National Claim Settlement Ratio
- Types of claim processes
- CSR of the company
- Claim filing process
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Updated on Aug 07, 2023 4 min read
The claim settlement is a health insurance company’s track record. This data gives you an idea of how many claims the company pays out during that financial year. It is calculated as a percentage, as the number of claims paid against the number of claims filed, divided by the total number of claims it gets. The higher the claim settlement ratio, the better the chance of settling your claim on priority.
With more than 3000 network hospitals, the National Health Insurance Company is considered one of India’s oldest insurance companies. It was formed on December 6, 1906. According to the IRDAI’s latest report for the year 2025, the claim settlement ratio of the National Insurance Company is 91.18%. They have an easy and minimal-step claim settlement process.
The company offers two types of claims according to the needs of customers. Now, let’s get into the details of the National Insurance Company Claim Settlement.
National Insurance Company has a simple, app-based claim process to make the customers’ experience fuss-free. You can contact the company for a claim, submit your documents, and check your claim status easily on their customer app,” NIMA”, and on their official website as well. Here is how the National Health Insurance cashless claims are made.
Step 1: To avail of the cashless benefit, the customer must undergo treatment at a network provider or public provider network(PPN). It must be pre-authorised by the TPA.
Step 2: In case of planned hospitalization, inform the company at least 72 hours before the admission, in case of emergency hospitalization, inform within 24 hours after the company or the TPA.
Step 3: Fill out the cashless request form, available at the public provider network(PPN), and send it to the TPA for authorization.
Step 4: After getting the cashless request form duly filled with all medical and other information, the TPA will issue a pre-authorisation letter to the hospital.
Step 5: After treatment, the customer will sign the discharge papers and will pay for non-medical and inadmissible expenses.
Step 6: On receiving the final documents, if the claim is accepted, then the payment will be made within 7 days.
Step 7: If the customer is unable to provide the required medical details, the TPA can hold the right to deny pre-authorisation, in case the claim gets rejected, then the customer may undergo treatment as per the doctor and claim for reimbursement later, or submit the missing/faulty information or documents.
A reimbursement claim is one in which the customer pays the medical expenses for his treatment upfront in the hospital and later requests reimbursement against the cost incurred by the company. Later, the money is transferred to the bank account of the customer.
A customer can file a reimbursement claim at both the network and non-network of the National Health Insurance. Here are the steps for the reimbursement claim process.
Step 1: Customers can undergo treatment at a network or non-network hospital.
Step 2: You need to submit all the essential documents along with the reimbursement claim form to the TPA/company within 30 days from the date of discharge from the hospital.
Step 3: After receiving the final documents, they will be approved by the company. If the claim is accepted, you will receive the payment directly in your bank account, within 7 days from the date of acceptance.
Step 4: If the customer is unable to provide the required medical details, the claims will be rejected. The customer then has to resubmit the correct documents.
National Insurance Company, with its rich history and extensive network of over 3,000 hospitals, continues to be a significant player in the Indian health insurance sector. Despite a slight adjustment to a 91.18% claim settlement ratio in 2025, the company maintains its commitment to a streamlined claim process through its app and website. By offering both cashless and reimbursement options, and emphasizing clear communication, National Insurance Company aims to provide reliable support during medical emergencies. Policyholders are encouraged to stay informed about the claim procedures and ensure timely submission of accurate documentation to facilitate a smooth claim experience. Secure your health and future with National Insurance Company. Download the ’NIMA’ app today to manage your policy, track claims, and access our extensive network of hospitals. You can also ask PolicyX.com, we provide you only expert advice.
To cater to the different medical needs of an individual & their family, National Health Insurance offers several Health Plans ranging from senior citizen plans to specialized plans for autistic children, to health insurance for cardiac patients, and many more.Take a look below to National Health Insurance plans explore more:
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Critical Illness Health Insurance
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Individual and Family Health Insurance
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National Parivar Mediclaim Policy aims to encourage the protection of the whole family on a single sum insured. This is a family floater plan that pro...
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Individual and Family Health Insurance
National Medicliam Plus Policy is a high sum insured policy that indemnifies for In-patient treatment expenses and 140+ Day Care Procedures/surgeries,...
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Accident Health Insurance
You can buy the National Insurance personal accident plan on an individual or family floater basis that acts as a standalone policy. This policy is de...
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Group Health Insurance
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Individual and Family Health Insurance
National Young India Mediclaim Policy, an indemnity-based insurance policy is available as an individual and family floater health plan. A standard he...
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Individual and Family Health Insurance
National Parivar mediclaim plus is a versatile family floater health insurance policy that comes in three different plan options that are A, B, and C....
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Know More About Health Insurance Companies
The customer app of the National Health Insurance Company is ‘NIMA’.
The documents required for filing the claim with the National Health Insurance Company are: Duly filled claim form Original cash receipts from the hospital or chemist along with the prescriptions Original payment receipt, etc. medical prescription. Reports of the medical tests. Any other necessary documentation if required as asked by company/TPA
Customers need to submit all the essential documents along with the reimbursement claim form to the TPA/company within 30 days from the date of discharge from the hospital.
According to the latest IRDAI report, the claim settlement ratio is 91.18%.
National Insurance Company has more than 3,000 network hospitals.
National Insurance Company offers Cashless Claims and Reimbursement Claims.
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Bindiya is a seasoned content writer specializing in keeping readers acquainted with the insurance industry, term insurance developments, and life insurance sector shifts. With an experience of 3 years in insurance, Bindiya ensures that her readers stay well informed with the insurance developments and factually correct information.
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