National Insurance Claim Settlement Ratio

The claim settlement is the track record of a health insurance company, this data gives you an idea of how many claims the company pays out during that financial year. It is calculated in the form of a percentage, as the number of claims paid against a number of claims filed of the total number of claims it gets. Higher the claim settlement ratio, better the chance of getting your claim settled on priority.

Claim Settlement Ratio of National Insurance Company

With more than 3000 network hospitals, the National Insurance Company is considered to be one of the oldest insurance companies in India. It was formed on December 6, 1906. According to the IRDAI latest report for the year 2021-22, the claim settlement ratio of National Insurance Company is 86.28%. 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

Health Insurance Claim Settlement Ratio

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 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 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.

Health Insurance Companies

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. Then the customer has to resubmit the correct documents.

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