Network-Based Plan (Health Care) Law and Legal Definition

Network based plan refers to the health care plan in which the insurance company will have contracted with doctors, hospitals, and other health care providers about the fee for the service offered. For any access to medical facilities and benefits under a network based plan the concerned policy holder will be responsible only for any cost-sharing required under his/her health care insurance policy cover. In network based plan, the medical costs incurred is very low as the policyholders or patients make use of the doctors, consultants, hospitals, and other health care providers who participate in the plan.

The following is an example of a federal statute defining the term:

Pursuant to 42 USCS § 1395w-22(d)(5)(C)(i) the term "network-based plan" means:

(I) except as provided in clause (ii), a Medicare Advantage plan that is a coordinated care plan described in section 1851(a)(2)(A)(i) [USCS § 1395w-21(a)(2)(A)(i)];

(II) a network-based MSA plan; and

(III) a reasonable cost reimbursement plan under section 1876 [42 USCS § 1395mm].