the term ‘Network Hospitals’. Health Insurance companies are mindful of the fact that private hospitals and clinics tend to charge more from patients with Health cover rather than those without it. Hence, to avoid unnecessary losses Health Insurance providers tie up with certain hospitals, thereby making them a part of their ‘network’. By doing so, insurance companies can negotiate treatment and stay costs with select hospitals to prevent their expenses from spiralling. Such hospitals are referred to as ‘Network Hospitals’. On the other hand, all other hospitals outside this mutual network are referred to as non-network hospitals.

How does it affect your Health Insurance claim?

Here are some scenarios that will help you understand how your Health Insurance claim will be affected by seeking treatment in a network hospital ‘vis-à-vis’ a non-network hospital:

  • Scenario 1:

If an insured individual gets hospitalized in a network hospital without cashless insurance, he/she will need to bear the expenses initially. Once discharged, he/she can submit the claims with all the required documentation to the insurer. On successful claim application, the insurer will process the claim as per the policy documents.

  • Scenario 2:

If an insured individual who has taken up a Cashless Health Insurance Plan is Hospitalized in a network hospital, he/she need not pay for anything. The insurer will directly make the payment to the hospital. Once, the insured is discharged, he/she can take the necessary claim-related documents for records. Hence, the insured can seek the best medical treatment from a network hospital without spending a dime. The only expenses the insured will bear will be those not covered under his/her policy terms.

  • Scenario 3:

If an insured individual gets admitted to a non-network hospital, the insurance company will not give him the benefit of the same since it’s a non-network hospital. It won’t matter whether the insured has a Cashless Health Insurance policy or not, he/she will have to pay for all the treatment expenses incurred. The amount can be claimed only after he/she is discharged from the hospital.

Which one is better – Network Hospital Vs Non-Network Hospital?

After considering the above scenarios, it becomes quite clear that getting medical treatment in a network hospital is always better. Every Health policy clearly mentions the list of all the network hospitals they are associated with. At Finserv MARKETS we have Health Insurance plans that have over 6000 hospitals under their network that offers cashless claims facility. Having a wide network of hospitals ensures that network hospitals are easily accessible in the event of medical emergencies. If you have a cashless Health Insurance plan, it’s essential to seek treatment only at a network hospital or you won’t be able to avail the cashless facility. So make a note of network hospital nearby and keep a list of network hospitals handy for quick reference during emergencies. Head to Finserv MARKETS to know all about health insurance and its advantages to help you make an informed choice.

Also know about health insurance tax benefits which you will receive after your opt for it

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Bajaj Finserv Direct Limited ("BFDL"), erstwhile Bajaj Financial Holdings Limited is a registered corporate agent of Bajaj Allianz Life Insurance Company Limited and Bajaj Allianz General Insurance Company Limited under the IRDAI composite registration number CA0551 valid till 10-Apr-2021. BFDL also renders services to Bajaj Finance Limited (‘BFL’) and Bajaj Housing Finance Limited (‘BHFL’) (referred hereinafter as ‘Lending Partner’) in sourcing of customers, providing preliminary credit support activities, fulfilment services and post-acquisition customer services related to lending business. Registered Office: Bajaj Auto Limited Complex, Mumbai – Pune Road, Akurdi, Pune – 411 035 CIN: U65923PN2014PLC150522