Niva Bupa Claim Procedure - Explained
23 August, 2023
16 Shares
25930 Reads
Share
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.
Secure your Health with comprehensive insurance plans from Niva Bupa
Health Insurance - Health Insurance | Medical Insurance | Best Health Insurance Plans | Health Insurance Plans | Health Insurance Policy | Best Health Insurance Plans | Best Family Health Insurance | Best Mediclaim Policy | Best Health Insurance In India | Best Medical Insurance In India | Best Health Insurance Plans In India | Best Health Insurance Policy In India | Mediclaim | Best Health Insurance For Senior Citizens In India | Best Health Insurance | Health Insurance With Opd Cover | Mediclaim Insurance | Medical Insurance Plans | Best Health Insurance Company in India | Critical Illness Insurance | Personal Accident Insurance | Mediclaim Policy | Individual Health Insurance | Pregnancy Insurance | Maternity Insurance | Best Family Health Insurance plans in India | Best Health Insurance company | Family Health Insurance | Best Health Insurance plans for Senior Citizens | Mediclaim Policy for Family
Health Insurance Schemes - Chief Ministers Comprehensive Health Insurance Scheme | Employee State Insurance Scheme | Swasthya Sathi Scheme | Pradhan Mantri Matru Vandana Yojna | Government Health Insurance Scheme | Dr. YSR Aarogyasri Scheme | Pradhan Mantri Suraksha Bima Yojna | Health Insurance Deductible | West Bengal Hcovealth Scheme | Third Party Administrator | Rashtriya Swasthya Bima Yojana | In Patient Vs Out Patient Hospitalization | Mukhyamantri Chiranjeevi Yojna | Arogya Sanjeevani Health Insurance | Copay Health Insurance | Cashless Health Insurance Scheme | Mukhyamantri Amrutum Yojna
Travel Insurance - Travel Insurance | International Travel Insurance | Student Travel Insurance | Travel Insurance USA | Travel Insurance Canada | Travel Insurance Thailand | Travel Insurance Germany | Travel Insurance Dubai | Travel Insurance Bali | Travel Insurance Australia | Travel Insurance Schengen | Travel Insurance Singapore | Travel Insurance UK | Travel Insurance Vietnam | Malaysia Tourist Places | Thailand Visa for Indians | Canada Visa for Indians | Bali Visa for Indians | ECR and Non ECR Passport | Qatar Visa Status | USA Visa | Vietnam Visa | USA H1B Work Visa
Become an agent - Insurance Agent | Insurance Advisor | Licensed Insurance Agent | Health Insurance Consultant | POSP Insurance Agent
Group Health Insurance - Startup Health Insurance | Commercial Health Insurance | Corporate insurance vs personal insurance | Group Personal Accident Insurance
Top Hospitals - Best Hospitals in Chennai | Top Hospitals in Delhi | Best Hospitals in Gurgaon | Best Hospitals in India | Top 10 Hospitals in India | Best Hospitals in Hyderabad | Best Hospitals in Kolkata | Best cancer hospitals in Bangalore | Best cancer hospitals in Hyderabad | Best cancer hospitals in Mumbai | Best cancer hospitals in India | Top 10 cancer hospitals in India | Top 10 cancer hospital in Delhi | Multi Speciality Hospitals in Mumbai | Multi Speciality Hospitals in Chennai | Multi Speciality Hospitals in Hyderabad | Super Speciality Hospitals in Delhi | Best Liver Hospitals in Delhi | Best Liver Hospitals in India | Best Kidney Hospitals in India | Best Heart hospitals in Bangalore | Best Heart hospitals in India | Best Heart hospitals in Kolkata | Best Heart hospitals in Delhi
Others - Top Up Health Insurance Policy | Corporate Health Insurance | Health Card | Section 80d of Income Tax Act | Ayushman Bharat | Health Insurance Portability | GoActive Family Floater Plan | Health Companion Family Floater Plan | Health Premia Family Floater Plan | Health Pulse Family Floater Plan | Health Recharge Family Floater Plan | Heartbeat Family Floater Plan | Money Saver Family Floater Plan | Saral Suraksha Bima Family Floater Plan | Senior Citizen Family Floater Plan | Super Saver Family Floater Plan | Corona Kavach Family Floater Plan | Hospital Cash Insurance | Cashless Health Insurance | Health Companion Price revision | Heartbeat Price revision | ReAssure Price revision
Health & Wellness - PCOD | PCOD Problems Symptoms | Stomach Infection | Stomach Infection symptoms | Home remedies for Stomach Infection | Hypertension definition | How to Control Sugar | Typhoid in Hindi | Blood sugar symptoms | Typhoid symptoms in hindi | Low sugar symptoms | ब्लड शुगर के लक्षण | pregnancy me kya kare | Open heart surgery cost | Blood infection symptoms in hindi | BP badhne ke karan | Khansi ka gharelu upay | Omicron | Coronavirus Health Insurance | Covid XE Variant | Norovirus
www.nivabupa.com
+91 11 41743397
1860-500-8888
3rd Floor, Capital Cyberscape, Sector 59, Gurgaon
- Insurance is a subject matter of solicitation. Niva Bupa Health Insurance Company Limited (formerly known as Max Bupa Health Insurance Company Limited) (IRDAI Registration Number 145, Category:Health), 'Bupa' and 'HEARTBEAT' logo are registered trademarks of their respective owners and are being used by Niva Bupa Health Insurance Company Limited (formerly known as Max Bupa Health Insurance Company Limited) under license. CIN: U66000DL2008PLC182918
- 1 Niva Bupa processes pre-authorisation 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 does not include pre-authorisation settlement at the time of discharge or system outage.
- 2 Since Inception refers to claim data from 2010 till December 2023.
- 3 ReAssure 2.0 Premium: The premium is including taxes and for Bronze Variant, for a 25-year-old individual living in Delhi.
- 4 Aspire Premium: The premium is including taxes and for Gold+ Variant, for a 25-year-old individual living in Delhi.
- 5 Senior First Premium: The premium is including taxes and for Gold Variant, for a 65-year-old individual living in Delhi.
- 6 Health Premia Premium: The premium is including taxes and for Silver Variant, for a 25-year-old individual living in Delhi.
- 7 SmartHealth + Disease Management Premium: The premium is including taxes and for Disease Management Gold Variant rider when bought with ReAssure 2.0 Bronze variant with Base Sum Insured of 5 lacs, for a 25-year-old individual living in Delhi.
- Beware of spurious / fraud phone calls! Do not share your confidential information like Debit / credit card number, Internet Banking User ID/Password, Pin, CVV, OTP, etc. with anyone. Avoid clicking on attachments / payment link received in mails / message from unknown sources. IRDAI is not involved in activities like selling insurance policies, announcing bonus or investment or premium. Public receiving such phone calls are requested to lodge a police complaint. Do not respond to unsolicited and attractive offers received through unidentified calls, emails, SMSs, and other social media platforms. Beware of misleading telephone calls from people posing as Niva Bupa officials, agents, IRDAI Officials, Officials from ECI (Office of the Executive Council of Insurers) etc. and offering alluring benefits or sharing false information on your policy or on Niva Bupa. Niva Bupa shall not be responsible for any loss or damages whatsoever for any acts or omissions arising out of such spurious calls, and all customers are advised to contact our customer care at 1860-500-8888 and verify any representations or promises made by any such spurious callers before acting upon the same.