Paul Sanchez
National Insurance Company Limited offers a range of health insurance plans, including the National Mediclaim Policy, which provides financial support in the event of a medical emergency or planned treatment. The process of claiming medical insurance from National Insurance involves several steps and requirements. Firstly, it is important to determine whether the claim will be processed by the company or a Third-Party Administrator (TPA). The insured individual or their representative must then provide written intimation to the company or TPA, including details such as the nature of treatment and policy number. In the case of hospitalisation, specific procedures must be followed, including submitting relevant documents and adhering to time frames. Understanding the specific plan and its coverage is essential for a successful claim.
How to Claim Medical Insurance from National Insurance
| Characteristics | Values |
|---|---|
| Who is it for? | Individuals, families, students, and senior citizens |
| What does it cover? | In-patient hospitalization, pre-hospitalization, post-hospitalization, maternity expenses, mental illnesses, morbid obesity, refractive error, ambulance charges, funeral expenses, personal accident cover, and repatriation expenses |
| What documents are required? | Original claim form, payment receipts, original bills, hospital discharge certificate, original hospital cash memo, prescription from the chemist, investigation test reports, medical practitioner's prescription, original payment receipt, certificate related to diagnosis, bill receipts from the medical practitioner, certificate from the surgeon disclosing the nature of the operation, and any other document as required by the TPA or the company |
| When to inform the company or TPA? | In the case of emergency hospitalization, within 24 hours after the insured individual is admitted to the hospital; in the case of planned hospitalization, 72 hours prior to admission |
| How to inform the company or TPA? | Intimation should be provided in writing, through a letter, fax, or email that contains all the relevant details related to the claim, including information such as the nature of treatment, policy number, etc. |
| Where to submit documents? | Documents can be submitted to the Policy issuing office or the nearest NIC office |
| When to submit documents? | All documents in original are to be submitted within 15 days from the date of discharge |
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What You'll Learn
National Mediclaim Policy: Individual Plan
The National Mediclaim Policy: Individual Plan is a health insurance plan offered by the National Insurance Company, which is the oldest general insurance company in India. The National Mediclaim Policy is an individual health insurance plan designed to provide optimal coverage against medical expenses incurred by the insured. The policy offers a high sum insured, ranging from Rs. 1,00,000/- to Rs.10, 00,000/-. It indemnifies in-patient treatment expenses (minimum 24-hour hospitalization) and 140+ day care procedures on a cashless or reimbursement basis, along with additional benefits depending on the chosen plan.
The policy covers pre-existing diseases after the first 48 months, with specific waiting periods for certain diseases. It also includes coverage for treatments such as change-of-gender, cosmetic or plastic surgery, vitamins, tonics, drug/alcohol abuse, and self-inflicted injury. However, it's important to note that dental treatment and Out Patient Department (OPD) treatment are excluded unless they arise from an accident requiring hospitalization.
To make a claim under the National Mediclaim Policy: Individual Plan, there are specific procedures to follow for planned and emergency hospitalization. For planned hospitalization, the insured individual or their representative must inform the Third Party Administrator (TPA) and the National Insurance Company in writing (letter, fax, or email) at least 72 hours in advance. This intimation should include details such as the nature of treatment, policy number, name and address of the hospital, and the condition requiring hospitalization.
In the case of emergency hospitalization, the TPA and the National Insurance Company must be notified within 24 hours of admission. The insured individual can avail of the cashless facility at network hospitals if they have selected 'claim processing by TPA'. The hospital will send a Pre-Authorisation Request for cashless treatment to the TPA, signed by the insured and hospital authorities, providing details of admission, illness, proposed treatment, and estimated expenses.
Upon discharge, the insured individual must sign the discharge documents and bear inadmissible and non-medical expenses. All original documents, including bills, payment receipts, medical history, discharge certificate, investigation reports, and claim forms, should be submitted to the TPA or the company within 15 days of discharge. If the insured individual cannot provide the necessary medical information, the TPA may decline pre-authorisation, and the individual can undergo treatment based on the advice of their doctor. In such cases, the relevant claim documents must be furnished to the TPA for reimbursement before the due date prescribed in the policy.
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National Young Mediclaim Policy
The National Young Mediclaim Policy is a health insurance plan offered by the National Insurance Company, which is the oldest general insurance company in India. The policy is designed to provide medical coverage to individuals and their families. It offers a range of benefits, including:
- A sum insured of Rs 3 lakh, Rs 5 lakh, or Rs 10 lakh.
- In-patient hospitalization coverage, including pre and post-hospitalization expenses.
- Maternity expenses and mental illness treatment.
- Coverage for adventure sports, HIV/AIDS, and genetic disorders.
- Treatments for morbid obesity and refractive error.
- AYUSH cover and personal accident cover.
- Restoration of the sum insured for plans with a sum insured of Rs 5 lakh and above.
- A 5% cumulative bonus of up to 50% of the sum insured for every claim-free year.
- Optional covers such as a waiver of PED diabetes/hypertension waiting period and double the sum insured for 11 critical illnesses.
The National Young Mediclaim Policy also offers multiple discounts, such as discounts for girl children, wellness discounts, long-term discounts, and COVID-19 vaccination discounts at the time of policy purchase. It provides a maternity benefit of up to INR 50,000 and lifetime renewability. Additionally, insured individuals are covered for death, permanent disability, and permanent partial disability up to the sum insured.
To file a claim with National Health Insurance, the insured individual or their representative must inform the National Insurance Company when filing a claim. The Third Party Administrator (TPA) must also be intimated if they are handling the claim processing. This intimation should be provided in writing, through a letter, fax, or email, and should include relevant details such as the nature of the treatment and policy number. For planned hospitalization, intimation must be sent to the TPA and the concerned officials of National Insurance at least 72 hours in advance. In cases of emergency hospitalization, notification must be given within 24 hours of admission.
