This is one of the market’s most important and least explained distinctions. Two basic structures exist, and their mix in a package fundamentally shapes everyday use.
The network-based (in-kind) model
Care happens within the insurer’s contracted partner network: the colleague calls the care coordinator, an appointment is booked at a network clinic, and settlement runs directly between insurer and clinic. For in-network care that is part of the package, the employee typically pays nothing and does not need to submit an invoice – care outside the package or above the limit may be at the employee's own cost. In exchange, choice is tied to the network – so the key question is how well the network covers your locations.
Conceptual clarification: both the network-based (in-kind) and the reimbursement-based (invoice-reimbursement) models are service-financed health insurance – together, these stand in contrast to sum-insured cover (daily indemnity, surgical indemnity, income replacement).
The reimbursement (invoice-reimbursement) model
Here the doctor is freely chosen: the colleague sees their usual gynaecologist or orthopaedist, pays for the visit, submits the invoice, and the insurer refunds it under the policy terms – typically up to a limit and at a percentage. More freedom, but costs are fronted and limits matter.
Which is better?
There is no universal answer. For an urban office team with network clinics nearby, the network model is more convenient. With many rural sites, or colleagues attached to their own doctors, reimbursement elements gain value. Most good packages combine the two – the question is the ratio.
What to check before choosing
- Network coverage at your actual sites – broken down to specific specialties, not the marketing map.
- For reimbursement: the refund percentage and annual limit – „we reimburse" alone means nothing.
- Appointment-organisation commitments: within how many days, for which specialties.
- Whether the two can be mixed – some insurers let you choose per element.
When comparing offers, it is worth looking at this separately: what is network-based, what is reimbursed, and with what limits. See also how group health insurance works.
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