Niva Bupa Claim Settlement Ratio

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*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C Apply

*Tax benefit is subject to changes in tax laws. Standard T&C Apply

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      Niva Bupa Health Insurance (Formerly known as Max Bupa Health Insurance) Claim Settlement Ratio

      The health claim settlement ratio is not a hard and fast rule to buy a health insurance plan. But it is recommended to check the claim ratio as it holds some stress over your final decision. The reason is that health insurance benefits like hospitalization expense cover, critical illness cover, sway you towards one policy over another and may not prove helpful if the insurer has a low health claim ratio.

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      The better the claim ratio of an insurer the higher the chances for your to reap the policy benefits. You also get some reassurance each time you pay your policy premiums that the insurer will settle the claim should there be an emergency.

      Niva Bupa Health Insurance Company (Formerly known as Max Bupa Health Insurance Company) Limited has a claim settlement ratio of 96% and anything above 90% is considered to be ideal. Let check out more about their claim process and the documents required.

      Niva Bupa Health Insurance (Formerly known as Max Bupa Health Insurance) at a Glance:

      Key Features Highlights
      Network Hospitals 4500+
      Incurred Claim Ratio 50.19
      Renewability Lifelong
      Pre-existing diseases Waiting Period 4 years
      No of health policies issued till 2019 309900 
      Claim Settlement Ratio 96%

      Claim Process of Niva Bupa Health Insurance (Formerly known as Max Bupa Health Insurance)

      To file a claim for a planned treatment you can inform the insurance company 2 days before hospitalization. For emergency hospitalizations, the insurer needs to be informed within 24 hours of the hospitalization.

      However, the process for both reimbursement and cashless claims are described below-

      Cashless Claim Procedure

      You can avail cashless treatment at a network hospital only. Please follow the process described below-

      • Firstly, take admission to a network hospital. You can check the list of network hospitals on their site.
      • For identification, you can furnish your Health Card/PAN card/Policy Number/ Voter 
      • Hospital authorities will validate your identity proof. After that, the pre-authorization request will be submitted to the health insurance
      • A confirmation email or fax will be sent to the hospital team.  You will receive the confirmation on SMS also. 
      • Once  all the formalities are completed, the claim will be settled

      Reimbursement Claim Procedure

      • Whether you take the treatment in a non-network hospital inform the insurer within 48 hours of the treatment. 
      • Pay all the bills to the hospital for the treatment 
      • Before the discharge do not forget to collect the medical reports, documents, discharge certificate, and original invoices
      • Now fill the claim form and sign it before sending it to the insurer. Submit all the documents with your age proof and valid ID proof. 
      • Once the procedure is completed, your claim request will be reviewed and on the basis of the same your medical insurance claim will be accepted or rejected.
      • If approved, your claim will be settled and the amount will be reimbursed. 

      Documents Required for Niva Bupa Health Insurance (Formerly known as Max Bupa Health Insurance) Claims

      For any of the Niva Bupa (Formerly known as Max Bupa) health insurance claims the documents that need to be furnished are given below:

      • Duly filled and signed claim form
      • KYC form 
      • Hospital discharge certificate
      • Medical reports/ receipts/bills 
      • Death certificate/post-mortem report ( accidental death)
      • Doctor’s prescription and consultation letter
      • Copy of health plan
      • Address proof 
      • I.R report ( accidental  cases)

      Additional documents as required. To lodge a claim, you can call our helpline number i.e. 1800-208-8787. You can also write a mail to us at customer care:

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