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Network Hospital parameter in decision making

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12 Jun, 2021 by  Dhanush Nambrath

Hi Experts,


My understanding of individual policy for my brother 28yr old.

Comparing, Max Bupa Reassure Vs. HDFC optima restore, both offer similar features.


The key difference- while HDFC has a high premium (cost per lakh SI) relative to Max Bupa it offers a higher % of the hospital network.


My dilemma:

How important is the 'hospital network' factor?

How can one give correct weightage to this parameter in overall decision-making?


Thank you.


Rgds,

Dhanush

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Health Insurance

2 Answer

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13 Jun, 2021

Network Hospitals is an important factor to consider while choosing health insurance. It is advantageous to take inpatient treatment at a network hospital for 2 reasons -


1) You get an easy cashless settlement facility at network hospitals.


2) Insurers have a pre-agreed tariff card for major procedures at their network hospitals. This reduces the chances of disagreement on the amount of hospital bills between you & the Insurer.


However, you should worry more about the network strength of the Insurer in your city or nearby cities where you take treatment rather than comparing the Insurers on the basis of their India-wide network. You can also check for specific hospital names in the network list of both HDFC Ergo & Max Bupa (preferred/big hospitals) before you take the decision.


Best Wishes,


Asad Akbar

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14 Jun, 2021
Dhanush Nambrath
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19 Jun, 2021

Hey Dhanush,


There are 30k hospitals pan-India which are part of cashless network of one insurer or the other. And yet, 65% of total claims are reimbursement claims (non-cashless). Why?


Because most people decide on doctor first and then think about how they will pay for treatment. Getting a trusted doctor is difficult, so people go by recommendations of their family and friends circle. Also, at the time of health emergency, one thinks of treatment first and consideration of cashless comes in later.


My advice - Don't waste your time looking at cashless network size. It is neither practical nor pragmatic, as the size of the network and hospital mix keeps changing every year. Tie-ups are not fixed.


Coming to Optima Restore and ReAssure, both are highly recommended plans. ReAssure has everything that Optima Restore plan has, and ReAssure has a few more features. Those features are marginally better. ReAssure ends up being 20% more expensive than Optima Restore over a 20-25 year period.


I hope these points help you arrive at a decision.


Anuj

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20 Jun, 2021
Dhanush Nambrath
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20 Jun, 2021
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26 Sep, 2021
vijay
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