National Claim Settlement Ratio
  • Types of claim processes
  • CSR of the company
  • Claim filing process
National Claim Settlement Ratio
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National Insurance Claim Settlement Ratio

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.

Claim Settlement Ratio of National Insurance Company

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 2022-23, the claim settlement ratio of the National Insurance Company is 91.31%. They have an easy and minimal-step claim settlement process.

Types of Claims by National Insurance Company

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.

  • Cashless Claims
  • Reimbursement Claims

National Insurance Company Cashless Claims

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.

National Health Insurance Reimbursement Claims

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, network and non-network of 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.

Explore other National Health Insurance

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:

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....

Unique Features

  • Multiple Plan Options
  • Up to 50 L SI
  • Avail Maternity Cover

National Parivar Mediclaim Plus Policy (Pros)

National Parivar Mediclaim Plus Policy
  • Multiple Discount Options
  • Tax Benefits
  • Road Accident Cover

National Parivar Mediclaim Plus Policy (Cons)

National Parivar Mediclaim Plus Policy
  • Hazardous or Adventure Sports
  • Treatment for Alcoholism
  • Drug or Substance Abuse

National Parivar Mediclaim Plus Policy (Other Benefits)

National Parivar Mediclaim Plus Policy
  • Maternity Cover
  • Infertility Treatment
  • Vaccination for Children
  • Obesity

National Parivar Mediclaim Plus Policy (Eligibility Criteria)

National Parivar Mediclaim Plus Policy
  • Min entry age: 18 Years
  • Max entry age: 65 Years
  • Initial Waiting Period: 30 Days
  • Sum Insured: Up to 50 L

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...

Unique Features

  • Maternity Cover
  • Cataract Cover
  • High SI

National Young India Mediclaim Policy (Pros)

National Young India Mediclaim Policy
  • Room Rent Cover
  • Day Care Procedure
  • AYUSH Treatment

National Young India Mediclaim Policy (Cons)

National Young India Mediclaim Policy
  • Morbid Obesity Treatment
  • Illegal Activites
  • Adventure Sports

National Young India Mediclaim Policy (Other Benefits)

National Young India Mediclaim Policy
  • Cumulative Bonus
  • Wellness Discount
  • Long Term Discount

National Young India Mediclaim Policy (Eligibility Criteria)

National Young India Mediclaim Policy
  • Min entry age: 18 Years
  • Max entry age: 43 Years
  • Initial Waiting Period: 30 Days
  • Sum Insured: Up to 10 L

Group Health Insurance

Buying individual health insurance may seem hectic for some of us, as the monthly premiums might be a pain for our pockets. Here comes the contributio...

Unique Features

  • Coverage for modern treatment
  • Covers HIV/AIDS treatment
  • Covers 140+ daycare procedures

National Insurance Group Mediclaim Policy (Pros)

National Insurance Group Mediclaim Policy
  • 140+ daycare procedure
  • HIV cover
  • Affordable premiums
  • AYUSH cover

National Insurance Group Mediclaim Policy (Cons)

National Insurance Group Mediclaim Policy
  • Treatment outside India
  • OPD diagnostic
  • Adventure sport injuries
  • Injuries due to illegal activity

National Insurance Group Mediclaim Policy (Other Benefits)

National Insurance Group Mediclaim Policy
  • Co-pay discounts available
  • PED cover
  • 30 day pre-hospitalisation
  • Modern treatment

National Insurance Group Mediclaim Policy (Eligibility Criteria)

National Insurance Group Mediclaim Policy
  • Entry age- 3 Months
  • Max entry age- N/A
  • SI- 50K to 10 L
  • Waiting Period- 30 days

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...

