A Guide to the Niramaya Health Insurance Scheme ( Part 3 )

Reimbursements under the Niramaya Health Insurance Scheme are processed via the Third-Party Administrator (TPA), Medi Assist. The policy caps total yearly medical expenses at ₹1,00,000 per person.

Strict Submission Deadlines (Time Limits)

To avoid immediate claim rejection, you must strictly follow these filing timelines:

  • Hospitalisation & Surgeries: File within 30 days from the exact date of discharge from the hospital.
  • OPD Treatments, Dental, & Specialist Visits: File within 30 days from the date of the doctor’s consultation or medical bill generation.
  • Ongoing Therapies: File recurring therapy bills (Physiotherapy, Speech, etc.) monthly or quarterly, but no later than 30 days after the final session of that billing cycle.
  • Online to Offline Courier Window: If you submit your claim online first, you must courier the original physical documents to the TPA office within 15 days of your digital submission.

Step-by-Step Claim Process (Online vs. Offline)

Method 1: The Online Process (Fastest Settlement)

  1. Get the App: Install the official Medi Assist App from your smartphone app store.
  2. Log In: Use your unique credentials:
    Username: [YourBeneficiaryID]@NATIONALTRUST.Com
    Password: Patient’s Date of Birth in DD-MM-YYYY format.
  3. KYC Update: Go to the profile panel and complete the mandatory one-time beneficiary KYC document upload.
  4. Initiate Claim: Tap “Submit Claim”, choose the medical condition, and type in the final bill amount.
  5. Upload Clear Documents: Take high-quality, readable photos of the completed Claim Form A, prescriptions, bills, and the beneficiary’s cancelled cheque.
  6. Track Progress: Hit submit to instantly receive a Claim Intimation Number via SMS.

Method 2: The Offline Process (Speed Post / Courier)

  1. Download Form: Get Claim Form A directly from the official Medi Assist Claim Forms Center.
  2. Fill Manually: Complete the form using a blue or black pen. Double-check that the patient’s name perfectly matches the bank passbook.
  3. Collate Originals: Place the completed claim form on top, followed by a photocopy of your Niramaya E-card, a copy of the UDID card, bank account proof, and your original physical prescriptions and medical bills.
  4. Courier the Envelope: Pack and mail the entire bundle via reliable courier or India Speed Post to the TPA central hub:
    Medi Assist Insurance TPA Pvt. Ltd. Niramaya Claims Department
    1st Floor, Block D,
    Noida Sector 3,
    Noida, Uttar Pradesh,
    PIN – 201301

Exact Financial Limits & Sub-Caps

The National Trust distributes the total 1-lakh policy structure into highly specific sub-sections:

Medical Category Specific Treatment Coverage Head Maximum Financial Cap
Hospitalisation & Surgeries Corrective Surgeries for primary or congenital disabilities ₹40,000
General Stays & Non-Disability Surgeries (Nested cap) ₹15,000
Total Overall Hospitalisation Cap ₹55,000
Outpatient Department (OPD) OPD Consultations, Medicines & Diagnostic Labs ₹15,000
Specialist Doctors (Ophthalmologist, ENT, Pediatrician, etc.) Covered under the general ₹15,000 OPD cap
Dental Care (Preventive & Corrective Dentistry) ₹4,000
Total Overall OPD Section Cap ₹19,000
Therapies Ongoing Therapies (Speech, Occupational, Behavioural, Physiotherapy) ₹20,000 (Requires a renewed doctor prescription every 6 months)
Other Benefits Alternative Medicine (AYUSH) ₹4,000
Medical Transportation Costs ₹2,000

Step-by-Step to Track Claim Process (Online vs. Offline)

To track your active Niramaya health insurance reimbursement claim, you can check its live processing status online using either the Medi Assist Mobile App or the official web portal.

Method 1: Using the Medi Assist Mobile App (Easiest)

  1. Open the App: Download and launch the official Medi Assist App on your smartphone.
  2. Log In: Use your dedicated Niramaya credentials:
    Username: [Your_Beneficiary_ID]@NATIONALTRUST.Com
    Password: The beneficiary’s Date of Birth in DD-MM-YYYY format.
  3. Go to Claims: Tap on the “Claims” or “Track Claim” icon on the home dashboard.
  4. View Status: Locate your active Claim Intimation Number. Click on it to see real-time updates (e.g., In-Progress, Under Process, Query Raised, or Approved).

Method 2: Using the Web Portal (No Login Required)

If you do not have the mobile app, you can track it via a browser using your Claim Number or Niramaya ID.

  1. Visit the TPA Tracking Page: Open the official Medi Assist Claim Track Portal.
  2. Select Tracking Type: Choose “Corporate” or look for the designated National Trust / Niramaya tracking filter option.
  3. Enter Credentials:
    Input your Claim Intimation Number (sent to your phone after submission) OR your Niramaya Beneficiary ID / E-Card ID.
    Enter the patient’s Date of Birth.
  4. Search: Click “Track Claim Status” to view your active file.

What to Look Out For

While checking your status, keep a close eye on the specific status tags:

  • Under Process / In-Progress: The medical team is currently reviewing your uploaded bills. No action is needed from you.
  • Awaiting Hard Copies: If you uploaded the claim online, the TPA is waiting for your original physical bills to arrive at their Noida office to finalize approval.
  • Query Raised / Clarification Needed: The TPA requires missing documents (like an updated doctor prescription or a clearer scan). You must respond quickly by uploading the requested document through the app to prevent the claim from being rejected.
  • Settled / Approved: The money has been approved. The financial pay-out will be deposited into the beneficiary’s linked bank account via NEFT within 3 to 7 working days.

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