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Navi Health Insurance Claim Settlement

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Claim SettlementDedicated Team
Claim Settlement Ratio86.98%
COVID-19 CoverYes
Network Hospitals10,000+
Policies Sold48,035

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Claim Settlement of Navi Health Insurance

Navi General Insurance (formerly known as DHFL General Insurance) offers a smooth claim settlement process to its health insurance customers. It allows them to make claims in two ways namely, cashless claims and reimbursement claims, for the healthcare expenses arising due to medical treatment that their health insurance policy covers them for. The good news is that the insurance company does not put any limit on the number of claims that can be made in a policy term. Also, it settles a claim or communicates the rejections if any, within 30 days of submission of the relevant documents required for the process. Kindly note that the claim can be made up to the sum insured limit was chosen under the policy.

  • Claim Process for Cashless Treatment

    You can avail of cashless treatment at any of the network hospitals of Navi General Insurance. Given below are the steps that must be followed to make a claim: 

    • Approach the network hospital for hospitalisation (intimate at least 24 hours prior in case of emergency and 48 hours in case of planned hospitalisation) to avail medical treatment 
    • Provide your health insurance details at the hospital admission counter
    • Fill up correctly the pre-authorisation form which is available at the hospital  
    • Your request will be forwarded by the network hospital within 24 hours of the hospitalisation
    • In the meantime, the network hospital will either treat the insured person by taking a token deposit or as per the rules in a situation requiring emergency medical attention
    • The hospital will refund the deposited amount to you barring a token amount to cover the non-covered expenses after the issuance of the authorisation in emergency hospitalisation
    • In case of approval in planned hospitalisation, the company will directly bear the medical expenses 
    • Whereas, if the request for claim gets rejected, then the policyholder is required to pay off the bills from their own pocket
  • Reimbursement Treatment

    There can be instances where the TPA or the company may reject cashless treatment due to some reason. And if you couldn't avail of the cashless treatment, don’t worry. You can submit your claim to the TPA office for reimbursement not later than 15 days after your discharge from the hospital. Given below are the steps to avail of the reimbursement facility-

    • Inform the company as soon as possible in case of emergency or planned hospitalisation
    • Submit the relevant documents as required according to the terms and conditions of the policy
    • The company will investigate the details on the claim form and other documents 
    • The approval letter will be sent to you by the claim management team of DHFL General Insurance confirming the approval
    • Within 15 days after this, you will get the amount reimbursed
    • If the claim request gets rejected, then the insured person can raise a query for the rejection
  • Documents Needed

    The company requires the following documents for the purpose of reimbursement-

    • Duly filled and signed claim form 
    • OT notes if available
    • Original discharge or death summary
    • Original bills from the pharmacy
    • Original main bill from the hospital along with break up bill and original receipts
    • Reports of X-ray, CT films, MRI, HPE etc.
    • Reference slips from the doctors 
    • KYC Documents 
    • FIR Report/MLC/Post Mortem Report (if applicable)
    • Cancelled cheque for NEFT payment

    You will be called for any additional documents or information required based on the circumstances of the claim. 

  • Incurred Claim Ratio (ICR) of Navi Health Insurance

    Incurred Claim Ratio or ICR, simply indicates how much you can believe in an insurance company as far as claims are concerned. Every year, IRDAI (Insurance Regulatory and Development Authority of India) releases the data of ICR for all the companies, according to which the ICR of Navi General Insurance for FY 2018-19 is 48%. ICR is the ratio of the claim incurred by the insurance company to the actual premium collected for that period. 

Save Tax upto ₹75000*
Under Section 80D

*Tax benefits are subject to changes in Income Tax Act.

Navi Health Insurance User Reviews

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    On: Jul 29, 2021
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    On: Jul 27, 2021
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    On: Jul 22, 2021
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    On: Jul 20, 2021
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Navi Health Insurance Contact Details

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Claim Process at Navi Health Insurance

  • Network Hospital
  • Non-Network Hospital
  • 1

    Claim Assistance

    For any assistance or query, call InsuranceDekho at the toll-free number 755 1196 989.
  • 2

    Claim Intimation

    Emergency hospitalisation needs intimation within 24 hours and for planned hospitalisation intimate within 48 hours prior to admission.
  • 3

    Claim Processing

    Fill in the pre-authorisation form and hand it over to hospital's insurance/TPA desk to initiate claim request.
  • 4

    Claim Settlement

    Once your request is approved, claim is settled. If not approved, claim for reimbursement after discharge.
  • 1

    Claim Assistance

    For any assistance or query, call InsuranceDekho at the toll-free number 755 1196 989.
  • 2

    Claim Intimation

    Emergency hospitalisation needs intimation within 24 hours and for planned hospitalisation intimate within 48 hours prior to admission.
  • 3

    Claim Processing

    Submit claim form with original documents such as doctor’s reports, hospital bills, diagnostic tests, etc.
  • 4

    Claim Settlement

    Once your request for reimbursement of expenses is approved, the claim will be settled.

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