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  • New India Health Insurance Claims Procedure

    New India Health Insurance

    New India Assurance has over 160 insurance and financial products that deals especially with general assurance products. The company provides cover commercial requirements such as large industries, SMEs, Retail, Rural, and Social as well as Micro Insurance. New India Assurance boasts of a distribution network including bancassurance partners, non-governmental organisations, auto majors, corporations, government and brokers. It has a network of 2,097 offices and counting along with 1,041 micro offices in India.

    The company was the most profitable general insurer during the year 2012 - 2013 in India. Its ‘AAA/Stable’ rating by CRISIL, giving it an extra edge over other insurance providers. Currently New India Assurance has 8 mediclaim or health insurance policy, each be spoked to the requirements of Indian citizens, which is why it is so popular. It also has a large network of hospitals where cashless facilities are available, across the country.

    Incurred Claim Ratio for New India Assurance:

    The Incurred Claim Ratio (ICR) of a particular insurance providing company is highly indicative of the company's performance, allowing prospective customers get a better understanding about what to expect in terms of health insurance. The Incurred Claim Ratio for New India Assurance Health Insurance products for the time 2014-2015 has been mentioned in the table:

    Net Earned Premium (in Lacs) Net Claims Paid (in Lacs) Incurred Claims Ratio (%)
    Rs. 368,785 Rs. 364,302 98.78%

    One can observe that the ratio is very marginal, noting that this company does not make much of a profit margin. However, the numbers of claim and earned premium shows that the company is one of India’s favourite health insurance providers.

    How to Claim?

    There are two situations that may occur when claiming health insurance. The cashless treatment is one that allows the policyholder to use the insurance as money to seek their treatment without having to pay any money upfront for treatment. The other scenario that is possible is in the case that the treatment has been already done and paid for but claim settlement requires to be made to allow the individual to be returned the money spent for treatment.

    For Cashless Treatment:

    Cashless treatment generally allows people to get treated for an illness covering all medical expenses for the treatment through the New India Assurance health insurance on an individual basis. The person concerned can do so at any of the network hospitals enlisted by New India Assurance on their website, or policy brochure, across the country.

    • Procedure to file a claim (Planned/emergency hospitalisation):

      Simply follow the steps mentioned below to file a cashless claim.

      1. Reach out to the network hospital and make sure you are carrying the health card issued by New India Assurance and seek admission.
      2. Intimating the cashless facility can be done by calling the number mentioned on the card or the health insurance helpline number mentioned on the company website. For planned hospitalization make sure you reach out to the company 2 days prior to admission.
      3. Submit the health card along with a proof of ID to the network hospital who in turn will conduct the verification of your credentials.
      4. Once this process is taken care of a pre-authorization form will be required to be filled in, from the hospital, where the attending doctor will have to sign it. In the general case of planned hospitalisation, a letter of authorisation has to be submitted.The pre-authorization form, once completed has to be sent by the hospital to the insurance provider with relevant information.
      5. In this case New India Assurance will communicate with the relevant bank to update the status of the claim made , which could be either be acceptance or rejection or possibly the request for additional information or documentation.
      6. Once accepted, the medical bills and costs covered under the policy are settled by New India Assurance, while things that are not covered will have to be taken care of, by the patient/card holder.
      7. The policy owner has to also verify and sign the original bills and at the same time keep a photocopy of the entire hospitalisation record.
    • Claims process

      Here is how the claim process for New India Assurance works:

      1. Register the claim within 7 days of the patient’s or the covered individual’s discharge, and immediately let New India Assurance know about it.
      2. The policyholder should fill and submit the Claims Form, providing a photocopy of a valid ID proof along with it.
      3. You need to send the required medical certificates along with diagnosis reports which has been signed by a doctor.
      4. Reports and discharge summary i.e. original has to be submitted for verification.

      New India Assurance will then approve or reject it based on the policy in place.

    For Reimbursement of treatment expenses:

    There are chances when New India Assurance may reject the claim for cashless hospitalisation and treatment. However, the insured individual can claim a reimbursement for the expenses incurred for the treatment with a few simple steps.

    • Procedure to file a claim:

      Here is what you need to do to file a claim

      • You need to inform the company immediately after being hospitalised.
      • After the treatment is completed, all hospital bills have to be settled by the policyholder, you need to keep all the bills and reports.
      • You need to then submit the duly filled claims form to New India Assurance for processing and reimbursement. The insurer will reimburse all bills if as long as all the information provided is given correctly.
    • Documents required:

      The following documents need to be submitted to New India Assurance:

      • The claim form which needs to be filled with relevant details, signatures and finally be submitted.
      • All the original hospital bills, with stamps and signatures from the hospital has to be submitted.
      • The original discharge report has to be submitted as well.
      • All other originals reports related to the treatment (including medicine bills and investigation reports) has to be submitted.
      • The future line of treatment as well as follow-up check-ups by the relevant doctor should be sent as well.
      • If seeking treatment in a non-network or unregistered hospital, you need to get the details of the hospital on the official letterhead that includes the number of doctors, nurses and beds available.

      Note: You may be asked for further documentation for the claim approval.

    • Claims process:
      • The policyholder must let the insurer know about hospitalisation within 7 days of his/her discharge.
      • Pre-authorization might be required from the company for certain situations.
      • All documents must be submitted within 10 days of the patient’s discharge.

      The claim will be approved or rejected based on the policy as well as documentation provided.

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