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