• National Health Insurance Claims Procedure

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    Cashless Treatment

    Customer Service

    Medical Coverage

    Claim Experience

    Responsiveness

    In case the processing of claims will be carried out by the company, the insured individual or his / her representative must inform the National Insurance Company when claims are filed. The TPA (Third Party Administrator) must be intimated in case the processing of claims is done by the TPA. The intimation should be provided in writing, either through a letter, fax or e-mail that contains all the relevant details related to the claim, including information such as nature of treatment, policy number, etc.

    To avail the cashless facility, details related to planned hospitalisation must be intimated to the concerned officials within 72 hours prior to the insured individual’s admission to PPN / network hospital. In case of emergency hospitalisation, the concerned officials of National Insurance must be notified within 24 hours after the insured individual was admitted to PPN / network hospital.

    With regards to notification of claims for reimbursement, planned hospitalisation details must be submitted to the TPA / company within 72 hours prior to the insured individual’s admission to hospital. In case of emergency hospitalisation, the company / TPA must be notified within 72 hours after the insured individual was admitted to hospital. Notifications can be sent by fax to 22831740, or via telephone on 22831705.

    Incurred Claim Ratio for National Insurance Health Insurance:

    The Incurred Claim Ratio of an insurance provider is a prominent indicator of its performance. It enables potential customers to better understand where the company stands in terms of reliability and efficiency. The Incurred Claim Ratio of the National Insurance Company is as follows:

    For 2015-16:

    Net Earned Premium (in lakhs INR) Net Claims Paid (in lakhs INR) Incurred Claims Ratio (Percentage)
    388709 429135 110.40

    For 2014-15:

    Net Earned Premium Net Claims Paid Incurred Claim Ratio
    Rs.332,965 lacs Rs.366,344 lacs 110.2%

    It is important to note that Incurred Claim Ratio is not the only parameter against which the credentials of a company can be judged as there can be discrepancies that do not disclose every detail that can help customers figure out whether or not they must choose a particular insurance provider.

    How to Make Claims?

    1. In case of Cashless Treatment:

      • Procedure to File a Claim (Planned / Emergency Hospitalisation):

        Network hospitals will provide the cashless facility to individuals who have selected ‘claim processing by TPA’. The insured individual can undergo treatment in PPNs or network hospitals provided that the TPA (Third Party Administrator) has given the authorisation in advance.

        The list of network hospitals can be accessed at the official website. The same website can be accessed to download the request from which should be filled in with the requisite details and submitted to the TPA so that it can approve and authorise the same.

      • Claims Process:

        When the TPA receives the request form along with other related medical details from the network provider or the insured individual, it will provide the network hospital with the pre-authorisation letter once it has verified the information received. At the time of discharge from the hospital, the insured individual will have to sign the discharge documents following verification and he / she will also have to bear inadmissible and non-medical expenses. If the insured individual cannot provide the necessary medical information, the TPA holds the right to decline pre-authorisation. If the medical insurance claim is declined, the insured individual can undergo treatment based on the advice of the treating doctor after which he / she will have to furnish the relevant claim documents to the TPA so that claims can be reimbursed.

    2. In case of Reimbursement of Treatment Expenses:

      • Procedure to File a Claim:

        To have claims reimbursed, the insured individual will have to furnish the relevant claim documents to the TPA prior to the due date prescribed in the policy. The insured individual can undergo treatment based on the advice of the treating doctor. The company will not cover costs related to the treatment of the insured individual neither before nor during the treatment. The insured individual will have to bear all costs incurred for the treatment. The insured individual will also have to furnish the bills along with the other relevant documents to the company / TPA for the reimbursement of claims.

      • Documents Required:

        The documents that must be furnished when claiming reimbursement from the company / TPA include the original claim form disclosing all the necessary details, payment receipts, original bills, hospital discharge certificate, original hospital cash memo, prescription from the chemist, investigation test reports along with the attending doctor / medical practitioner’s prescription, original payment receipt, certificate related to diagnosis and bill receipts from the attending doctor / medical practitioner, certificate from surgeon disclosing the plan or nature of operation underwent by the individual along with the diagnosis certificate supported by bills, and any other document as required by the TPA or the company.

        The documents can be sent to 3, Middleton Street, Prafulla Chandra Sen Sarani, Kolkata, West Bengal, 700071. They can also be faxed to 22831740.

