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National Health Insurance Claim Settlement

The National Insurance Company Limited prides itself on providing a high National Insurance mediclaim ratio. The company also provides a claim settlement process that is easy and hassle-free.

The National Insurance Health Insurance claim form can be collected from the hospital that falls within the network of the company. If you are planning to purchase a National Health Insurance, then you should do it as the National Insurance claim settlement ratio is also quite high.

The National Insurance Company Claim Process

The National Insurance Company allows policyholders to file for claims through two methods, including cashless claims and reimbursement claims. It should also be noted that the policyholder can only get cashless treatments done at a network hospital.

The process that has to be followed for filing for a cashless claim request is mentioned below.

  • Get a cashless request form from the hospital that falls under the network of the company
  • The completed form should be sent to the TPA for authorization
  • A pre-authorization letter is issued by the TPA to the hospital after getting the cashless request form and information related to the medical operation that the policyholder needs to get
  • The medical and admissible expenses will be paid by the insurance provider
  • The policyholder should not forget to verify and sign the discharge papers at the time of discharge
  • After receiving the final documents, the offer will either be accepted or rejected
  • If the offer is accepted, the due payment will be made within 7 days from the date of acceptance by the insurance provider
  • If the claim request is denied, the policyholder can undergo the treatment according to the doctor’s recommendation and later apply for a reimbursement claim

In case of reimbursement treatment claim, the steps that the policyholder will have to follow are:

  • After going through the treatment, the policyholder has to submit the necessary documents to the company within the prescribed time frame
  • The claim form should also be submitted to the company within the time limit
  • It is also the duty of the policyholder to intimate the insurer at least 72 hours before hospitalization in case of planned medical procedures
  • In case of emergency hospitalization, the company should be informed before the hospitalization occurs
  • After receiving the documents, if the request is accepted, then the policyholder will receive the due amount within 7 days of acceptance
  • If the claim request is rejected, then the policyholder will have to pay for the medical treatment on his or her own

How to Check National Insurance Health Insurance Claim Form Status?

If you have applied for a claim request and wish to know about the status of your policy, then you can do that through two methods, including online mode or offline mode. The steps for checking the claim form status through the online method are:

  • Visit the official website of the National Insurance Company
  • Go to the ‘Lodge Claim’ option at the corner of the website and click on it
  • Click on ‘Track Claim Status’
  • Enter the required details like your policy number, customer ID number, claim number, and date of loss
  • After entering the details, click on ‘Submit’

After following these steps, you should be able to track the claim status of your request. Further, in the case of an offline method, the policyholder will be required to visit the nearest branch office of the National Insurance Company. One can also call the customer service department to learn about the National Insurance Health Insurance claim form status.

Documents Required

It can be said without a doubt that the documents you submit with your claim form play a very large role in deciding whether the request will be accepted or rejected. This is why you must make sure that you have all the documents in place.

But what if you don’t know what documents you need to attach? In that case, we’ll help you out. Go through the list of documents given below.

  • Original cash memoirs from the hospital
  • Original cash memoirs from the chemist
  • Prescription
  • Original payment receipt
  • Prescription form from the attending medical practitioner
  • Original certificate from the surgeon specifically mentioning the diagnosis and nature of the medical operation that would be performed
  • Any other documents required by the insurance provider

If you have any doubts related to the documents you need to submit, then you can also directly call the customer service department of National Health Insurance.

National Insurance Claim Settlement Ratio

For the financial year of 2018 – 2019, the National Insurance claim settlement ratio has been reported as an amazing 107.64%! This is an excellent ratio that goes to show the potential of the company.

Reviews and Ratings

  • Amazing Policy by Kanishka Rao (5 stars / 5 stars)

I have bought the National Insurance National Parivar Mediclaim Plus policy. And I must say that it is an amazing policy. This policy provides ample coverage to me and my entire family. I have already recommended this policy to my friends and other dear ones!

  • Additional Benefits by Kishwar Tiwari (5 stars / 5 stars)

I have always been aware of the fact that the National Insurance health insurance policies are great. I also knew that the National Insurance claim settlement ratio is also very high. However, what I didn’t know about was the number of benefits that I have got with this policy. The National Parivar Mediclaim Plus policy is amazing and you would make the best decision of your life if you brought this policy now!

FAQs

I’m scheduled for a planned hospitalization. I want to inform the National Insurance company regarding the same. When should I do it?

Ideally, policyholders should inform the National Insurance company about any planned hospitalization at least 72 hours in advance. This will ensure a smoother reimbursement claim process.

In how many ways does the National Insurance company settle claims for customers?

The National Insurance company settles claims in two different ways. These methods are:
Cashless claims
Reimbursement claims

How many hospitals fall under the cashless treatment network of National Insurance?

The National Insurance company has over 6,000 hospitals within its network in India. All policyholders can seek cashless treatments at any of these network hospitals.

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