Niva Bupa is a leading health insurance provider in India. They are aimed at providing quick and efficient health insurance solutions all across the country. Whether you go for a cashless or a reimbursement claim, their dedicated customer support team will be there to guide you every step of the way. 

Furthermore, Niva Bupa Health Insurance has a healthy claim settlement ratio of 91.6%, so you can be sure that your claims are in good hands!

Niva Bupa Health Insurance Claim Settlement Ratio

Here’s the claim settlement ratio for Niva Bupa Health Insurance: 

Insurer

Claim Settlement Ratio

Premium Price

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Niva Bupa Health Insurance

91.6%

₹596/month

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How Does the Niva Bupa Claim Settlement Ratio Benefit Policyholders?

It’s no surprise that a good claim settlement ratio is always a plus point. Here, we have listed a few reasons why Niva Bupa’s healthy claim settlement ratio is beneficial for you: 

1. Quick Settlement 

With a reliable insurance partner like Niva Bupa, you can rest assured that your insurance claim settlements will adhere to the promised timeline. With health insurance claims, time is often critical, so the assurance of quick settlements can give you immense peace of mind. 

2. Efficient Processes

Niva Bupa has put in place tried and tested claim processes that are sure to make filing and tracking your claims a breeze. What’s more, you’ll get a dedicated relationship manager who'll be there to guide you through the entire process. 

3. Reliable Insurance 

Having a health insurance provider that you can trust is crucial. This can help you focus on your medical treatment and take the rest you need instead of worrying about the expenses involved. With a healthy claim settlement ratio and a fleet of claim experts, you can rely on Niva Bupa. 

4. Trustworthy Provider 

Claim settlement ratios are a widely accepted metric for understanding an insurer’s credibility. With a claim settlement ratio of 91.6%, Niva Bupa is easily one of India’s most trusted health insurance providers. 

Types of Niva Bupa Health Insurance Claims

There are two types of Niva Bupa Health Insurance claims - cashless claims and reimbursement claims. Let’s explore these two claims a little bit further to help you understand them better. 

What are Niva Bupa Health Insurance Cashless Claims?

A cashless claim is when you go to a network hospital and get treated there. Since this is a network hospital, you will not be required to settle the bills, Niva Bupa will take care of that for you. 

Niva Bupa Health Insurance has 8600+ network hospitals all across the country. You can enjoy cashless benefits in any of these hospitals. Additionally, making a cashless claim with Niva Bupa Health Insurance is simple and takes very little time. 

How to File Niva Bupa Cashless Claims

Here’s how you can file a Niva Bupa cashless claim: 

  • Step 1: Go on the Niva Bupa app or website, navigate to the ‘Health Network’ section. 

  • Step 2: Search by entering in your preferred network hospital or city.

  • Step 3: Once you’ve narrowed down a network hospital of your choice, visit the TPA desk of the hospital in case of a planned hospitalisation. Make sure to do this two days in advance of your hospitalisation dates. 

  • Step 4: Complete the pre-authorisation form. Make sure to carry identification proof, policy number and OPD prescription details.

  • Step 5: Once the cashless claim decision has been finalised, you will receive an email and/or an SMS indicating the same within 30 minutes. Your cashless claim has now been finalised and you can get your treatment. 

     

In case of emergencies, seek medical attention as soon as possible. Afterwards, you can check if your hospital falls under the Niva Bupa Health Network. If it does, then you can follow the same process as mentioned above. If not, you can file for a reimbursement claim. 

Documents Required for Filing Cashless Claims

Here are some documents that you will need to file a cashless claim: 

  • Health Card number 

  • Photo ID of the patient

  • OPD prescription

  • Investigation reports confirming the diagnosis

In case your claim amount exceeds ₹1 Lakh, you will also need the following documents for KYC:

  • A recent photo of the patient 

  • A copy of Aadhaar Card, Driving Licence or Passport

What are Niva Bupa Health Insurance Reimbursement Claims?

A reimbursement claim is when you get treated at a hospital of your choice, settle the bill out of pocket and then file a reimbursement claim. Niva Bupa will then examine your claim, once it’s verified and approved, your reimbursement amount will be credited to your bank account. 

How to File Niva Bupa Reimbursement Claims

Here’s how you can make a Niva Bupa Health Insurance reimbursement claim: 

  • Step 1: Get treated at any recognised hospital and settle the bills out of pocket. (Please check the list of hospitals where claim will not be paid before admitting)

  • Step 2: Collect all relevant documents, bills, invoices, discharge certificate, medical reports and payment receipts.

  • Step 3: Go on the Niva Bupa ‘Claims’ and upload all relevant documents while filing your claims. 

