National Health Insurance Claim Settlement
Claim Settlement | Dedicated Team |
Claim Settlement Ratio | 83.78% |
Network Hospitals | 6,000+ |
Renewability | Lifelong |
Starting Premium for 5 lac SI | Rs.586/month |
Starting Premium for Rs. 5 lakhs SI | Rs. 586/month |
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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 and reimbursement.
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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
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 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 claim 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 the ease in process.
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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 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 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
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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 7551-196-989.
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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 2018-19 is 107.64%.

*Tax benefits are subject to changes in Income Tax Act.
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National Health Insurance Claim Settlement FAQs
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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.
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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.
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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
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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