National Insurance Company was established in the year 1906 in Kolkata. Thus, the company has a lineage of more than a hundred years in offering general insurance solutions and is trusted by millions of customers in India. The company is not only present in India but in Nepal too where it offers general insurance products to the people of Nepal for covering different types of contingencies that they face. National Insurance Company has a wide network of branches with more than 1730 offices in India.
National Insurance Company offers a range of general insurance plans and health insurance policies are one such product which the company offers to its customers. National Insurance offers different types of health insurance plans which provide a comprehensive scope of coverage at affordable premium rates. Moreover, health insurance claims are also settled by the company at the earliest if the proper claim procedure is followed by the policyholder. If you are unsure of the detailed claim process of National Insurance health insurance plans, here’s a complete guide for your understanding –
National Insurance health insurance claims
Claims under your National Insurance health insurance policy can be settled in two ways – cashless and reimbursement. The process of claim settlement would depend on the way in which the claim is settled. So, let’s understand the individual claim settlement processes of both types of health insurance claims –
Cashless health insurance claims occur when you seek treatments at a hospital which is tied-up with National Insurance. Such a hospital is called a Preferred Provider Network (PPN). Cashless claims are settled through a Third Party Administrator (TPA) of National Insurance. TPAs are companies which help in settlement of cashless claims. You have to contact the TPA of National Insurance to get your claims settled on a cashless basis. The TPA would, then, provide you the list of networked hospitals or PPNs at which you can avail treatments on a cashless basis. The process for cashless claim settlement is as follows –
Reimbursement claim settlement happens either when you avail treatment at a non-networked hospital or if your request for cashless claim is denied. Under reimbursement claims, you are required to bear the medical expenses yourself. Thereafter, when the treatment is complete, you have to submit your medical bills and other related documents and National Insurance would reimburse you for the medical costs that you incur. You are, however, required to follow the reimbursement claim process to get reimbursement of your medical expenses. The process is as follows –
Once all the documents are duly submitted, the insurance company would either accept or reject your claim. The decision of accepting or rejecting the claim would be given by National Insurance within 30 days of receipt of all claim-related documents.
In order to get your health insurance claim processed and settled by National Insurance, the following documents would have to be submitted to the company –
Health insurance claims might take some time to get settled and in the meanwhile if you want to track your National Insurance claim status, you can do so online. The insurance company allows policyholders to track their National Insurance claim status online on its website. To check the status, you should follow the below-mentioned steps –
National Insurance Company settles most of the health insurance claims which are made on it provided the claims are genuine and you follow the prescribed claim process. The claim payment record of the company can be judged by its Incurred Claims Ratio. The Incurred Claim Ratio is the amount of claim paid by the company against the total premiums that it has earned in a financial year. A high ratio indicates high claim payments and the Incurred Claim Ratio for National Insurance over the last few years has been high. The ratio is as follows –
Net Premiums Earned
Incurred Claims Ratio
INR 10,400.23 crores
INR 11,434.03 crores
INR 11,266.55 crores
INR 12,870.68 crores
INR 4021 crores
INR 5105.82 crores
INR 388,709 lakhs
INR 429,135 lakhs
INR 332,965 lakhs
INR 366,344 lakhs
So, National Insurance is a reputed public sector general insurance company which aims to settle your health insurance claims efficiently. You should know and understand the claim settlement process and follow it to get your claims settled easily.
If the claim is accepted, the company would have to settle the claim within 7 days of accepting it. If the claim is delayed, you would be entitled to receive an interest on the outstanding amount of claim. This interest would be calculated at the bank rate plus 2%.
The list of PPN hospitals can be availed from the TPA of National Insurance Company.
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