Documents Needed to Make a National Health Insurance Claim

• You need to give these documents when you ask for money from your health insurance:Filled claim form (provided by National Health Insurance)Medical history of the patientSurgeon’s note saying what surgery was doneTest reports and payment slips with the doctor’s prescriptionsDoctor’s note with the date the illness was foundHospital discharge paper (when the patient leaves the hospital)Hospital bills and payment receiptsCash memo from the chemist or hospital with a prescription copy

How to Make a Claim with National Health Insurance?

• You can make a cashless claim or ask for reimbursement (money back). Here is the simple process for a cashless claim:Cashless Claim Process: You can only get cashless treatment at a network hospital (a hospital tied up with National Insurance).Step 1: Tell the insurance company:
  - 72 hours before a planned hospital stay
  - Or within 24 hours if it is an emergencyStep 2: Show your health card and policy number at the hospital.Step 3: The hospital’s insurance help desk will give you a pre-authorization form. Fill this form, and the hospital will send it to the insurance company or TPA (Third Party Administrator).Step 4: The insurance company or TPA will check your documents. They will either approve or reject your request and may also ask for extra documents.Step 5: After your treatment and discharge, the insurance company/TPA will pay the hospital bill directly.Step 6: If you have any bills after leaving the hospital (like follow-up checkups or tests), you must submit those documents within 15 days to get your money back.Reimbursement Claim Process: You can only get cashless treatment at a network hospital (a hospital tied up with National Insurance).Tell the insurance company about your hospital stay:
  - Within 24 hours if it is an emergency
  - Or at least 72 hours before if it is plannedGet your treatment and pay all the bills when you leave the hospital.Send all the documents (bills, reports, forms) to the TPA (Third Party Administrator).The insurance company’s team will check your documents and decide to approve or reject your claim.If your claim is approved, the insurance company will send the money back to you.