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Navi Health Insurance Claim Settlement

What are your primary considerations when identifying a good health insurance policy? Most health insurance seekers primarily look at the sum insured and the benefits offered. Cash strapped buyers might be most concerned with the premium that they would need to shell out. 

However, the most important factors that you should be considering are the health insurance company’s claim settlement process and the number of empanelled hospitals where you can seek cashless hospitalization.

The Navi Health Insurance Claim Settlement process is very simple and easy to follow. Moreover, it is easier to make a cashless Navi Health Insurance claim because it has a comparatively larger network of over 10,000 partner hospitals. 

Navi Health Insurance Claim Settlement Ratio is also on the higher side, that is 86.98%, which means that there is a higher probability of getting your claim settled. In fact , this rather balanced claim settlement ratio is ideal because it also means that the company is clearly not paying off every claim that comes their way. Why is this important to an insurance buyer? Well, you want your insurer to be discerning when settling claims because if they indiscriminately approve claims, they will be low on profitability, which does not bode well for policyholders in the long term. Navi Health Insurance Claim Settlement Ratio is far from low or even average; it is definitely on the higher side, but neither is it so high the policyholders need to worry about the insurer’s long term survival. 

Before purchasing a health insurance policy, it makes sense to know what the claim settlement process is. If you go with  Navi Health Insurance, you have two options in terms of claim settlement. Let us observe the two methods of Navi Health Insurance Claim Settlement

Cashless hospitalization claim

How it works: 

In this type of claim, the policyholder contacts the insurer prior to hospitalization and the hospital and insurer sort out payment between them. The insured person need not pay anything other than policy exclusions or costs not covered under the policy. 

Cashless hospitalization is preferred by a lot of health insurance policyholders because it means that they do not have to pay any amount upfront. There is also a lower amount of documentation required for this method because the hospital forwards all proofs, certificates, bills, invoices and receipts on your behalf. However cashless claims may not always be approved in time, especially in case of emergency hospitalization, where you don’t have lead time in hand  to coordinate with the insurance company.  In such cases (and even if the cashless claim is rejected), one can go in for a reimbursement claim post hospitalization. 

How to go about making a cashless Navi Health Insurance Claim: 

Step 1 – coordinate with Navi Health Insurance 24 to 48 hours prior to your planned hospitalisation with all the relevant details. 

Step 2 – at hospital admission be sure to mention that you intend to make a cashless hospitalization claim. 

Step 3 – Fill up the pre-authorization form that you can get at the hospital.

Step 4 

–  pay the token sum or else undergo treatment as determined by law in serious emergencies.

– in the meanwhile Navi Health Insurance and the hospital will be in touch with each other on your claim approval.

Step 5 

– if approved, you will get a refund of anything you have paid, minus any expenses not covered by your policy. 

– if rejected, do not compound your health situation by stressing. Information and parwoek for the purpose of an insurance claim is often lacking at the early phase of your hospitalization. Things get smoother when you have proofs, certificates, bills, invoices and receipts in hand. You can still opt for a reimbursement claim at a later stage. Do be in touch with Navi Health Insurance. 

Reimbursement claim

How it works: 

In this type of claim, the policyholder contacts the insurer once hospitalised and the insured person and insurer sort out payment between them. The insured person pays the whole amount to the hospital and later receives reimbursement, except for policy exclusions or costs not covered under the policy. 

Reimbursement claims definitely mean less hassle at the moment when hospital admission and treatment are ongoing, which is already a high stress period for most people. If you have liquid funds available, you might prefer to choose this route. Navi Health Insurance gives you 15 days after discharge to make your claim. 

Moreover, if your cashless claim has been rejected, you must definitely make a reimbursement claim.

How to go about making a reimbursement method Navi Health Insurance Claim:  

Step 1 – get admitted to a hospital and state upfront that you will need proper documentation so as to make an insurance claim later 

Step 2 – paperwork is everything in this process and this means that either you or your caregiver/caregivers will need to stay on the ball with regards to maintaining original copies of diagnostics, certificates, bills, invoices and receipts. Don’t forget to keep those little prescription slips and bills and receipts from the pharmacy too. 

Step 3 – when getting discharged from the hospital do take stock of everything you will need to make your claim, including the hospital discharge certificate, final bill settlement receipt and all x-rays, ECGs, MRIs, doctor’s certificates and so on. 

Step 4 

– complete your paperwork and submit your claim

-Navi Health Insurance will now go through your claim by scrutinizing your documents. Once approved, your costs as covered under your policy will be reimbursed to your bank account. You must supply a cancelled cheque with your application for this purpose 

FAQs

My mother needs to be hospitalised right away. We do not have 24 hours advance notice to give the insurer but I don't want to forgo my insurance. Will I lose the insurance now?

Not at all. If a cashless claim is not possible, you do not forgo your sum insured. You simply need to make a reimbursement claim later. You can go ahead and secure your mother's health first and apply for reimbursement claim settlement once the hospitalisation is complete.

Is it good to go with an insurance company that does not have a 100% claim settlement ratio? Navi Health Insurance only has 86%. Is that good?

Actually this is a misconception. A company that offers 100% claim settlement could run into losses very quickly. At least a few claims need to be rejected for two reasons 1) not all claims are legitimate and 2) the insurer needs to stay profitable to stay in business. If the insurance company had to shut down due to massive losses due to negligent settling of even bogus claims, you stand the chance of not receiving your genuine claim eventually.

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