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National Health Insurance Claim Settlement
Claim Settlement Ratio (CSR) shows how often an insurance company pays claims. A higher number means the company is more likely to pay when you make a claim. In this section, let’s discuss more about the National Health Insurance claim settlement process and other important things.
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
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.
How to Make a Claim with National Health Insurance?
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FAQs
Cashless claim means you don’t pay money at the hospital. The insurance company pays the hospital directly if it is a network hospital.
You need a filled claim form, doctor’s certificates, hospital bills, test reports, and discharge papers. These papers help the company check your claim and pay you.
The company usually reviews your documents and decides within a few days to a few weeks. If your claim is approved, the money will be paid quickly.
You can make a claim either by cashless treatment in network hospitals or by paying first and asking for reimbursement later. You need to tell the company about your hospital stay and submit important documents.