National Insurance Claim Settlement Ratio

The claim settlement ratio is a health insurance company’s track record, indicating how many claims the company pays out during a financial year. It is calculated as a percentage of claims paid against the total claims received. A higher claim settlement ratio generally indicates a better chance of your claim being settled promptly.

Claim Settlement Ratio of National Insurance Company

With more than 3000 network hospitals, National Insurance Company is considered one of India’s oldest insurance companies, formed on December 6, 1906. According to the IRDAI’s latest report for the year 2025, the claim settlement ratio of National Insurance Company is 91.18%. The company offers an easy and minimal-step claim settlement process.

Types of Claims by National Insurance Company

The company offers two types of claims to meet customer needs. Let’s look at the details of National Insurance Company’s claim settlement processes:

• Cashless Claims
• Reimbursement Claims

National Insurance Company Cashless Claims

National Insurance Company provides a simple, app-based claim process for a fuss-free customer experience. You can contact the company for a claim, submit documents, and check your claim status easily on their customer app, "NIMA", and on their official website. Here is how National Insurance cashless claims are processed:

Step 1: To avail of the cashless benefit, the customer must undergo treatment at a network provider or Public Provider Network (PPN). This must be pre-authorised by the TPA.

Step 2: In case of planned hospitalization, inform the company at least 72 hours before admission. For emergency hospitalization, inform the company or the TPA within 24 hours of admission.

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 receiving the duly filled cashless request form 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 pay for non-medical and inadmissible expenses.

Step 6: On receiving the final documents, if the claim is accepted, payment will be made within 7 days.

Step 7: If the customer is unable to provide the required medical details, the TPA reserves the right to deny pre-authorisation. If pre-authorisation is denied, the customer may proceed with treatment and file for reimbursement later, or submit the missing/corrected information.

National Insurance Reimbursement Claims

A reimbursement claim is one where the customer pays the medical expenses for treatment upfront at the hospital and later requests reimbursement from the company. The approved amount is then transferred to the customer's bank account.

A customer can file a reimbursement claim at both network and non-network hospitals of National 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 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, the company will review them. 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 claim will be rejected. The customer then has to resubmit the correct documents.

Conclusion

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. The company reported a 91.18% claim settlement ratio in 2025, demonstrating 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 for a smooth claim experience. For further assistance or to compare plans, visit PolicyX.com.