Network hospital

What is a network hospital?

A network hospital is a hospital, nursing home or other healthcare provider that has signed an agreement with a health insurer, directly or through a TPA, to treat that insurer's policyholders on a cashless basis. The insurer pays the hospital directly for admissible expenses, at rates or packages agreed in advance, and the patient pays only what the policy does not cover. A hospital outside the list is a non-network hospital, where the policyholder usually pays first and files a reimbursement claim.

Each insurer has its own network, so a hospital can be in one insurer's network and not another's. Networks also change during the year as agreements are signed, renegotiated or ended.

How hospital networks work in India

Insurer policy. IRDAI's Master Circular on Health Insurance Business (May 2024) requires every insurer to have a board-approved policy on quality standards and benchmarks for empanelling hospitals and healthcare providers. That policy must aim at 100% cashless service and allow empanelment of all categories of hospitals, so that people at different price points have a choice. It also covers providers for day care, outpatient, domiciliary and home care treatment.

Disclosure. Insurers must display on their websites the list of hospitals they have cashless tie-ups with, the hospitals in the common network, and a clear statement that treatment elsewhere must be claimed by reimbursement.

Timelines. Once a network hospital sends a cashless request, the insurer must decide within one hour. Final discharge approval is due within three hours of the hospital's request; if it takes longer and the hospital charges extra, the insurer must pay that amount from its shareholders' funds.

Cashless Everywhere. In January 2024 the General Insurance Council announced that policyholders could seek cashless treatment at hospitals outside their insurer's network. The customer must inform the insurer at least 48 hours before a planned admission, or within 48 hours of an emergency admission. This is an industry initiative applied through each insurer's own process, so acceptance at a non-network hospital still depends on the insurer and the hospital agreeing terms for that case.

Common empanelment. IRDAI's January 2025 circular on senior citizens' premiums also asked insurers to work towards common empanelment of hospitals and to negotiate package rates on the lines of AB PM-JAY. The General Insurance Council has since built a common empanelment platform under which a hospital can sign one agreement covering participating insurers, with standard packages and payment terms, and the Council acts as mediator in disputes. Hospital associations have opposed parts of the model, mainly over rates. The 2024 master circular also asks insurers to bring hospitals onto the National Health Claims Exchange (NHCX) for faster claims.

Disputes. Rate negotiations between insurers and large hospital chains sometimes end in cashless being suspended. In 2025, Niva Bupa customers lost cashless access at Max Hospitals from 1 September after the two failed to agree rates, and the Association of Healthcare Providers (India) announced, then rolled back, a suspension of cashless service for Bajaj Allianz policyholders. In such cases the policy still pays; only the payment route changes to reimbursement.

What a network hospital means for distribution

The network list is one of the most concrete things a customer can check before buying, and one of the most common reasons for an angry phone call after a claim.

• Check the customer's hospitals, not the total count. A national network of many thousand hospitals means little if the two hospitals the family uses in their town are missing. Good advisers ask which hospitals the customer would go to and confirm those on the insurer's current list.
• Explain that networks change. A hospital listed at sale can leave the network mid-year. Customers should check the list again before a planned admission, and advisers should flag known disputes in their area.
• Non-network does not mean no cover. Customers often assume a non-network hospital means no cover. The policy still pays, subject to its terms, but the customer must pay first and claim later, or use the Cashless Everywhere route with prior notice.
• Tier 2 and Tier 3 towns. Network depth outside metros is uneven. For Tier 2 and Tier 3 distribution, network coverage in the local district can matter more to the sale than the premium.
• Senior citizens. Older customers use hospitals more often and find reimbursement paperwork harder. For senior citizen health insurance, the local network deserves extra attention.
• Group clients. Employers usually want the hospitals near their offices and staff homes in the network, along with a help desk at large hospitals. Brokers negotiating group renewals often ask for specific hospitals to be added.

Network, non-network and Cashless Everywhere