Claim Process - National Insurance

  1. Intimation
  2. Availing Treatment
  3. Compilation / Submission of Claim File

How to intimate health claim with National Insurance

Planned Treatment - At least 72 Hrs prior to hospitalization
Emergency Treatment - Within 24 Hrs of hospitalization
E-Mail
354100@nic.co.in or TPA email id
Nearest Branch

Details required for Registration/ Intimation of Claim

To Register claim by calling/FAX on above contact point, you will need to provide the following information to the customer support executive:-
  • Name of the Insured
  • Policy number
  • Health ID card number.
Once the claim is registered, the customer support executive will provide you with a Claim Reference/Intimation Number.

Points to Remember

  • Every claim should be intimated & should be submitted within time, as non adherence can lead to delay in claim settlement.
  • The claim is decisioned only when all required & necessary documents are submitted.
  •  NEFT & KYC details should be updated with the Insurer for easier & faster claim settlement.
  •  Pre hospitalization expenses may be claimed along with main hospitalization expenses.
  • Unreasonable & Non medical expenses are not payable.
  • Every claim should be intimated & should be submitted within time, as non adherence can lead to delay in claim settlement.
  • The claim is decisioned only when all required & necessary documents are submitted.
  •  NEFT & KYC details should be updated with the Insurer for easier & faster claim settlement.
  •  Pre hospitalization expenses may be claimed along with main hospitalization expenses.
  • Unreasonable & Non medical expenses are not payable.

 

The claim file has to be submitted at the below mentioned addresses within 15 days of discharge.

 

The claim file has to be submitted at the below mentioned addresses within 15 days of discharge.
Courier Address
TPA mailing address or issuance branch office




List of Documents

  • Completed claim form 
  • Bills, payment receipts, medical history of the patient recorded, discharge certificate/ summary from the hospital etc. 
  • Cash-memo from the hospital (s)/chemist (s) supported by proper prescription 
  • Payment receipt, investigation test reports etc. supported by the prescription from attending medical practitioner 
  • Attending medical practitioner’s certificate regarding diagnosis along with date of diagnosis and bill receipts etc. 
  • Surgeon’s original certificate stating diagnosis and nature of operation performed along with bills/receipts etc. 
  • In the event of claim under Section 1.2.11, confirmation of the need of family member from attending medical practitioner 
  • Any other document required by company/TPA 

Process of Claim

01
The treatment is to be intimated within prescribed timelines.
02
Post completion of treatment, documents are to be collected from hospital during discharge.
03
The claim file is to be prepared with reference to check list. (The claim form part B is to be filled by hospital)
06
Post receiving of all required info, the claim will be processed within 30 days.
05
National Insurance will inform about any deficiency within 7 days.
04
Duly filled claim forms along with all necessary documents are to be submitted within prescribed timelines.
07
If the claim is approved, amount will be transferred within 30 days.
08
If the claim is rejected, letter with details are to be shared with Insured.
  • Save ₹3,900/month & get
    up to ₹50 Lakhs on Retirement
    or ₹30,000 Pension/month
    CHECK NOW
  • By clicking on the "GET A CALL" button, I accept the terms and conditions & authorize OneInsure representatives to contact me (via Call/SMS/Email).

THANK YOU!