  • Step 4: Your claim will be reviewed and once approved, you will receive your reimbursement amount. 

Documents Required for Filing Reimbursement Claims

Here are some documents that you will need to file a reimbursement claim: 

  • Discharge summary

  • All bills and receipts 

     

1. Final bill 

 

2. Detailed breakup of final bill 

 

3. Medicine bills 

 

4. Investigation bills 

 

5. Payment receipts 

 

6. Indoor case reports 

 

7. First Information Report (FIR) or Medico-legal Case (MLC) wherever applicable  

  • Investigation reports 

  • Cancelled cheque with your name printed on it

In case your reimbursement claim amount exceeds ₹1 Lakh, you will also need the following documents for KYC:

  • A recent photo of the patient 

  • A copy of Aadhaar Card, Driving Licence or Passport

Why Your Niva Bupa Health Insurance Claims May Get Rejected?

Niva Bupa Health Insurance has a very healthy claim settlement ratio and the chances of claim rejections are quite slim. However, there are instances where claims may be rejected. We’ve compiled a list of some common reasons for claims rejections so you can avoid them. 

  • Claiming from a lapsed policy 

Claiming from a policy plan that’s expired is a common cause for claim rejections. Make sure to always be aware of your policy renewal dates and renew in time to stay adequately protected. 

  • Claiming beyond the scope of your coverage 

All inclusions and exclusions are clearly outlined in your policy document, so it’s a good idea to read it carefully before making a claim to avoid any claim rejections. 

On that note, you’d be well-advised to be aware of your policy details even before you purchase your plan. This way, if you feel like your plan doesn’t offer sufficient coverage, you can always purchase a different plan or add riders to enhance your coverage. 

  • Claiming during the waiting period 

Most health insurance policies have a waiting period, your policy’s coverage will kick in after this period. If you make a claim during this period, your claim will likely be rejected. 

  • Suppression or misrepresentation of information

Suppressing facts or misrepresenting critical information is a serious offence. Not only is it cause for claim rejections but can also have legal consequences. So, always make sure to furnish all information to the best of your knowledge. 

How Can I Track My Niva Bupa Health Insurance Claim Status?

There are a number of ways to track your Niva Bupa Health Insurance claim status, both online and offline. Here’s how you can go about doing the same. 

1. Online

  • Go on the Niva Bupa Health Insurance page - https://www.nivabupa.com/

  • Log in to your account

  • Navigate to the ‘Claims’ page 

  • You’ll be able to track your claims status in real-time here 

Alternatively, you may also track your Niva Bupa Health Insurance claim status on the Niva Bupa mobile app. 

2. Offline

  • Give a call on Niva Bupa’s customer care number - 1860-500-8888 

  • You’ll be connected with a customer service representative

  • Inform them that you would like to track your claim status and they’ll guide you through the entire process

     

Niva Bupa Health Insurance Company Limited (formerly known as Max Bupa Health Insurance Company Limited) (IRDAI Registration No. 145). ‘Bupa’ and ‘HEARTBEAT’ logo are registered trademarks of their respective owners and are being used by Niva Bupa Health Insurance Company Limited under license. Registered office:- C-98, First Floor, Lajpat Nagar, Part 1, New Delhi - 110024; Fax: +911141743397; Customer Helpline: 1860-500-8888; www.nivabupa.com. CIN: U66000DL2008PLC182918. For more details on risk factors, terms and conditions please read the sales brochure carefully before concluding sales.* Niva Bupa processes pre-auth requests within 30 minutes for all active policies, subject to receiving all documents and information(s) up to Niva Bupa’s satisfaction. The above commitment doesn’t include pre-authorization settlement at the time of discharge or system outage.

Bajaj Finserv Direct Limited is a registered corporate agent of Niva Bupa Health Insurance Company Ltd. For Bajaj Finserv Direct Limited, IRDAI Registration Number CA0551.  

Frequently Asked Questions About Niva Bupa Health Insurance Claim Settlement 

What is Niva Bupa Health Insurance’s claim settlement ratio? 

Niva Bupa has a healthy claim settlement ratio of 91.6%.

Does Niva Bupa allow for reimbursement claims? 

Yes, Niva Bupa allows for both cashless claims and reimbursement claims. 

Is Niva Bupa Health Insurance a good option for planned hospitalisations? 

Absolutely! What’s more, with Niva Bupa’s cashless claims benefit, you won’t be required to settle the medical bill for planned hospitalisations.

How many network hospitals does Niva Bupa have? 

Niva Bupa has over 8600 network hospitals and is actively expanding its reach as well.

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