National Claim Settlement Ratio
- Types of claim processes
- CSR of the company
- Claim filing process
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 2022-23, the claim settlement ratio of the National Insurance Company is 91.31%. 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, 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.
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
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
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
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
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
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
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
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
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
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
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
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.
See More Health Insurance Articles
See More Health Insurance Articles
4.4
Rated by 2628 customers
Select Your Rating
Let us know about your experience or any feedback that might help us serve you better in future.
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.
You May Also Know About
Do you have any thoughts you’d like to share?