Definition
Network Hospital
A network hospital is a healthcare provider that has a tie-up with the insurer or TPA to offer cashless treatment to policyholders.
At a network hospital, the policyholder can avail cashless hospitalisation: the insurer or third-party administrator settles approved bills directly with the hospital, so the patient pays only for non-covered items and deductibles. Non-network hospitals require the patient to pay first and claim reimbursement.
IRDAI's push for cashless everywhere aims to let policyholders get cashless treatment even at non-network hospitals, reducing the disadvantage of going outside the panel. The size and quality of an insurer's network is a practical factor when choosing a health plan.
Related terms
- Cashless ClaimA cashless claim is a settlement method where the insurer or TPA pays the network hospital directly, sparing the policyholder from upfront payment of covered costs.
- Reimbursement ClaimA reimbursement claim is when the policyholder pays the hospital first and later submits documents to the insurer to recover eligible expenses.
- Third-Party Administrator (TPA)A Third-Party Administrator is an IRDAI-licensed intermediary that processes health insurance claims and manages cashless services on behalf of insurers.
Plain-English explainer from The Dispatch Investors Encyclopedia. General information, not financial advice.