Niva Bupa supports both cashless claims and reimbursement claims. This section covers the information on how to check Niva Bupa health insurance claim status, fill Niva Bupa health insurance claim form, and the claim settlement process.
Cashless claims are a hassle-free way to settle your claims. You can take advantage of a cashless claim only when you seek treatment at a Niva Bupa network hospital.Take a look at the steps you need to follow to ensure a smooth claim.
Step 1: Choose a cashless hospital:
Choose a Niva Bupa cashless hospital for your treatment. You can always choose the hospital at your convenience from the Niva Bupa Hospital list on the company’s website
Step 2: Admission procedure:
On admission, you will have to produce your Health Card at the hospital help desk. In case you do not remember to carry the same or have the Health Card handy, you can always provide the Niva Bupa policy number along with your KYC documents.
Step 3: Pre-authorisation form:
You also need to fill the pre-authorisation form for claim approval which would be sent to the claims department of Niva Bupa from the hospital TPA desk.
Step 4: Cashless treatment:
Once the pre-authorisation is approved by Niva Bupa Health Insurance, your cashless treatment will begin with initial approval
Step 5: Discharge formalities:
At the time of discharge, the hospital would share the final bill along with the line of treatment, discharge summary, original bills and invoices, etc.,to Niva Bupa Health Insurance for final approval. In case additional information is needed, the insurer will share an email with the hospital.
Step 6: Claim settlement:
Once the claims department approves the claim, the bills would be directly settled by the insurer to the hospital. In case of any part of the claim that is not covered, would need to be paid by you such as consumables or deductibles.
If, for some reason, you were not able to seek treatment at a Niva Bupa network hospital, you can always file a reimbursement claim.
Step 1: Hospitalisation:
In case you get admitted to a non-network hospital, you need to inform the Niva Bupa Claims department as a claim “intimation” within a timeframe of 48 hours of the hospitalisation in case of emergency hospitalisation or before 3-5 days for planned treatment.
Step 2: Pay and get the treatment done:
In this case, you would have to pay for the entire treatment on your own.
However, remember to carry all original bills, receipts, prescriptions, discharge summaries specifying the line of treatment, test reports for diagnosis, etc.
Step 3: File a reimbursement claim:
After discharge, you need to file a reimbursement claim with all relevant documents along with your Niva Bupa Health Insurance card, the insured person’s identity and age proof and the policyholder’s bank account details.
Step 4: Verification:
Once Niva Bupa Health Insurance receives all your documents, the same will be verified.
Step 5: Claim settlement:
Thereafter, you will be reimbursed for the hospitalisation expenses, as per your Niva Bupa health plan. Typically, you would be reimbursed within 7 days of submission.
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A network hospital is a specific hospital that has a tie-up with the insurer so that cashless claim facilities are provided to its clients. This helps in the speedy claim settlement process as well.
So, in a network hospital, you only need to provide your insurance and KYC details at the time of hospitalisation and the hospital takes care of the entire documentation process. Claims are settled directly by the insurer to the hospital without you having to pay the upfront amount for treatment.
On the other hand, non-network hospitals do not provide cashless treatment facilities. In these hospitals, you need to pay for the entire bill yourself and then claim the same from the insurer as a reimbursement along with all documentation, treatment details, original bills and receipts and your bank account details.
This is the basic difference between the two.
There are certain eligibility criteria that you need to fulfil to be eligible to buy a health plan by Niva Bupa. Being a citizen of India and meeting the age criteria are generic criteria. Generally, Niva Bupa Health Insurance policies cover all dependent children when they are in the age group of 91 days to up to 25 years. However, most policies allow adults upto 65 years of age to enter a plan, unless it is a specifically designed Senior Citizen Plan. However, some plans also have a lifelong entry age.
Also, remember that all Niva Bupa Health Insurance policies can be renewed lifelong as long as the premiums are paid on time and there is no lapse.
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