Niva Bupa Claim Procedure - Explained

The insurance claim procedure is the process of filing a claim with an insurance company in order to receive compensation for a loss. The process typically begins when a policyholder notifies their insurance company of a loss, such as a house fire, car accident, or medical emergency. 

Once the policyholder has reported the loss, the insurance company will open an investigation to determine whether the policyholder is eligible to receive compensation. This includes verifying the policyholder's coverage and assessing the extent of the damage. The insurance company may also request additional documentation, such as photographs of the damage, medical documentation, or estimates for repairs.

At the time of medical emergency, we understand that convenience is your only priority. You want to focus on taking care of your loved ones rather than run around for claim. At Niva Bupa, we are there for you to ensure that insurance claims are processed as quickly as possible.

Niva Bupa has 90% claim ratio which is a reason why people trust us when it comes to health claims processing. We’ve been awarded the ‘Most Trusted Health Insurer’ 3 years in a row, so you can stay assured that Niva Bupa will be your trusted partner in critical medical emergencies.

We have 10,000+ network hospitals, which make the process seamless for you. Our 30 minutes promise means that we respond to every insurance claim request from a network hospital within half-hour. To further make the process hassle-free, Niva Bupa settles your claim directly without any TPA involvement.

In case, you are getting treatment in a non-network hospital, you can file a reimbursement claim. Explained below is the claims procedure so that you’re equipped with the right information at the time you need it:

For Cashless Health Claims

Cashless claims are insurance claims that do not require the policyholder to pay for services in cash. Instead, the insurer will pay for the services directly, through electronic transfer or a third-party provider. This type of claim can benefit the insurer and the policyholder, as it allows for a streamlined and efficient way to receive service reimbursement.

The primary benefit of cashless claims is that they are quick and easy to process. Instead of having to wait for a check to arrive in the mail, policyholders can receive reimbursement almost immediately. As a result, it helps to reduce delays and paperwork and makes it easier to keep track of expenses. Additionally, cashless claims can help to reduce fraud, as the insurer can verify the services have been provided as claimed.

You can follow these steps to apply for cashless claims:

Step 1: Get admitted to any one of Niva Bupa network hospitals.

Step 2: Use your Niva Bupa Health Card or share your policy number with the concerned team at a hospital along with your Passport/PAN card/ Voter’s ID as identification proof.

Step 3: Now, the network hospital will verify your identity for validation and submit the pre-authorization request to us

Step 4: After validation, we review and provide our confirmation to the network hospital by fax and email. We ensure you are also notified of the same through text message and email. Niva Bupa will respond to your request within 30 minutes of filing of the claim request.

Step 5: The only activity left to do now is the final settlement of your insurance claim (as per policy terms & conditions) with the hospital after completion of all the necessary formalities

For Reimbursement Health Claim

Reimbursement claims for health insurance are a way for policyholders to get back the money they have spent on medical expenses. Generally, the claim procedure is as follows:

Step 1: If you get hospitalized, notify us within 48 hours of admission in our network or non-network hospital. After getting admitted pay the amount directly to the hospital you are in.

Step 2: After you are discharged from the hospital, make sure you have all the relevant documents, invoices, medical reports and discharge certificate with you. We would need the originals of all the mentioned documents to process your reimbursement.

Step 3: Send all the documents to us which should be completely filled and signed the claim form. Send your valid ID proof and age proof as well. The claim form is available on: 1. Our website www.nivabupa.com 2. In your policy document.

Step 4: After receiving your documents, we review your claim request and accordingly will give our approval, raise a query or reject the same (as per policy terms & conditions).

Step 5: Finally, we will settle the claim (as per policy terms & conditions) and reimburse the approved amount.

For OPD Reimbursements

In case you wish to reimburse an OPD claim, ensure that you have availed the OPD services from the list of doctors/clinics that have been impaneled within our network only. Retain a copy of a valid bill issued by that doctor or clinic. Given below are the steps:

Step 1: Login to ‘My Account’ and click on ‘Raise a claim’ under OPD tab in the ‘My Account’ section.

Step 2: Enter the details in the search section to look for the doctor.

Step 3: From the search results, click on ‘Raise a claim’ against the doctor with whom you availed OPD services.

Step 4: Fill in the health claim form by correctly entering bill details, bank details and uploading the mentioned documents before submitting it.

Step 5: Finally, we will review the insurance claim based on the details shared by you. Subsequently, we will approve it, send a query or reject the same (as per policy terms & conditions).

For Diagnostic Center Reimbursements

Diagnostic centre reimbursements are an essential part of health insurance coverage. They provide services to diagnose and treat medical conditions. These services can include physical exams, laboratory tests, X-rays, ultrasounds, and other procedures.

The insurance company will usually pay a certain percentage of the cost for these services. This amount will depend on the particular insurance plan and its coverage. Generally, the reimbursement will cover a portion of the cost of the diagnostic services.

Step 1: To reimburse a diagnostic claim, make sure you have a valid bill copy with you.

Step 2: Login to ‘My Account’ and click on ‘Reimbursement claim’ under the annual health check-up tab in ‘My Account section’.

Step 3: Complete the claim form by entering correct bill details, bank details and upload the mentioned documents. Then submit it.

Step 4: Finally, we will review the claim based on the details shared by you. Subsequently, we will approve it, send a query or reject the same (as per policy terms & conditions)

These claims can help to improve customer satisfaction. By making the insurance claim procedure more efficient and streamlined, policyholders can receive reimbursement in a timely manner, reducing the likelihood of frustration and dissatisfaction. Overall, cashless claims can be a beneficial way for insurers and policyholders to receive reimbursement for services. They can help to reduce delays, paperwork, fraud, and administrative costs while improving customer satisfaction.