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Niva Bupa Claim Settlement Ratio


Niva Bupa


Industry Average

Health claim settlement ratio is the percentage of claims settled against the total claims received by the insurance company in a given fiscal year. Niva Bupa has a claim settlement ratio of 91.6%, as compared to the industry average of 94.21%.

Niva Bupa Claim Process

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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Niva Bupa is among the most well-known health insurance companies in India. It has won various recognitions and awards, which is also trusted by many. An exhaustive list of Niva Bupa cashless hospitals allows you to seamlessly settle your claims. Niva Bupa is one of the exclusive health insurance providers who focus on settling claims within a matter of 30 minutes. They are customer-centric in their approach, and they also offer a range of products to suit everyone’s needs at affordable pricing with the latest features and benefits. This is why you should opt for Niva Bupa Health Insurance policies for all your health insurance requirements.

A cashless facility is available only at a Niva Bupa network hospital. If you are admitted to a non-network hospital, you’ll have to pay the bills upfront and file for a claim after your discharge from the hospital. You can check the Niva Bupa hospital list on the company website.

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.

Niva Bupa Health Insurance plan allows you a grace period of 30 to 60 days of grace period after the premium due date during which the premium needs to be paid. However, the health insurance coverage would lapse if the premium is not paid within the due date and no claim would be admissible. So, in case you wish to file a claim within the grace period, you would first need to pay the premium to get the policy in force and then file a claim. The grace period is given so that you can retain your no-claim bonus for that duration.

Niva Bupa makes the claim process very easy and simple. Depending on the hospital that you seek treatment in, you can file your claim. The advantage of a network hospital is that you can get the benefit of making cashless claims. Your medical bills will be settled directly by Niva Bupa, and you will only have to cover the uncovered expenses. As Niva Bupa Health Insurance has an in-house claim settlement team, they are very quick to settle claims.

You have the option of buying Niva Bupa health insurance online from the Niva Bupa website. However, with Turtlemint, you can experience a smooth and pocket-friendly purchase.

Claim Settlement Ratio varies from time to time as it is a representation of the claims settled by an insurance company against the total number of claims made in a financial year. Niva Bupa claims to have settled 91.6%⁶ of their claims.
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