      • Claims Process:

        Should the company accept the insured individual’s settlement offer, the customer will receive the payment within seven days after the offer has been accepted. In case there’s a delay in making the payment to the customer, the company will pay 2% interest above and beyond the bank rate.

        In case the company rejects the claim of an insured individual for any reason whatsoever, it will communicate the same to the individual in writing within 30 days after it has received the final document.

    This Insurance Company has not partnered with BankBazaar.com. For more details, please visit its website/branch office. The trademarks, logos and other subject matters of intellectual property belong to their respective owners.

    GST rate of 18% applicable for all financial services effective July 1, 2017.

    Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.

    National Health Insurance Claims Procedure Reviews

  • Page 1 of 8 1 2 3 4 5
    • National Insurance Health Insurance
      "Average Service"
      0.5 2.0/5 "Expected more"
      I've a very bad claim experience with the national insurance company. They need to improve the way how hey respond to the claim request of their customer. Somehow finally I managed get the claim amount but it was tedious task to follow up with them regarding the claim.
      Was this review helpful? 0
      , new delhi
      Reviewed on May 26, 2018
    • National Insurance Health Insurance
      "Claim experince was really good"
      0.5 5.0/5 "Blown Away!"
      I hold a health insurance with National insurance and the total policy coverage is for 3.5 lakhs including my family. There was a claim experience for my family and the experience was really good. The service from there end was really good.
      Was this review helpful? 0
      , kochi
      Reviewed on May 25, 2018
    • National Insurance Health Insurance
      "Good medical policy"
      0.5 5.0/5 "Blown Away!"
      I have the medicare health insurance policy from the NATIONAL INSURANCE for the past 7years. The customer support service and the response is good from the national . This policy covers 3member in my family. This policy ha the medical coverage up to Rs,2,00,000 per year. I can claim up to Rs,6000 per year per head,
      Was this review helpful? 0
      , kolkata
      Reviewed on May 21, 2018
    • National Insurance Health Insurance
      "Below average service"
      0.5 2.0/5 "Expected more"
      I got the mediclaim health insurance policy from the NATIONAL INSURANCE company around 2 years ago. The customer support service and the response is good from the NATIONAL INSURANCE but while it comes to claim experience they are not up to the mark . I have the medical claim up to Rs,2,00,000, but they are taking too much time to settle the claim amount. The process need to be quick and fast from the NATIONAL INSURANCE health insurance policy.
      Was this review helpful? 0
      , nasik
      Reviewed on May 21, 2018
    • National Insurance Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I hold a health insurance policy with National Insurance from last 10 years, i am happy with the coverage value of this insurance policy. A premium of Rs 1400 has to be paid for this insurance policy. My claim experience was good and they covered 100% and the coverage amount is up to Rs 1 lakh
      Was this review helpful? 0
      , delhi
      Reviewed on May 17, 2018
    • National Insurance Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have my health insured with National insurance from last 5 years, i am not aware of the premium amount as my company pays it. My claim experience was very good and there was no cashless treatment as the hospital was not listed. I have a coverage value of Rs 5 lakhs for this insurance.
      Was this review helpful? 0
      , bangalore
      Reviewed on May 11, 2018
    • National Insurance Health Insurance
      "Health insurance with National insurance"
      0.5 3.0/5 "Satisfactory"
      I hold a Corporate health insurance from National insurance. The policy coverage will be for 3 lakhs rupees. This policy have the coverage for my family as well. There is no claim experience till now. They do have cashless and reimbursement facility.
      Was this review helpful? 0
      , bangalore
      Reviewed on Apr 25, 2018
    • National Insurance Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance with National insurance from last 4 years, i am not aware of the premium amount as my company pays it. I do not have claim experience so far with this insurance and i have a coverage value of Rs 3-4 lakhs which is satisfactory.
      Was this review helpful? 0
      , bangalore
      Reviewed on Apr 10, 2018
    • National Insurance Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I hold a health insurance policy with National insurance from last 2 years and it is a good policy to use. I pay a premium of Rs 17000 which has to be renewed every year for this insurance. I do not have claim experience so far with this insurance and the coverage value for this insurance is Rs 2 lakhs.
      Was this review helpful? 0
      , ahmedabad
      Reviewed on Apr 06, 2018
