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National Health Insurance Claim Settlement

The claim settlement process at National Health 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 procedures. The National Insurance Company lets you file claims in two scenarios: cashless and reimbursement.

  • Claim Process for Cashless Treatment

    To avail of 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 a 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 the 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 reimbursement

    How to Check National Insurance Health Insurance Plan Claim Status

    You can check the status of your claim either through online mode or offline mode.

    Online Procedure

    You can check your claim status by following the steps given below:

    • Go to the official website of the National Insurance Company.
    • Select the Lodge Claim icon at the corner of the website and click on ‘Track Claim Status’.
    • Enter the details like policy no, customer ID no, claim no, date of loss, etc.
    • Click on ‘Submit’. You can track your claim status.

    Offline Procedure

    Policyholders can also track the status of their claims through offline mode. They can either visit the nearest branch of National Insurance or call their customer care executive at 1800 200 7710(Toll-Free Number). Do not forget to carry all the relevant details regarding your policy for ease of process.

  • Reimbursement Treatment

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

    • The insured individual has to undergo treatment at the network or non-network hospital
    • Submit the necessary documents along with the duly filled Reimbursement claim form 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 health insurance company or the TPA prior to hospitalisation of the insured individual
    • After receiving the 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 settlement, 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 the 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 requested by the company/TPA

    If you have any doubts, get in touch with the customer care executives at InsuranceDekho at 7551-196-989.

  • 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 National Health Insurance claim settlement for the year 2018-19 is 107.64%. 

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FAQs

  • When should I inform the company in case of planned hospitalisation for reimbursement of the treatment?

    You must inform the company at least 72 hours before the admission in case of planned hospitalisation to get reimbursement for the treatment. 

  • In how many ways does National Insurance settles claims?

    National Insurance settles claims in two different ways. These are-cashless and reimbursement. 

  • In how many hospitals can I enjoy a cashless treatment with National Insurance?

    National Insurance has over 6,000 network hospitals across India, where the policyholders can seek cashless treatment. 

  • What are the documents required for claim settlement with National Insurance?

    National Insurance requires the following documents for the claim settlement-

    • Duly filled claim form
    • Relevant cash memos and prescriptions
    • Certificate of diagnosis from the attending medical practitioner
    • Payment receipt in original along with the attending medical practitioner’s reports
    • Any other related documents as asked either by the company or the TPA
  • How to calculate the Claim Settlement Ratio (CSR) of National Insurance?

    Claim Settlement Ratio of National Insurance can be calculated using the formula given below:

    Claim Settlement Ratio = (Total no. of claims approved/Total no. of claims received) x 100

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    InsuranceDekho’s customer care executives advised me to buy the National Health Insurance Policy. I liked the policy benefits so I bought the National Health Insurance policy instantly online via a secured payment gateway. It was Affordable health insurance as per my needs. I am delighted to have bought it.

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    By Tanuj Raghav
    On: Apr 02, 2024
  • Several Plans To Choose From

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    National
    By Nagesh Yadav
    On: Mar 08, 2024
  • Digital Documentation

    I had a marvelous experience with InsuranceDekho. My purchase of National Health Insurance Plans was so convenient and easy. I am amazed at buying a national health insurance policy through online mode. It was so easy to compare the health insurance policies, do all the paperwork, and get protected with the health insurance. All the paperwork was done digitally without any problem. Thank You!

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    National
    By Manisha Sharma
    On: Feb 27, 2024
  • Digital Paperwork

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    By Parneet Kumar
    On: Feb 15, 2024