How to File a Claim with National Health Insurance?

How to File a Claim with National Health Insurance?

National Insurance Company prides itself on a simple, efficient claim process designed to handle your health insurance claims smoothly. Their internal claim settlement team is dedicated to providing fast and efficient service, emphasizing reliability and transparency in all their dealings. The process is tailored to be as stress-free as possible, ensuring policyholders can focus on their health rather than administrative concerns. This guide is tailored for those with a National health insurance policy, covering all you need to know about their claim process, including important contact information and step-by-step instructions.

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Ways to File a National Health Insurance Claim

National Insurance Company offers two practical claim filing methods to its policyholders, addressing diverse medical needs: cashless claims and reimbursement claims.

1. Cashless Claims

   With National Insurance Company, policyholders can enjoy an efficient cashless claim process in the company's extensive network of hospitals. This facility allows for medical treatments without upfront payments, providing convenience in urgent situations. The procedure is designed for quick processing and efficiency.

2. Reimbursement Claims

   In cases where treatment is sought at hospitals outside National Insurance Company's network, the company facilitates an uncomplicated reimbursement claim process. Policyholders initially pay for their medical expenses and later claim these costs from the insurer. This approach gives access to a broader range of hospitals and is systematically arranged to ensure effective claim processing.

How to File a National Health Insurance Claim Online with Policybazaar?

Filing an online claim for National health insurance through Policybazaar involves the following steps:

Step 1: Contact Policybazaar's claim support team as soon as possible after your hospitalization. Reach them at 1800-258-5881 or via email at care@policybazaar.com.

Step 2: Log into Policybazaar.com and select 'File a New Claim' in the 'Claims' section.

Step 3: Pick 'Health Insurance' and enter your mobile number, followed by the OTP/password for login.

Step 4: Comply with the instructions and initiate a new claim by clicking 'File a new claim'.

Step 4: Proceed to select 'File a new claim' and follow the guided instructions for filing the claim. Your claim will be filed, and Policybazaar will handle the coordination with the National Insurance Company on your behalf.

How to File a Claim with National Health Insurance

Understanding the process of filing a claim with National Health Insurance is essential. Here are the steps for both cashless and reimbursement claims:

1. National Health Insurance Cashless Claim Process:

   Below is the detailed procedure for the Cashless Claim Process with National Health Insurance:

   Inform the Insurer

   As the first step, promptly notify the National Insurance Company about the hospitalization that necessitates the claim. This should be done within 24 hours of hospitalization, either through an email or by contacting their customer service.

   Show Identification

   When you arrive at the network hospital, head to the insurance desk and present your National Health ID card. This is to confirm your identity and policy coverage.

   Pre-Authorization by TPA

   Submit a pre-authorization form, available at the network provider or PPN, to the TPA. The TPA reviews the form along with your medical details to issue pre-authorization. If pre-authorization is denied due to insufficient information, you can still proceed with the treatment and later apply for reimbursement.

   Discharge and Payment of Non-Medical Expenses

   At discharge, you'll need to check and sign the discharge papers. Although the insurance covers most expenses, any non-medical or inadmissible expenses must be paid by you at the hospital.

   Claim Processing

   The TPA processes your claim based on the pre-authorized treatment and the medical bills submitted by the hospital.

   Claim Settlement

   After the treatment, the hospital sends the bills to the National Insurance Company. The insurer then settles the bills directly with the hospital, ensuring a hassle-free process for you.

2. National Health Insurance Reimbursement Claim Process:

   Here is the step-by-step guide for the Reimbursement Claim Process with National Health Insurance:

   Inform the Insurer

   Notify National Insurance Company of your hospital admission as soon as possible, preferably within 24 hours of admission.

   Settle All Bills

   After receiving treatment, settle all medical and hospital bills upon discharge. This is essential for the subsequent reimbursement claim.

   Gather Medical Documents

   Collect all necessary medical documents, bills, and receipts before leaving the hospital. These documents are critical for your claim process.

   Complete the Claim Form

   Download and fill out the reimbursement claim form from the National Insurance Company’s website. Ensure the accuracy and completeness of the information provided.

   Submit the Documents

   Send the completed claim form along with all relevant documents to the National Insurance Company within the stipulated time frame, typically 15 days from discharge.

   Claim Settlement

   National Insurance Company reviews your submitted documents and, upon approval, reimburses the claim amount to you. This process is typically completed within a specified period post-document submission.

Documents Required to File a National Health Insurance Claim

To file a reimbursement claim with National Health Insurance, ensure to submit the following essential documents:

• Claim Form Duly signed
• Copy of the claim intimation, if any
• Original Pre-authorization request
• Copy of the Pre-authorization approval letter
• Copy of photo ID card of patient verified by hospital
• Hospital Main bill
• Hospital Break-up bill
• Hospital Discharge Summary
• Pharmacy Bill
• Operation Theatre Notes
• ECG
• Doctor's request for investigation
• Investigation Reports (including CT/ MRI/USG/HPE)
• Doctor's Prescription
• MLC report & Police FIR, in case of accidents
• Original death summary from the hospital, where applicable

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