Max Bupa (Now Niva Bupa) Health Insurance Claim Settlement Ratio, Process, Form

Niva Bupa Health Insurance Claim Settlement Ratio

Niva Bupa Health Insurance claim settlement ratio must be checked before buying a Niva Bupa health plan. It is a ratio of the total number of claims paid by the insurer versus the total claims received in a financial year. The better is the Claim Settlement Ratio (CSR) of an insurer, the higher are the chances of your claims getting paid.

The Niva Bupa Health Insurance Company has a claim settlement ratio of 90.1% (FY 2021-22). Since a CSR above 85% is considered ideal, it indicates that the insurer honours most of the claims filed by policyholders.

Claim Process of Niva Bupa Health Insurance

Policyholders can file a cashless or reimbursement claim with the Niva Bupa Health Insurance Company. To file a claim for a planned treatment, you must inform the insurance company at least 2 days before hospitalization. For emergency hospitalizations, the insurer needs to be informed within 24 hours of the hospitalization. Check out the claim process for both cashless and reimbursement claims below-

Cashless Claim Procedure:

You can avail cashless treatment at a network hospital only. Follow the process described below to file a cashless claim-

Firstly, get admitted to a network hospital. You can check the list of network hospitals online on the insurer’s website or Policybazaar.com.
For identification, you can furnish your health card/ PAN card/ policy number/ Voter ID card.
Hospital authorities will submit the pre-authorization request to Niva Bupa Health Insurance Company for cashless treatment.
The insurer will verify the details and send a confirmation email or fax to the hospital. You will also receive the confirmation via SMS.
Once your treatment is over and all the formalities are completed, the claim amount will be settled with the hospital.

Reimbursement Claim Procedure:

Get hospitalized and avail treatment for your injury/illness
Pay all the bills at the hospital for the treatment at the time of discharge.
Do not forget to collect the medical reports, documents, discharge certificate, and original invoices before leaving the hospital.
Now, fill out the claim form and sign it before sending it to the insurer. Submit all the required documents with your age proof and valid ID proof.
Your claim request will be reviewed by the insurer and will be accepted or rejected on its basis.
If approved, your claim will be settled, and the amount will be reimbursed.

Documents Required for Niva Bupa Health Insurance Claims

To file a Niva Bupa health insurance claim, the following documents need to be furnished:

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

To lodge a claim, you can also call our helpline number, i.e. 1800-208-8787. You can also write a mail to us at care@policybazaar.com.

Policybazaar exclusive benefits

30 minutes claim support*(In 120+ cities)
Relationship manager For every customer
24*7 claims assistance In 30 mins. guaranteed*
Instant policy issuance No medical tests*

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Disclaimer: The list mentioned is according to the alphabetical order of the insurance companies. Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by any insurer. For complete list of insurers in India refer to the Insurance Regulatory and Development Authority of India website www.irdai.gov.in

Niva Bupa Health Insurance Plans

Heartbeat Individual

Heartbeat Family First

Heartbeat Family Floater

Health Assurance Critical Illness

Health Companion Individual