National Health Insurance Claim Settlement

To process cashless insurance claim under National Insurance plans, you must follow the steps given below:

• Inform the National Insurance Company about the hospitalisation, before 72 hours in case of planned hospitalisation and within 24 hours in case of emergency hospitalisation. 
• Get a cashless claim request form from the insurance company or the insurance provider and submit it to the concerned person at the hospital. The hospital authorities will share the documents with the insurer. 
• Your documents will be verified along with the pre-authorisation form. 
• On the basis of documents submitted, the insurance company will make a decision on whether to accept or reject the claim request. 
• The network hospital will then send the final request and settle the bills at the network hospital.

To make reimbursement claims under health insurance plans offered by the National Insurance Company, you must follow the steps given below:

• Intimate National Insurance Company about the hospitalisation, before 72 hours in case of planned hospitalisation and within 24 hours in case of emergency hospitalisation. 
• Avail the required medical treatment and settle the bills out of your own pocket. Collect the documents related to your treatment, when leaving the hospital.
• Submit the duly filled request form along with relevant documents to the insurance company.
• Your documents will be verified by the insurance company and if the claim is made in accordance with the terms and conditions of your health insurance policy, then the company will pay you for the expenses incurred for the treatment.

In case of a claim under National Insurance plan, you are required to inform National Insurance Company 72 hours in advance in case of planned hospitalisation and within 24 hours in case of emergency hospitalisation.

According to the IBAI’s General Insurance Claim Insights Handbook For Policyholders-5th Edition, the Claim Settlement Ratio of National Insurance for the financial year 2019-20 is 83.78%.

As per the IRDAI (Insurance Regulatory and Development Authority of India), the Claim Settlement Ratio of National Insurance for FY 2019-20 is 83.78%.