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  • 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 9 1 2 3 4 5
    • National Insurance Health Insurance
      "Excellent Service"
      0.5 5.0/5 "Blown Away!"
      This insurance policy has been taken through the company which i am working, the premium amount has been taken every month and it was a good service which they had been making so far. I had two times availed the claim through them and the method in getting the claim has also been good.
      Was this review helpful? 0
      , gandhidham
      Reviewed on Nov 14, 2018
    • National Insurance Health Insurance
      "Very low premium policy"
      0.5 4.0/5 "Great!"
      I have not used the health insurance for any kind of claim services. The health insurance policy from National has been issued from my organization. I have called the customer care service for a normal enquiry and the response was good. They have given me a coverage value of Rs. 5 lakhs and all the family members of mine is included in this policy.
      Was this review helpful? 1
      , dehradun
      Reviewed on Nov 13, 2018
    • National Insurance Health Insurance
      "Very easy to get a claim"
      0.5 4.0/5 "Great!"
      My employer has provided me a health insurance with National Insurance. They have given the health insurance policy for my family also. I have got the coverage amount of Rs. 29 lakhs and the chained hospitals list was good. In ten days, i have got my claim settlement. They are providing a cashless treatment facility.
      Was this review helpful? 0
      , bangalore
      Reviewed on Nov 12, 2018
    • National Insurance Health Insurance
      "Excellent"
      0.5 5.0/5 "Blown Away!"
      I have a health insurance in National Insurance for me and my family. The policy covers minor disease and critical illness. The customer service is excellent. Am paying yearly 16K as a premium. Last year have applied for claim, the refund was 100% excluding food. The policy coverage is 10L, I have taken in the year of 2005 or 2006. Am getting good benefits on this policy.
      Was this review helpful? 0
      , new delhi
      Reviewed on Nov 03, 2018
    • National Insurance Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance policy with National insurance from last 8 months, i am not aware of the premium amount as my company pays it. If i want additional premium then i have to pay Rs 1500. I have no claim experience from this insurance and the coverage value is Rs 3 lacs.
      Was this review helpful? 2
      , ghaziabad
      Reviewed on Aug 29, 2018
    • National Insurance Health Insurance
      "Good Service"
      0.5 5.0/5 "Blown Away!"
      I've a health insurance policy with the National Insurance. I am paying a premium 11.5 K per year. The policy for the entire family. There hasn't been any claim experience with the policy yet and it offers an annual coverage of 5 lacs anywhere in India.
      Was this review helpful? 1
      , vadodara
      Reviewed on Aug 16, 2018
    • National Insurance Health Insurance
      "Good"
      0.5 4.0/5 "Great!"
      It is a corporate policy with national insurance. I have my health insurance with them. The coverage is for my family and I. The medical coverage is also good. I have the medical cards too. Fortunately I have no claim experience to use the policy.
      Was this review helpful? 0
      , jamnagar
      Reviewed on Aug 11, 2018
    • National Insurance Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have my health insured with National insurance from last 2 years., i am happy with the coverage value of this insurance policy. I pay a premium of Rs 6000 for this insurance policy. My claim experience was good with this insurance and they covered 80%. The coverage for this policy is up to Rs 2 lakhs.
      Was this review helpful? 0
      , coimbatore
      Reviewed on Aug 06, 2018
    • National Insurance Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have taken a health insurance policy with National Insurance from last 1 year, i am not aware of the premium amount as my company pays it. My claim experience was good with this insurance and they covered 85% of the billed amount. The coverage value for this insurance is 4 lakhs.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Aug 01, 2018
    • National Insurance Health Insurance
      "Good Service"
      0.5 4.5/5 "Excellent!"
      I've a health insurance policy with the National Insurance. When my Father had an operation, the claim experience was good. It was bit difficult to send the documents but they processed the claim with out any hassle. I am paying a premium 15000, its for me and my parents. I have claimed almost 2 lacs for the treatment of my father.
      Was this review helpful? 0
      , kolkata
      Reviewed on Jul 26, 2018
    • National Insurance Health Insurance
      "Good Service so far"
      0.5 4.0/5 "Great!"
      I've a health insurance policy with the National Insurance. It offers an annual Coverage of 3 lacs, the policy covers me and my parents and I do not have any claim experience with the policy so far. I never had any issues with their services.
      Was this review helpful? 1
      , gurgaon
      Reviewed on Jul 14, 2018
    • National Insurance Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have my health insured with National insurance since 1994, this is a family health policy. I have no claim experience so far from this health insurance. I have a coverage value of Rs 5 lakhs for this insurance policy and i have to pay a premium of Rs 23000 every year.
      Was this review helpful? 0
      , ahmedabad
      Reviewed on Jul 01, 2018
    • 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
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