Navi Health Insurance Claim Settlement

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

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 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.