When claiming reimbursement, the insured individual will need to provide relevant claim documents, bills, and other supporting documentation to the TPA or the company. This includes the original claim form, payment receipts, original bills, hospital discharge certificates, prescription from the chemist, investigation test reports, and any other documents required by the TPA or the company. These documents must be submitted within the timeframe specified by the insurance provider, usually within 15 days after completion of post-hospitalization treatment.
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National Senior Citizen Mediclaim Policy
National Insurance is the oldest general insurance company in India, formed in 1906. It offers a wide range of health insurance plans, including the National Senior Citizen Mediclaim Policy, which is a customised plan designed to cover the medical needs of senior citizens aged 60 and above. This plan offers a sum insured option ranging from Rs 1 lakh to Rs 10 lakh.
The National Senior Citizen Mediclaim Policy covers hospitalisation expenses, day-care procedures, and domiciliary hospitalisation. It also provides coverage for morbid obesity, refractive error, and adventure sports injuries. Ambulance charges and funeral expenses are also included in the policy. A 5% cumulative bonus is granted for every claim-free year, and there is an option to cover PED diabetes/hypertension, OPD treatments, personal accidents, and critical illnesses.
To file a claim with National Health Insurance, the insured individual or their representative must inform the National Insurance Company when filing a claim. The Third-Party Administrator (TPA) must also be notified in writing, via letter, fax, or email, with relevant details such as the nature of treatment and policy number. In the case of planned hospitalisation, the TPA must be informed at least 72 hours in advance, and in an emergency, they must be notified within 24 hours of admission.
The insured individual will need to provide various documents for reimbursement of claims, including the original claim form, payment receipts, original bills, hospital discharge certificate, original hospital cash memo, prescription from the chemist, investigation test reports, and the original payment receipt. These documents must be submitted within 15 days of completing post-hospitalisation treatment.
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National Critical Illness Policy
The National Critical Illness Policy is designed to cover the expenses incurred on critical illnesses. The policy pays out a fixed lump sum to the insured if they are diagnosed with a specified illness or undergo a specified procedure or treatment. The sum insured ranges from Rs. 1 lakh to Rs. 75 lakhs, with the amount being paid in full on the first diagnosis of a covered critical ailment. The policy is available under two plans: Plan A, which covers 11 critical illnesses, and Plan B, which covers 37 critical illnesses.
The National Critical Illness Policy is a unique benefit policy, with the added benefit of tax deductions on premiums paid. One can claim a tax deduction of Rs. 25,000 for insurance availed for self, spouse, and dependent children. An additional deduction of Rs 25,000 can be claimed if the policy is taken for parents under 60 years of age, and if the parents are over 60, this deduction can be up to Rs. 50,000.
To make a claim on the National Critical Illness Policy, the insured must survive for 30 days after the diagnosis. The insured will have to furnish the bills and other relevant documents to the company/TPA (Third Party Administrator) for the reimbursement of claims. The documents required include the original claim form, payment receipts, original bills, hospital discharge certificate, original hospital cash memo, prescription from the chemist, investigation test reports, and the original payment receipt, among others.
In the case of planned or emergency hospitalisation, network hospitals will provide a cashless facility to individuals who have selected 'claim processing by TPA'. The insured individual can undergo treatment in PPNs or network hospitals, provided the TPA has given prior authorisation. The TPA will provide the hospital with a pre-authorisation letter once it has verified the information received.
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Claiming reimbursement
To claim reimbursement for medical insurance from the National Insurance Company, the insured individual must first inform the company when the claims are filed. This can be done by contacting the company on their toll-free number: 1800 200 7710.
In the case of planned hospitalisation, the insured individual must notify the company or Third Party Administrator (TPA) at least 72 hours in advance of admission. This can be done by letter, fax, or email and must include details such as the nature of the treatment and the policy number. The TPA will then provide a pre-authorisation letter. In the case of emergency hospitalisation, the company or TPA must be notified within 24 hours of admission.
Upon discharge from the hospital, the insured individual must sign the discharge documents and bear any inadmissible and non-medical expenses. All original documents and bills must be submitted to the company or TPA within 15 days of discharge. This includes the hospital discharge certificate, original bills, payment receipts, medical history, and any other relevant documents as required by the company or TPA.
If the insured individual cannot provide the necessary medical information, the TPA may decline pre-authorisation. In this case, the individual can still undergo treatment based on the advice of their doctor. Following treatment, they must then submit the relevant claim documents to the TPA for reimbursement.
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Frequently asked questions
The insured individual must inform the National Insurance Company and the Third Party Administrator (TPA) in writing, either through a letter, fax, or e-mail. This intimation should include details such as the nature of treatment and policy number. In the case of emergency hospitalisation, the TPA must be notified within 24 hours of admission. The insured individual will also need to provide the necessary medical information and relevant claim documents to the TPA.
National Health Insurance offers a range of health insurance plans with benefits such as access to a wide hospital network, add-on covers, cashless claims, tax deductions on premiums, and comprehensive health covers, including individual, family floater, senior citizen, and group mediclaim policies.
The National Mediclaim Policy covers hospitalisation expenses, chemotherapy, radiotherapy, treatment for HIV/AIDS, morbid obesity, refractive error, mental illness, hazardous sports, ambulance charges, AYUSH treatment, and preventive health check-ups.
The following original documents are required: bills, payment receipts, medical history, discharge certificate, hospital cash memo, prescription from the chemist, investigation test reports, attending medical practitioner's prescription and certificate, surgeon's certificate, and any other documents as required.
