National Health Insurance Claim Settlement Ratio

National Insurance Company Limited has a satisfying claim settlement ratio of 85.47%.  Both cashless and reimbursement claims are available and you can file for both. With the health claim ratio you get to know how good the Health insurance company is when it comes to settling the claim requests. If you are insured under a National health insurance policy then here we are going to discuss in detail the claim procedure that is followed by the insurer.

National Health Insurance at a Glance:

Key Features

Highlights

Network Hospitals

6000+

Incurred Claim Ratio

115.55

Renewability

Lifelong

Waiting Period for Pre-existing Illness

4 years

Claim Process of National Health Insurance

Whether you are filing a cashless claim request or filing for reimbursement it is required to know the document required, and the process for both cashless hospitalization where you can directly avail treatment in a network hospital. Or if you are submitting hospital bills to get reimbursement of your medical expenses.

Claim process to follow in case of an emergency or planned hospitalization-

  • Provide the policy number and the health card at the network hospital
  • Hospital’s insurance desk will ask you to provide your personal details, policy ID and fill the pre-authorization form 
  • The hospital’s insurance desk will fill the rest of the details and send the document to the insurer
  • Your documents will be reviewed by the insurer and basis on this the approval or rejection will be sent to the hospital
  • Either you will receive approval. Or you will need to furnish more documents to get claim accepted
  • In case it is rejected, a claim reimbursement process  should be followed

If it is a cashless hospitalization the process goes as follows-

  • All the details filled in the pre-authorization form will be verified by the TPA and the hospital 
  • Once the pre-authorization form is submitted, the insurer will take care of all the communication related to the settlement of the bill
  • Before discharge, the patient or the proposer is intimated, if there are any expenses that are beyond the scope of coverage and the amount is paid as per the sum insured.

If you want to reimburse your claim then follow this process-

Once the claim form is duly filled, all the necessary documents are attached to it and sent to the insurer and the process begins - 

  • The in-house insurance team reviews papers
  • Once approved by the National Insurance Company Limited, the funds will be processed and the payment will be reimbursed within a week or so. 
  • You will receive the intimation of the same. And the approval will be sent. 
  • In case it is rejected, intimation will be sent to you. If required you will need to submit more documents to ensure claim resolution as soon as possible and the file will open for review.
  • Once cleared, the money will be reimbursed

For a smooth claim, process do not forget to keep the following documents ready with you -

  • Age proof of the policyholder
  • Document of medical check-ups conducted before the policy approval 
  • Proposal form 
  • Medical documents supporting pre-existing health ailments

For more details please write to us at This email address is being protected from spambots. You need JavaScript enabled to view it. or speak to our health claim experts at 1800-208-8787

FAQs

Written By: PolicyBazaar - Updated: 15 April 2021

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