A health insurance network is comprised of the facilities, providers, and suppliers an individual’s health insurer or plan has contracted with to provide healthcare services, either through the private healthcare exchange or through an employer-sponsored plan.

There are certain doctors, hospitals, and services that are covered under your plan. If so, your insurance company has contracted with these “in-network” providers to pay a certain portion of the fees associated with the services that you utilize.

However, if you utilize out-of-network services—or, services that are not covered by your insurance—you may be subject to much higher healthcare costs.

There are four main types of insurance networks: 

1. Exclusive Provider Organization (EPO): Services are only covered under this plan if you use the doctors, specialists, and hospitals in that plan’s network. 
2. Health Maintenance Organization (HMO): A plan that typically limits a participant’s coverage to doctors contracted by or working with the HMO.
3. Point of Service (POS): When using this plan, participants pay less when using providers that belong to the plan’s network, but specialists require referrals from PC doctors.
4. Preferred Provider Organization (PPO): When using this plan, participants pay less when using providers that belong to the plan’s network, and you can visit providers outside of the network for an additional cost.

Consult directly with your insurance company to determine whether or not a provider is in-network. You can also contact the provider’s billing department or office to determine whether or not your insurance will cover costs if you seek out their services. 

Sometimes, though it depends on the coverage and the costs. This information can be found either on the provider’s website or in the plan documents that you received when electing benefits. 

Regardless, it’s strongly recommended that plan participants stay in-network when seeking medical services, as they may receive much higher bills.

Related Terms: Benefits Enrollment