National Health Insurance Claim Settlement

National Health Insurance

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Network Hospitals6,000+
Policies Sold17,25,290
Incurred Claim Ratio115.55%
Lifelong RenewabilityLifelong
Claim Settlement Ratio85.47%
COVID-19 CoverYes
Claim SettlementDedicated Team

Claim Settlement of National Health Insurance

The claim settlement process at National Insurance Company Ltd. is quite easy and hassle-free. With thousands of network hospitals across the country, this insurance company boasts of its high numbers of claim settlement records through fast and easy claim procedure. The National Insurance Company lets you file claims in two scenarios: Cashless hospitalisation and through Reimbursement process. 

  • Claim Process for Cashless Treatment

    To avail the cashless treatment, you are required to undergo treatment at the network hospital. 

    • One can undergo treatment in a network provider/PPN, which is pre-authorised by the TPA
    • Get a cashless request form from the network provider/PPN or TPA and send the completed form to the TPA for authorization
    • The TPA will issue a pre-authorisation letter to the hospital after getting cashless request form and related medical information from the insured individual or network hospital or PPN and will pay for the medical and admissible expenses
    • Verify and sign the discharge papers at the time of discharge and pay for non-medical and inadmissible expenses
    • After receiving final documents the offer gets accepted, the due payment will be made within 7 days from the date of acceptance by the company
    • The TPA holds the right to deny pre-authorisation if the insured individual is unable to provide the required medical details
    • In case the cashless access gets denied, then the insured person may undergo treatment as per the doctor and later claim for reimbursement 
  • Reimbursement Treatment

    There is no need to worry if your request for cashless claim gets rejected as you can always try for reimbursement in that case. 

    • Insured individual has to undergo treatment at network or non-network hospital
    • Submit the necessary documents to the TPA/company within the prescribed time  
    • In case of planned hospitalisation, inform the company or the TPA at least 72 hours before the admission of an insured individual to the hospital
    • Even in case of emergency hospitalisation, inform the company or the TPA prior to hospitalisation of the insured individual
    • After receiving final documents if the request is accepted, you will receive the due payment within 7 days from the date of acceptance by the company
    • The TPA holds the right to deny pre-authorisation if the insured individual is unable to provide the required medical details
  • Documents Needed

    To file a reimbursement claim, the following documents must be available- 

    • Completed claim form
    • Original cash memos from the hospital(s) or chemist(s) along with the proper prescriptions 
    • Original payment receipt, etc. supported by the prescription from attending medical practitioner
    • Attending medical practitioner’s certificate of diagnosis and receipts, etc.
    • An original certificate from the surgeon stating diagnosis and nature of operation performed along with bills or receipts, etc.
    • Any other necessary documentation as asked by company/TPA

    If you have any doubt, get in touch with the customer care executives at InsuranceDekho at 1800-1205-698.

  • Incurred Claim Ratio (ICR) of National Health Insurance

    The Incurred Claim Ratio (ICR) is the net claims paid by an insurer against the net premium earned. Each year, the information on Incurred Claims Ratio of all the companies is published by the Insurance Regulatory and Development Authority of India (IRDAI). The ICR of National Insurance Company Ltd. as published for the year 2017-2018 is 115.55%. 

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