Niva Bupa Health Insurance Claim Form

Niva Bupa Health Insurance Claim Form

Niva Bupa health insurance claim form is provided by Niva Bupa Health Insurance Company Limited. It is one of the most crucial documents that the policyholder must submit to raise a health insurance claim. If the policyholder submits an incomplete claim form or furnishes incorrect details, the claim may be rejected.

What is the Niva Bupa Health Insurance Claim Form?

The Niva Bupa health insurance claim form is needed to officially initiate a claim. It includes critical information, such as details of the health insurance policy, claim type, patient information, hospitalization and treatment type, medical bills, etc. The policyholder must submit this form for a reimbursement claim under the Niva Bupa health insurance plans. To obtain a cashless claim, they must submit a document called a pre-authorization form.

Types of Niva Bupa Health Insurance Claim Forms

The Niva Bupa health insurance claim forms are available for both reimbursement and cashless claims. However, the official document through which the insured can file a cashless claim is called a pre-authorization form.

1. Reimbursement Claims

   For a reimbursement claim, the policyholder is required to initially pay the medical expenses from their own pocket and then raise a request to get the refund per the health insurance coverage. Reimbursement claims can be raised through the insurer's website, app, or toll-free number.

2. Cashless Claims

   Under cashless claims, the insured does not have to pay medical expenses upfront; the insurer settles the bill directly with the hospital. The insured must submit the pre-authorization form before the treatment begins to obtain cashless approval.

   It is to be noted that although the treatment cost is covered by the health insurance, the policyholder may still have to bear exclusions and non-medical expenses at the time of final settlement.

How to Download the Niva Bupa Health Insurance Claim Form?

You can download the Niva Bupa health insurance claim form directly from the insurer's website or mobile app or get it by contacting customer support.

Website - Downloads Page

• Visit the Niva Bupa Downloads page.
• Expand the 'Claim Forms' tab.
• For a reimbursement claim, click on 'Niva Bupa Reimbursement Claim Form'.
• The reimbursement claim form will open in a new tab. You can download or print it.
• Similarly, you can download the 'Niva Bupa Pre-Auth Claim Form' for a cashless claim.

Website - Claims Section

• Visit the official website of Niva Bupa Health Insurance Company Limited.
• Click 'Claims' on the main menu bar. You will be directed to the Claims page.
• Under the section 'Reimbursement Claims,' click on 'Submit Claim Now'.
• You will be redirected to the Customer Log In page.
• You must enter your policy number or membership number and date of birth.
• For a cashless claim, you must click on:

• 'Intimate for Cashless Everywhere,' for cashless treatment at a non-network hospital
• 'Pre-Auth Intimation,' for cashless treatment at a network hospital

Mobile App

The policyholder can also download the claim forms via the Niva Bupa Health app.

Other ways to get the Niva Bupa health insurance claim form:

• The Niva Bupa reimbursement claim form can also be downloaded via the 'Customer Log In' page.
• The policyholder can also obtain a physical copy of the Niva Bupa health insurance claim form at their nearest branch office.

Pro Tip: Niva Bupa Health Insurance Company Limited also provides a list of Unrecognized Hospitals on their website. It is important for the insured to review this list, as the insurer will not cover any claims for treatment at these hospitals.

How to Fill the Niva Bupa Health Insurance Claim Form?

The Niva Bupa health insurance claim form has two parts – Part A and Part B. While the insured must vigilantly fill Part A of the claim form, Part B has to be completed by the hospital.

1. Part A of the Niva Bupa Reimbursement Claim Form

   • Policy Number
   • Sl. No./Certificate No.
   • Company/TPA ID No.
   • Policyholder's name and address
   • Details of insurance history - if currently covered by any other health insurance policy, its date of commencement, company name, policy number, sum insured, and previous insurer details
   • Details of hospitalized insured person - name, gender, age, date of birth, relationship to primary insured, occupation, address
   • Details of hospitalization - name of the hospital where admitted, room category, hospitalization reason, date of injury or first detection of the disease, date and time of admission, date and time of discharge, etc.
   • Details of claim- details of treatment expenses, lump sum/ cash benefit, domiciliary hospitalization
   • Details of bills enclosed - bill number, date, issued by, towards and amount
   • Submitted claim documents checklist
   • Details of the primary insured's bank account - account number, PAN, bank name and branch, cheque details, IFSC code
   • Declaration by the insured (with date, place and signature)

   Disclaimer: The above-mentioned claim form details are indicative only. The policyholder must fill out all required details in the claim form provided by Niva Bupa Health Insurance Company Limited.

2. Part B of the Niva Bupa Reimbursement Claim Form

   This part of the claim form has to be filled out by the hospital.

Common Mistakes to Avoid when Submitting Niva Bupa Health Insurance Claim Form

Here are some common mistakes that must be avoided when filling out the Niva Bupa health insurance claim form:

• Mentioning incorrect policy details
• Not submitting the payment proof
• Submitting an unsigned or inaccurately signed claim form
• Mismatch in bank account details
• Inconsistency in treatment and medical history
• Not attaching all the required documents
• Missing the claim form submission deadline

Pro Tip: Double-check the filled claim form before submitting to ensure faster claim settlement.

Documents Required with the Niva Bupa Health Insurance Claim Form

The policyholder must submit the following documents along with the Niva Bupa health insurance claim form:

• Discharge summary stating date and time of admission, date and time of discharge, symptoms, final diagnosis, investigation done, treatment given and patient's status on discharge.
• Final medical bill with a detailed break-up
• Original receipts of payments made to the hospital and pharmacy bills
• Investigation and lab reports
• MLC/FIR (in case of road accident)
• Cancelled cheque
• KYC documents
• Specific X-ray reports and scans in case of some treatments
• Claim consent and authorization letter

FAQs on Niva Bupa Health Insurance Claim Form