National Health Insurance

National Insurance is a public sector insurance company which is owned by the Government of India. The company was founded in the city of Kolkata in the year 1906. After 66 years, when the general Insurance Business Nationalisation Act was passed in the year 1972, the company was merged with other foreign and Indian insurance companies and the National Insurance Company was formed. After nationalisation, the company was a subsidiary of the General Insurance Corporation but in the year 2002,it was delinked from GIC and is now operating as an independent general insuranccompany.

National Insurance serves customers in India as well as in Nepal. It has won various awards the latest one being the Economic Times Iconic Brands Award in 2018 in the general insurance category. National Insurance also offers a range of general insurance products to its customers and its health insurance plans are quite popular among individuals.

National Claim Settlement Ratio

Health claim settlement ratio is the percentage of claims settled against the total claims received by the insurance company in a given fiscal year. National has a claim settlement ratio of 86.28%, as compared to the industry average of 94.21%.

Top Features From National Health Plans

National Insurance is a preferred health insurance provider among individuals because of the following reasons

The company offers a range of health insurance plans which are suitable for the varied insurance needs of individuals
The premiums of its policies are low and affordable
Policies are also offered for travelling individuals who need health insurance coverage abroad
The company has a high claim settlement ratio and settles most of its claims quickly
The company provides 24*7 support and assistance to customers for their queries as well as grievances

Coverage offered by National Insurance mediclaim plans :

National Insurance Health Insurance plans provide a range of coverage benefits to policyholders. Some of the benefits which are covered under almost all health insurance plans offered by National Insurance include the following

Hospitalisation expenses : If you are hospitalised for a period of 24 hours or more, the costs incurred on such hospitalisation would be covered. These costs include rent of the hospital bed, ICU room rent, fees payable to surgeons, doctors, anaesthetists, nurses, etc., cost of blood or medicines, treatment costs, etc.
Pre-hospitalisation expenses : Expenses which are incurred before you are actually hospitalised are called pre-hospitalisation expenses. Health plans cover pre-hospitalisation expenses for a specific period
Post hospitalisation expenses : After you are discharged from the hospital you might incur medical costs for monitoring of your condition and for recovery. These expenses are called post hospitalisation expenses and they are covered for a specified period
Day care treatments : There are some treatments which do not need you to be hospitalised for 24 hours or more due to the advancements in the field of medicine.These treatments are called day care treatments and health insurance plans cover these treatments up to the sum insured
Domiciliary treatments : If you have to take medical treatments at your own home due to non-availability of any hospital bed or if you cannot be moved to the hospital, such treatments are called domiciliary treatments, National health insurance plans cover these domiciliary treatments up to specified limits
Organ donor treatments : The costs incurred in harvesting organs from an organ donor so that you can undergo a transplant surgery are covered under health insurance plans under the head organ donor treatments
Free health check-ups : Free health check-ups are value-added benefits which are available under National health insurance plans. The plans allow free medical check-ups at specified intervals so that you can monitor and track your health
Alternative treatments : Alternative treatments or AYUSH treatments are also covered under some National mediclaim policies. These treatments include treatments taken using non-allopathic means like Ayurveda, Homeopathy, etc.

Exclusions Across National Health Plans

Exclusions under National health insurance plans: Though National Insurance health insurance plans have a comprehensive scope of coverage, there are some instances and treatments which are not covered under any health plan. These are called exclusions and common exclusions found under every National insurance health policy includes the following

Suicide, self-inflicted injuries or attempted suicides are excluded
Pre-existing illnesses are not covered during a specific waiting period
Illnesses within the first 30 to 60 days of buying the policy are not covered
Illnesses or injuries suffered due to alcohol usage, drug usage and under the influence of any other intoxicants are not covered
Cosmetic treatments are not covered
Dental treatments and expenses incurred on outpatient basis are not covered under all health plans
Maternity related expenses are not covered unless the plan specifically covers them
Illnesses or injuries due to nuclear perils, war, rebellion and other related perils are not covered
Treatments for infertility, obesity, mental disorders and congenital abnormalities are not covered under most National medical insurance plans

National Premium Calculator

Use the National health insurance premium calculator to estimate your health insurance premiums.

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National Customer Care

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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 Claims

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

National Health Insurance Renewal Process

To maintain the coverage and benefits of your health insurance policy from National Insurance Company Limited, policyholders must undergo a renewal process at the end of the policy term.Any necessary modifications can be made during this renewal process.In the event of a delay in renewal, the insurer allows a grace period of 30 days

National Insurance health plans typically have a 1-year policy term,and each plan offers a lifetime renewal option. After the policy period concludes, you have the option to renew it either online or offline

For National Health Insurance Policy Renewal through offline channels, you can connect with the insurer at 1800-345-0330.Alternatively, you can visit the nearest branch of National Insurance for renewal

If you face any problem during the renewal process then you can contact NICL at their toll free number above or you may write to them at customer.support@nic.co.in