PPN and Non-PPN hospitals are two categories of hospitals associated with health insurance providers. PPN hospitals have pre-negotiated treatment rates with insurers, and Non-PPN hospitals do not have these special pricing arrangements.
This article will discuss the differences between PPN and Non-PPN hospitals, their relation to health insurance, and what this means for your treatment and claim. This knowledge is important when choosing which hospital is best for you to go to in case of a medical emergency.
What is a PPN hospital in health insurance?
A PPN (Preferred Provider Network) hospital is one that has signed a rate deal with your health insurance company. At these hospitals, the prices for many treatments are fixed in advance. You can get cashless treatment, which means the insurer pays the hospital directly.
Therefore, you don’t need to pay your entire hospital bill in advance and then claim your money back. PPN hospitals serve as the right choice for planned treatment procedures such as surgery.
For instance, consider that you wish to go through cataract surgery, and the total expenditure comes out to be ₹40,000. You opt for a PPN hospital, which is associated with your insurance provider. After your claim is processed successfully, your insurance company directly transfers the eligible amount to the hospital. You just have to bear the expenses not covered by your policy, if any.
What is a non- PPN hospital in health insurance?
A Non-PPN (Non-Preferred Provider Network) hospital is a hospital that does not have a special pricing agreement with your health insurance company. Unlike PPN hospitals, treatment costs at these hospitals are not pre-negotiated with the insurer.
In most cases, payments to a Non-PPN hospital are made through the reimbursement process. This means that you will need to settle the bill with the hospital first and then file the necessary papers for reimbursement. The amount of reimbursement depends on the policy terms and expenses covered.
For instance, in case a Non-PPN hospital charges you 50,000, but not all expenses are covered under your policy, the insurance company will only reimburse what your policy covers, whereas you will have to settle the balance.
PPN hospital vs non-PPN hospital: key differences
Feature | PPN Hospital | Non-PPN Hospital |
|---|---|---|
Network status | Part of the insurer's preferred network | Not part of the insurer's preferred network |
Treatment rates | Pre-negotiated with the insurer | Set by the hospital |
Cashless treatment | Usually available | Usually settled through reimbursement |
Upfront payment | Minimal or none (subject to approval) | Generally paid by the patient first |
Billing process | The insurer settles the bill directly with the hospital | Policyholder submits documents for reimbursement |
Claim process | Simpler and faster | Requires claim submission and document verification |
Best suited for | Planned treatments and hospitalisations | Situations where a preferred network hospital is unavailable |
Explore our guide to the 10 most frequently asked questions about cashless claims in health insurance.
How are PPN hospital rates set in health insurance?
The PPN hospital rates are established jointly by the insurer and the hospital, before any patient is treated. The exact discount for a Preferred Provider Network (PPN) hospital depends entirely on your insurer's contract and the specific medical procedure. These agreed rates are often around 10% to 30% lower than the hospital's normal charge for the same treatment.
The insurer sets a single package price for common procedures, such as an angioplasty or kidney stone removal. This makes the costs more predictable for both the insurer and the policyholder.
How to find PPN hospitals in health insurance
Here’s how you can find PPN hospitals in health insurance:
- Most insurance companies in India allow you to search for network hospitals by city, PIN code, or hospital name on their website or mobile app.
- You can also contact your insurer or a TPA to confirm whether a hospital is on the list.
- If you have group health insurance coverage from work, the HR team usually shares the hospital list when the policy starts. It is best to confirm this before a planned admission, not on the day:
Know what a Third-Party Administrator (TPA) does in health insurance.
Key takeaways
PPN hospitals offer cashless treatment at fixed rates. The insurer pays the hospital directly.
Non-PPN hospitals usually require you to pay the bill first and claim reimbursement later. The amount reimbursed depends on your policy terms and eligible expenses.
Before any medical treatment, ensure that you verify whether there are PPN hospitals within the insurer’s network.
Frequently asked questions
PPN stands for Preferred Provider Network. It is the group of hospitals that have agreed fixed rates with an insurer and offer cashless treatment to its policyholders.
PPN in a TPA (Third-Party Administrator) refers to the same preferred network that the TPA manages for the insurer. The TPA checks your cover and clears cashless bills at the listed hospitals.
GIPSA packages are pre-negotiated treatment rates agreed upon between certain hospitals and the public sector general insurance companies that are part of the General Insurance Public Sector Association (GIPSA). Similarly, PPN packages are pre-agreed treatment rates between hospitals and insurers within a Preferred Provider Network (PPN).
Look on your insurer's website and search the network hospital list by city. You can also call your TPA to confirm.
Yes, you can often get cashless treatment at a non-PPN (Preferred Provider Network) or non-network hospital. However, it is usually subject to the insurer's approval and the hospital's willingness to coordinate with the insurer.
About the authors
Neviya Laishram
Written by · Senior Editor – Health, Life and Group Health Insurance Content at ACKOWith a journalism background, she brings 9 years of experience in strategising and editing health, life, and group health insurance content. Having written for magazines and digital publications, she combines research and editorial expertise to create credible, useful content for readers.
Dr Nitin Kumar Gupta
Reviewed by · SVP – Health Underwriting & Claims at ACKO General InsuranceWith 20+ years of experience in digital transformation and growth, he is a leader specialising in health, life, accident, and disability insurance. Backed by an MBBS degree and insurance designations (FLMI, FALU, FLHC, ACS, ARA), he combines expertise with leadership.
