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National Health Insurance Claim

The key to keeping yourself and your loved ones safe and sane in these unpredictable times is to have a suitable health insurance plan. Critical illness, sudden injuries, unforeseen health issues- only a health insurance policy can help you cope with such undesirable situations. But amidst all the chaos and confusion of hospitalisation, will you be in a sound state of mind to go through the policy papers to find the claim procedure? No, right?

You must be well-versed with the claim filing process of your health insurance company. Only then you will be in a position to act pro-actively when any of your loved ones get hospitalised. 

This blog discusses the claim procedure of the National Health Insurance company. It is one of the leading insurance companies in India and offers multiple health insurance plans. It has been quite a popular choice among the policyholders because of its simple and swift claim approval process, and quick policy renewal facility. Besides, the health insurance company has an incurred claim ratio of about 101.09%. If you are planning to buy health insurance or have already bought a policy with the National Health Insurance company, then you should definitely read on and grasp the claim filing procedure.

How Can You File Your National Health Insurance Claim In a Few Easy Steps?

Cashless Facility

  • The very first step involves crosschecking if a specific hospital comes under the cashless network hospitals category of the National Health Insurance company.
  • Make sure you intimate the company or the TPA at least 72 hours prior to hospitalisation (in case of planned hospitalisation).
  • However, if the patient has to be rushed to the hospital in case of an emergency, then you can inform the TPA or the insurer within the first 24 hours of hospitalisation.
  • The next step involves forwarding the Pre-Authorisation form to the TPA/insurance company by the hospital authority. The form must carry the signatures of the insured as well as that of the hospital. It should clearly mention details like illness, admission details, estimated expenditure, proposed line of treatment, and so on. You can claim for pre and post hospitalisation charges separately once the treatment is over.
  • Do not forget to submit each and every original document to the TPA/insurance company within 15 days of post-hospitalisation treatment.

Reimbursement Facility

  • You must inform the TPA/insurance company about the hospitalisation within 72 hours of emergency hospitalisation. But if it is a planned one, you need to intimate the TPA/insurer at least 72 hours before getting the patient admitted.
  • Collect documents like investigation report, discharge summary, claim form parts A and B, etc. Submit the original copies of these documents to the insurance company or the TPA within 15 days of discharge.
  • You have the right to claim for pre and post hospitalisation expenses separately once the treatment is done.
  • Make sure you submit all the original documents well within 15 days of post-hospitalisation treatment.

Critical illness Claim

  • In case of critical illness, you are required to write to the insurance company within the first 15 days of diagnosis of the health condition.
  • Next, you need to submit all the documents, such as investigation reports, duly filled claim form at the office of the insurance company within 30 days of the survival period (60 days/90 days/ 6 months)

Some of these significant documents are:

  • Do not forget to include the medical practitioner’s certificate that confirms the diagnosis of the critical health issue.
  • An original or certified copy of the discharged summary has also to be submitted.
  • Radio-logical or pathological or any other diagnostic test reports that confirm the critical illness can also be submitted.

Claim Process for Outpatient Treatment

  • You are required to submit all the claim documents that support outpatient treatments to the insurance company or TPA. The stipulated time for submission is 30 days from completion of the 6-months period.
  • Make sure you submit all the below-given documents to support your claim-
  • Copy of medical reports
  • Diagnostic test bills
  • Bills and prescriptions by the practitioner
  • Any other document that the insurance company may ask for

NOTE: 

The claim filing procedure may vary slightly as per different health insurance plans offered by the company. You can reach out to the customer support executives of National Health Insurance company for further clarity.

How To Track Your National Health Insurance Claim Status Online?

You may wish to know the status of your health insurance claim. National Insurance company has made tracking the claim status so easy and convenient. Follow the below-given steps to keep a tab on your claim status:

  • First, visit the official website of the National Insurance company.
  • You will notice 7 teal green tabs on the extreme right side of the screen.
  • Choose the last one that carries the symbol of a magnifying glass.
  • As you hover your cursor over the symbol, the option of “Track claim status” pops up.
  • Click on it and you will be redirected to a new page.
  • You will have to fill in the details like your customer ID, claim number, policy number, date of loss, and captcha answer.
  • Now click upon the “Search” tab and you are done.

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