National Health Insurance Claim Settlement
National Claim Process
National supports both cashless claims and reimbursement claims. This section covers the information on how to check National health insurance claim status, fill National health insurance claim form, and the claim settlement process.
Cashless claim process:
- Find out the empanelled hospitals in your area. Empanelled hospitals would be the one which would allow you cashless claim settlement
- If your hospitalisation is planned, inform the TPA (Third Party Administrator) of the company at least 72 hours prior to hospitalisation. You should mention the reason for hospitalisation and the hospital which you have selected
- In case your hospitalisation is an emergency, inform the TPA within 24 hours of such hospitalisation
- When you are admitted, a pre-authorisation form would be sent by the hospital to the TPA. The form would contain all the medical details and the expected cost of treatment. The insurance company would assess the form and approve the claim
- The costs would then be directly settled by National Insurance
- You would have to submit the medical documents and bills to the insurance company within 15 days after the post-hospitalisation coverage is over
- After the documents are submitted, the claim would be settled by the National health insurance company
- Collect the Discharge Summary from the hospital after you are discharged and submit the summary along with all the relevant medical reports and bills to the TPA
- The documents should be submitted within 15 days of discharge from the hospital for the claim to be processed easily
Reimbursement claims :
- If you are admitted to a non-empanelled hospital, your claim would be settled on a reimbursement basis. You should inform the TPA of the company within 72 hours of planned or emergency hospitalisation
- Collect the Discharge Summary from the hospital after you are discharged and submit the summary along with all the relevant medical reports and bills to the TPA
- The documents should be submitted within 15 days of discharge from the hospital for the claim to be processed easily
- After the submission of the documents, they would be verified by the company
- After successful verification, National Health Insurance company would reimburse you for the medical costs incurred by you and settle the claim
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FAQs
Yes, National Insurance offers a range of family floater health insurance plans which can be taken to cover your entire family including you, your spouse, dependent children and dependent parents
The group health insurance policy would give you limited coverage which might not be sufficient for the coverage needs of your family. The sum insured would also be limited and given the rising medical costs, you need a higher coverage level. Moreover, the group insurance coverage would be valid until you are employed with your employer. When you leave your job, the coverage would stop. It is, therefore, better to buy an independent health insurance plan covering all the family members and having an optimal level of sum insured
Yes, National health insurance plans allow coverage even if you have pre-existing illnesses. Pre-Existing diabetes would, however, be covered after a waiting period. Alternatively, if you want coverage from the start of the policy, you can pay an additional premium and get coverage for your diabetes
The coverage level depends on various factors which include the expected cost of treatments, the number of members covered, the city where you live (metro cities have higher hospitalisation costs than non-metro ones), etc. You should always choose a high level of sum insured so that the rising medical costs can be easily covered under your health insurance plan.
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