Unique Features

  • PPD/ PTD & TTD cover
  • Accidental death coverage
  • Assured death payout

National Personal Accident Policy (Pros)

National Personal Accident Policy
  • 100% accidental death payout
  • PTD benefit
  • PPD benefit
  • TTD benefit

National Personal Accident Policy (Cons)

National Personal Accident Policy
  • PEDs not cover
  • Adventure sports not covered
  • Vaccination not covered

National Personal Accident Policy (Other Benefits)

National Personal Accident Policy
  • Mortal remains portability
  • Death coverage benefits
  • Loss of organ cover
  • Educational fund

National Personal Accident Policy (Eligibility Criteria)

National Personal Accident Policy
  • Entry age: 5-70 years
  • SI: Upto INR 10 lakh
  • Policy tenure: 1 year
  • Waiting period: None

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,...

Unique Features

  • National Mediclaim Plus features
  • Learn about the eligibility criteria
  • Exclusions & claim process

National Mediclaim Plus Policy (Pros)

National Mediclaim Plus Policy
  • 12 modern treatment covered
  • Maternity covered
  • Lifelong renewability

National Mediclaim Plus Policy (Cons)

National Mediclaim Plus Policy
  • Pre-existing diseases
  • Treatment outside India
  • Adventure sports injury

National Mediclaim Plus Policy (Other Benefits)

National Mediclaim Plus Policy
  • COVID vaccination
  • Air ambulance
  • Hospital cash benefit

National Mediclaim Plus Policy (Eligibility Criteria)

National Mediclaim Plus Policy
  • Min entry age: 18 Years
  • Max entry age: 65 Years
  • Initial Waiting Period: 30 Days
  • Sum Insured: Up to 50 L

Individual and Family Health Insurance

National Insurance Mediclaim Policy is a traditional health insurance plan that provides comprehensive coverage to the policyholders. This plan was la...

Unique Features

  • National Mediclaim plan features and benefits
  • Eligibility criteria
  • Easy claim process

National Mediclaim Policy (Pros)

National Mediclaim Policy
  • All-Inclusive Coverage
  • Maternity Benefits
  • No Claim Bonus

National Mediclaim Policy (Cons)

National Mediclaim Policy
  • Cosmetic Surgery
  • IVF
  • Dental Treatment

National Mediclaim Policy (Other Benefits)

National Mediclaim Policy
  • Tax Benefits
  • Avail 10% Discount
  • Health Incentives

National Mediclaim Policy (Eligibility Criteria)

National Mediclaim Policy
  • Min entry age: 18 Years
  • Max entry age: 65 Years
  • Initial Waiting Period: 30 Days
  • Sum Insured: Up to 10 L

Individual and Family Health Insurance

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...

Unique Features

  • Explore the plan’s key features
  • Find out the eligibility criteria
  • Learn its benefits & exclusions

National Parivar Mediclaim Policy (Pros)

National Parivar Mediclaim Policy
  • Infertility treatment cover
  • Vaccination covered
  • Ambulance covered
  • Cataract covered

National Parivar Mediclaim Policy (Cons)

National Parivar Mediclaim Policy
  • Treatment outside India
  • OPD diagnosis
  • Adventure sports

National Parivar Mediclaim Policy (Other Benefits)

National Parivar Mediclaim Policy
  • AYUSH cover
  • No co-pay
  • Vaccination

National Parivar Mediclaim Policy (Eligibility Criteria)

National Parivar Mediclaim Policy
  • Min entry age: 18 Years
  • Max entry age: 65 Years
  • Initial Waiting Period: 30 Days
  • Sum Insured: Up to 10 L

Individual and Family Health Insurance

National Arogya Sanjeevani Policy is a standard indemnity health insurance product from National Health Insurance Company, having Sum Insured up to 10...

