National Insurance health insurance claim process

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

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 –

• If you are undergoing a planned treatment, you should inform the TPA at least 72 hours before being hospitalised in a networked hospital (PPN)
• If, however, your hospitalisation is an emergency case, the TPA should be informed within 24 hours of your hospitalisation at a PPN
• A cashless request form, called a pre-authorization form, should be filled in and sent to the TPA for authorization of your cashless claim. This form should be submitted when the TPA is informed of your hospitalisation 
• The TPA would, then, verify the details contained in the pre-authorization form. The medical details would be cross-checked with the PPN and the insured person. Thereafter, the TPA would issue a pre-authorization letter to the hospital 
• Once the letter is issued, you can avail cashless treatments
• When you are discharged from the hospital, you should collect all the medical bills and pay for the costs which are not covered under your health insurance policy
• The claim form should, then, be filled and submitted to the insurance company along with all the documents after the post hospitalisation treatments are done. The documents should be submitted within 15 days of completion of all treatments.
• If, due to any reason, your cashless claim is denied, you can take medical treatments as advised by your doctor and pay the medical expenses yourself. Later on, you can file for reimbursement of your claim.

Reimbursement health insurance claims

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 –

• If you are undergoing a planned treatment, you should inform the TPA at least 72 hours before being hospitalised 
• If, however, your hospitalisation is due to an emergency, the TPA should be informed within 24 hours of hospitalisation 
• Take the medical treatments which are required and pay the bills yourself
• When you are being discharged, collect all your medical reports, bills and discharge summary from the hospital
• Fill up the claim form and submit it along with all relevant documents to the insurance company for reimbursement of your claim. The documents should be submitted within 15 days from the completion of all medical treatments, including post hospitalisation treatments.

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. 

Documents required for health insurance claims

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 – 

• Part A and Part B of the claim form which is issued by National Insurance, filled and signed by the policyholder 
• All medical bills associated with your treatment in original 
• All medical reports which contain the medical history of the patient
• Discharge certificate or summary issued by the hospital at the time of discharge
• Cash memo received from the chemist or hospital for medicines bought along with the prescription in original
• All payment receipts which show the medical expenses that you paid in original 
• Investigative reports conducted for assessment of the illness, injury or disease
• A certificate from the attending medical practitioner showing the diagnosis of illness
• Original certificate issued by the surgeon showing the diagnosis of the illness and details of the surgery performed 
• All bills and receipts of the surgery and treatment taken
• Any other document as required by National Insurance or its TPA for settlement of your claim

National Insurance claim status

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 –

• Visit https://nationalinsuranceindia.nic.co.in/portal/page/portal/Corporate/Home/ClaimsDetailsFromEbao
• Provide your customer ID, policy number, claim number and date of loss. The policy number and the claim number and mandatory details which are needed to be provided. The other two details are optional and you can provide them if you have them with you.
• There would be a captcha code which you should enter and then click ‘Submit’
• Upon submission of the online request you would be able to check the National Insurance claim status of your health insurance policy.

Incurred Claims Ratio for National Insurance Company 

 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 –

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.