Whenever anyone is buying health insurance, knowing about empanelment hospitals plays a crucial role in ensuring that one gets access to quality medical services at times of need. Whether you are taking treatment in any hospital or going to the health care provider, getting empanelled with an insurance company means being part of their network of trusted partners.
In this blog, we will explore the significance of empanelment in health insurance.
- What is Empanelment in Health Insurance
- Key Benefits of Empanelment in Health Insurance
- How do you check if the hospital is empanelled with an insurer?
What is Empanelment in Health Insurance?
Empanelment in health insurance is the process through which healthcare providers, such as hospitals, clinics, and diagnostic centers, become part of the network of an insurance company. When a provider gets empanelled, it means they have been approved by the insurer to provide medical services to its policyholders under the terms and conditions specified in the health insurance plan.
Key Benefits of Empanelment in Health Insurance
Access to Cashless Treatment
One of the key benefits of having empanelment in health insurance is the cashless treatment offering. Whenever you visit for medical care at an empanelled hospital, the insurer will pay off all the medical bills, eliminating the need for you to pay upfront. This is especially beneficial during emergencies or when large hospital bills are involved.
Access to Quality Healthcare Services
Insurance companies prefer to empanel those healthcare providers who meet certain quality standards. It ensures that the policyholder gets the best quality medical services from trusted hospitals and doctors, making their healthcare experience more reliable and secure.
Wide Network Coverage
Empanelment in Health Insurance helps in expanding their network of hospitals and medical centers. The best part is that here, policyholders have access to more options, ensuring that they have easy access to healthcare services across various geographical locations.
Streamlined Claims Process
Empaneled hospitals and healthcare providers are familiar with the health insurance process. This means that they can quickly and efficiently handle claims, leading to faster processing and reduced paperwork for the insured.
How do you check if the hospital is empanelled with an insurer?
- Visit the official website of the insurance provider.
- Navigate the section that lists empanelled hospitals or network providers.
- Enter your location or search criteria to find the empanelled hospital near by you.
- Verify that the hospital you intend to visit is listed in the empanelled city.
To sum up
Empanelment in health insurance is a win-win benefit for both insurers and policyholders. From the perspective of insurers, it ensures they have a trusted network of the best healthcare providers. From the perspective of policyholders, it means access to cashless treatment, faster claim processing, and better cost efficiency.
FAQs
What is meant by empanelment in health insurance?
Empanelled Hospitals provide cashless medical treatment services to the policyholders or beneficiaries.
Can I use my health insurance at any hospital?
You can use your health insurance at any hospital that is part of the insurer’s empanelled network. If you seek treatment at a non-empanelled facility, you may not be eligible for cashless treatment and could be required to pay the bills upfront, seeking reimbursement later from the insurer.
What is the difference between maturity and the sum assured?
Sum Assured is the amount paid to your family if something happens to you, while Maturity Amount is the total you get if you outlive the policy, including bonuses.
Can an empanelled hospital be removed from the network?
Yes, insurers have the right to remove hospitals or healthcare providers from their network if they do not meet the required standards or fail to adhere to the terms of the empanelment agreement. The insurer may also remove a provider due to issues like poor claim history, non-compliance with regulations, or inadequate services.
How does empanelment affect claim settlement?
Empanelled hospitals streamline the claims settlement process because both the insurer and the provider are familiar with the procedures for cashless treatment. Claims are processed directly between the insurer and the hospital, minimizing paperwork for the policyholder and reducing the time it takes to settle claims.