Unique Features

  • Understand the plan features
  • Learn about its eligibility criteria
  • Know more about its exclusions

National Arogya Sanjeevani Policy (Pros)

National Arogya Sanjeevani Policy
  • Online purchase dicount
  • EMI facility available
  • High SI
  • Affordable premium

National Arogya Sanjeevani Policy (Cons)

National Arogya Sanjeevani Policy
  • Treatment outside India
  • OPD diagnostics
  • Adventure sport injuries
  • Injury due to illegal activities

National Arogya Sanjeevani Policy (Other Benefits)

National Arogya Sanjeevani Policy
  • Enhanced limits for room rent
  • Avail online discounts
  • Change sum insured
  • Lifelong renewal

National Arogya Sanjeevani Policy (Eligibility Criteria)

National Arogya Sanjeevani Policy
  • Min entry age: 18 Years
  • Max entry age: 65 Years
  • Initial Waiting Period: 30 Days
  • Sum Insured: Up to 50 L

Critical Illness Health Insurance

The deadly virus called 'COVID-19' has proved to be an eye-opener for all of us in understanding the importance of protecting our family's health. Eve...

Unique Features

  • Corona Kavach features and benefits
  • Eligibility requirements
  • Buying process of the plan

National Corona Kavach Policy (Pros)

National Corona Kavach Policy
  • Covers spouse and children
  • Home care treatment
  • No sub-limit

National Corona Kavach Policy (Cons)

National Corona Kavach Policy
  • Treatment outside India
  • OPD diagnosis
  • Injury due to illegal activity

National Corona Kavach Policy (Other Benefits)

National Corona Kavach Policy
  • 15 day pre hospitalisation
  • Discount available
  • Tax benefit

National Corona Kavach Policy (Eligibility Criteria)

National Corona Kavach Policy
  • Min entry age: 18 Years
  • Max entry age: 65 Years
  • Initial Waiting Period: 30 Days
  • Sum Insured: Up to 5 L

Top Up and Super Top Up

National Super Top Up Mediclaim Policy is a high threshold health insurance product, covering the members of a family under a single sum insured on fl...

Unique Features

  • Super Top-up Mediclaim features and benefits
  • Eligibility criteria
  • Modern treatment cover

Super Top-up Mediclaim Policy (Pros)

Super Top-up Mediclaim Policy
  • Organ donation covered
  • Morbid obesity treatment covered
  • Portability allowed
  • High SI

Super Top-up Mediclaim Policy (Cons)

Super Top-up Mediclaim Policy
  • Treatment outside India
  • OPD diagnosis
  • Adventure sport injuries

Super Top-up Mediclaim Policy (Other Benefits)

Super Top-up Mediclaim Policy
  • Affordable premiums
  • Tax benefits
  • HIV/AIDS cover

Super Top-up Mediclaim Policy (Eligibility Criteria)

Super Top-up Mediclaim Policy
  • Min entry age: 18 Years
  • Max entry age: 65 Years
  • Initial Waiting Period: 30 Days
  • Sum Insured: Up to 20 L

Senior Citizen Health Insurance

National Senior Citizen Mediclaim Policy is a plan especially designed and launched for senior citizens, allowing them to live a relaxed life post-re...

Unique Features

  • Plan options available
  • Domiciliary hospitalization
  • Modern treatments

National Senior Citizen Policy (Pros)

National Senior Citizen Policy
  • Reinstatement of Sum Insured
  • Cataract
  • Ambulance Cover

National Senior Citizen Policy (Cons)

National Senior Citizen Policy
  • Obesity
  • Adventure Sports
  • Illegal Activities

National Senior Citizen Policy (Other Benefits)

National Senior Citizen Policy
  • Hospital Cash
  • Doctor’s Home Visit
  • Funeral Expenses

National Senior Citizen Policy (Eligibility Criteria)

National Senior Citizen Policy
  • Min entry age: 60 Years
  • Max entry age: 80 Years
  • Initial Waiting Period: 30 Days
  • Sum Insured: Up to 10 L

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National Claim Settlement Ratio: FAQs

1. What is the name of the customer app of National Health Insurance Company?

The customer app of the National Health Insurance Company is ‘NIMA’.

2. Documents required for filing the claim with the National Health Insurance Company?

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

3. When should I submit all the essentials for a reimbursement claim form to the TPA/company from the date of discharge from the hospital?

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.

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Bindiya Sinha

Written By: Bindiya Sinha

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.