    • National Insurance Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance with National Insurance from last 2.5 years and it is a good insurance policy to use. I am not aware of the premium amount as it is covered by the organization.I do not have claim experience and i have not taken any cashless treatment so far. I have a coverage of Rs 2 lakhs and i am satisfied with it.
      Was this review helpful? 0
      , chennai
      Reviewed on Mar 14, 2018
    • National Insurance Health Insurance
      "Average"
      0.5 3.0/5 "Satisfactory"
      I took my health insurance with National Insurance through an agent. The policy coverage was 5L which covers the entire family. The customer service was not good. They don't respond properly. I don't have any claim experience. I am paying 11,000 rupees yearly through cheque.
      Was this review helpful? 0
      , kolkata
      Reviewed on Mar 13, 2018
    • National Insurance Health Insurance
      "Decent insurer"
      0.5 4.0/5 "Great!"
      I took my health insurance in National Insurance for last 3 years. As of now I don't have any claim experience. The policy was taken through family agent. The premium was decent and good compared to others. The policy coverage was 5L for the entire family. They have a good network of hospitals for the cashless treatment.
      Was this review helpful? 0
      , faridabad
      Reviewed on Mar 10, 2018
    • National Insurance Health Insurance
      "Excellent service"
      0.5 5.0/5 "Blown Away!"
      I have taken Health Insurance with National Insurance,the premium amount is 1600 debited from my salary account.The policy coverage amount is including family members is five lakhs.I have taken this policy last eight years ago.I have claim experience its 100% covered cash less treatments.
      Was this review helpful? 0
      , bangalore
      Reviewed on Feb 26, 2018
    • National Insurance Health Insurance
      "Good"
      0.5 3.0/5 "Satisfactory"
      I am having the health insurance policy with the National Insurance company. I used to talk with them very often and the claim went in easy manner. Everything went in the good aspects with them till now.
      Was this review helpful? 0
      , kolkata
      Reviewed on Feb 17, 2018
    • National Insurance Health Insurance
      "Good policy to use"
      0.5 5.0/5 "Blown Away!"
      I have a health insurance with national insurance from last 2 months and it is a good insurance policy. I pay a premium of Rs 170 on monthly basis. I do not have claim experience so far and i have not taken any cashless treatment. I have a coverage of Rs 3 lakhs which is satisfactory.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Feb 13, 2018
    • National Insurance Health Insurance
      "Good service"
      0.5 3.0/5 "Satisfactory"
      For the past 2 years I have the health insurance policy from the NATIONAL INSURANCE. The customer support service is average with the NATIONAL INSURANCE company. This policy covers 3 members in my family and the medical coverage is good with this policy , I can claim up to 4lakhs for the hospitalization.
      Was this review helpful? 0
      , gorakhpur
      Reviewed on Feb 12, 2018
    • National Insurance Health Insurance
      "Okay"
      0.5 3.0/5 "Satisfactory"
      I have taken a health insurance policy with National Insurance 6 years back and it is a good insurance policy. I have not made any claim experience with the National Insurance. The policy which I have taken is best benefited. The cashless treatment policy is also good.
      Was this review helpful? 0
      , mumbai
      Reviewed on Feb 09, 2018
    • National Insurance Health Insurance
      "Good policy to use"
      0.5 5.0/5 "Blown Away!"
      I have taken a health insurance policy with National Insurance 5 years back and it is a good insurance policy. I pay a premium of Rs 12000-13000 for this insurance policy. My claim experience was very good with this policy and they covered 100%. I have a coverage of Rs 5 lakhs and i have not taken any cashless treatment with this insurance.
      Was this review helpful? 0
      , pune
      Reviewed on Feb 05, 2018
    • National Insurance Health Insurance
      "Good policy to use"
      0.5 5.0/5 "Blown Away!"
      Got the national health insurance policy in the year of 1996, which is provided by my company. This policy covers 4 members in my family. This policy has the medical coverage up to Rs,2,50,000 per head. I got the claim experience with this policy and I have got the claim amount within a month time and I was admitted with the help of cashless treatment.
      Was this review helpful? 0
      , vijayawada
      Reviewed on Feb 05, 2018
    • National Insurance Health Insurance
      "Good policy to use"
      0.5 4.0/5 "Great!"
      I am having a health insurance policy with National Insurance from last 5 years and it is a good policy to use. I pay a premium of Rs 500 on monthly basis. I have a coverage of Rs 2 lakhs in this insurance. I have not taken any cashless treatment and i do not have claim experience with this insurance policy.
      Was this review helpful? 0
      , chennai
      Reviewed on Jan 30, 2018
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