National Health Insurance Claim Settlement Ratio

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      National Health Insurance Claim Settlement Ratio

      National Health Insurance Claim Settlement Ratio (CSR) lets customers know how good the insurance company is when it comes to settling their claim requests. A high claim settlement ratio indicates that the insurer is more likely to pay your claims. Mostly, a CSR of 85% and above is considered good.

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      National Insurance Company has earned an impressive claim settlement ratio of 94.8% in FY 2021-22. This implies that the insurer paid 94.8% of the total claims received, making it an ideal choice for buying health insurance.

      Claim Process of National Health Insurance

      Whether you are filing a cashless claim or reimbursement claim, you must know the process for raising a claim. The procedure for filing a National health insurance claim is given below:

      Cashless Claim Process:

      Cashless claims can be availed only if you get admitted to a network hospital of National Insurance Company. The process to file a cashless claim is as follows:

      • Inform the insurer at least 72 hours before a planned hospitalization and within 24 hours of an emergency hospitalization.
      • Provide the policy number and the health card at the network hospital.
      • The hospital’s insurance desk will ask you to fill out the pre-authorization form and the same will be submitted to the insurer or the TPA.
      • Your documents will be reviewed by the insurer/TPA, and your cashless claim request will be approved or rejected. You may also need to furnish additional documents to get your claim accepted.
      • Once your treatment is over and you have been discharged from the hospital, the insurer/TPA will pay the bill amount.
      • In case of post-hospitalization expenses, submit all the documents within 15 days.

      Reimbursement Claim Process:

      The process to file a National health insurance reimbursement claim is as follows:

      • Intimate the insurer about your emergency hospitalization within 24 hours and planned hospitalization at least 72 hours in advance.
      • Avail the treatment and pay all the bills while getting discharged from the hospital.
      • Submit all the supporting documents to the TPA.
      • The in-house claims team will review your document and will approve or reject your claim.
      • Once approved by the National Insurance Company, the claim amount will be processed, and the payment will be reimbursed to you

      Documents Required to File a National Health Insurance Claim

      The following documents need to be submitted while raising a National health insurance claim:

      • Duly filled National health insurance claim form
      • Medical history of the patient
      • Doctor’s certificate specifying the date of diagnosis
      • Surgeon’s certificate specifying the nature of the surgery
      • Test reports and payment receipts supported with prescriptions
      • Hospital discharge summary
      • Hospital bills and payment receipts
      • Cash memo from chemist/hospital supported by prescriptions

      For more details, please write to Policybazaar at or speak to our health claim experts at 1800-208-8787.

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      Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

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