What is a network hospital in group health insurance?

A network hospital is a hospital that has signed a service agreement with an insurance company to offer cashless treatment to the insurer's policyholders. When an employee is treated at a network hospital under a group health insurance policy, the hospital directly bills the insurer through its TPA instead of asking the employee to pay upfront.

What makes a hospital a network hospital?

A hospital becomes part of an insurer's network by entering into a Preferred Provider Network agreement with the insurer. This agreement covers pre-negotiated rates for common procedures, the cashless claim process, and service standards such as pre-authorisation response time. Each insurer maintains its own network list, which is published on the insurer's website and updated regularly as new hospitals are added or existing ones are removed.

Does the network list vary by insurer?

Yes. Each insurer's network is independent, meaning a hospital that is a network partner of ICICI Lombard may not be part of the Star Health network, and vice versa. Employers running group health insurance should check the network list of the specific insurer underwriting their policy before publishing a hospital directory to employees. Plum works with partner insurers including ICICI Lombard, HDFC ERGO, Bajaj Allianz, Star Health, Niva Bupa, and Aditya Birla Health Insurance, and each maintains a distinct network list.

Does IRDAI's Cashless Everywhere framework replace network hospitals?

Not quite. The IRDAI Cashless Everywhere circular dated 23 January 2024 requires insurers to offer cashless treatment at any hospital that meets basic registration norms, even outside the empanelled network. Network hospitals remain relevant because the process is smoother, pre-negotiated rates typically apply, and the hospital's insurance desk is already set up to coordinate with the TPA. At a non-network hospital, cashless is available but may involve longer coordination and can occasionally default to a reimbursement route if the hospital does not process cashless requests operationally.

Can an employee be treated at a non-network hospital?

Yes. Employees are not restricted to network hospitals for treatment. At a non-network hospital, the employee can either request cashless treatment under Cashless Everywhere or pay the bill and file a reimbursement claim after discharge. Both routes are valid, and the eligible claim amount is calculated using the same policy terms.

How does an employee find network hospitals?

The insurer's website carries a searchable network hospital list by city and specialty. TPAs also maintain the same list on their portal and mobile app, and employees can call the TPA helpline printed on the health card for the nearest network hospital. Employers running group health insurance often share a curated list of network hospitals at the employee's base location during onboarding.

How Plum approaches this

Plum publishes the current network hospital list for the employer's underwriting insurer inside the Plum employee dashboard, refreshed as insurers update their empanelment. Plum's claims team helps employees confirm cashless eligibility at the specific hospital before admission, especially where the hospital's status is unclear or has recently changed. Across Plum's group health book, claims NPS runs at 79 and cashless pre-authorisation clears in a median of 45 minutes, both partly a function of how proactively Plum tracks the network hospital list at partner insurers including ICICI Lombard, HDFC ERGO, Bajaj Allianz, Star Health, Niva Bupa, and Aditya Birla Health Insurance. Plum's group cover is available for employers from 7 employees upward.

Frequently asked questions

How many network hospitals are typical for a group health policy?

The count varies by insurer, but most major group health insurers in India maintain networks running into thousands of hospitals across the country. The exact number is insurer-specific and updates over time.

Do network hospitals guarantee cashless approval?

Being on the network does not guarantee approval of every claim; the insurer's decision still depends on policy terms, sum insured, and the treatment being covered. It does mean the hospital is set up to submit the request under the cashless process.

Are network lists the same across cities?

No. Each insurer's network is deeper in metros and thinner in smaller cities. Employers with employees in tier-2 and tier-3 cities should check the insurer's local network before finalising the policy.

Can a hospital leave the network mid-policy year?

Yes. Hospitals can exit an insurer's network due to disputes over billing rates or service issues. When this happens, the hospital's cashless status ends immediately, though ongoing admissions typically continue on cashless terms until discharge.

Does the network hospital list change at renewal?

The list is updated continuously, not only at renewal. Employers renewing a policy should check for any material changes in the network before communicating to employees.