Niva Bupa Claim Process
  • What are Claims
  • Cashless Claims
  • Learn Reimbursement Claims
Niva Bupa Health Insurance Claim Process
premium

Network hospitals

10000+

premium

Claim settlement ratio

99.99

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Sum insured

3 CR

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No. of Plans

14

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Solvency Ratio

1.7

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Pan India Presence

-

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Age of Eldest Member

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Network hospitals

10000+

premium

Claim settlement ratio

99.99

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Sum insured

3 CR

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No. of Plans

14

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Solvency Ratio

1.7

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Pan India Presence

-

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Niva Bupa Health Insurance Claim Process

Navigating through claims can be a daunting task as this process involves intricate details, legal jargon, and specific documents. During a medical emergency, we do not want to waste our time processing claims. It is important to make a mindful decision when selecting an insurance provider, with a simple claim process. Niva Bupa understands the importance of hassle-free claims, which is why they have designed a convenient method of processing claims. Here is an overview of Niva Bupa Claim Processing:

Health Insurance Companies: Policy and Claim Process

How To Claim Niva Bupa Health Insurance

The company has divided the process into four parts. Let us go through all of them one by one:

Niva Bupa Cashless Claims Process

This claim process allows the policyholder to receive the treatment without paying the medical expenses right away. The insurance provider later settles the bill with the hospital directly. Let's proceed step by step through the process:

Step 1: Get admitted to the network hospital.

Step 2: Share the 'Health Card' and the policy details with the hospital authority or TPA, along with the ID proof of the policyholder. This step informs the company about the claims.

Step 3: After receiving the treatment, collect all the documents and submit them to the TPA along with the pre-authorization form.

Step 4: The TPA will verify the claim and forward it to the company. Then, the next verification will be done by the in-house claim team of Niva Bupa Health Insurance Company.

Step 5: After successful verification of policy details and the submitted documents, the company will send a notification for the approval of the claim through text message and email. Niva Bupa generally responds to the request within 30 minutes of filing the claim request.

Step 6: Now, the company will settle the claim with the hospital. This is the final step of the cashless claim settlement.

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Niva Bupa Reimbursement Claim Process

Through this procedure, the policyholder is free to choose a hospital even if it is not on the network hospitals list. The customers pay for the expenses upfront, and the company then reconciles the account with the policyholder. Lets us walk through the process :

Step 1: Receive the treatment from any of the non-network hospitals, and intimate the company about the claim. Policyholders can contact the customer support of the company to inform them about the claim.

Step 2: After treatment, pay the amount and collect all the documents such as discharge bills, pharmacy bills, reports, and other essential documents.

Step 3: Send all the documents to the company along with the claim form, valid ID proof, and age proof. Mail the document to the head office of Niva Bupa Health Insurance Company.

Step 4: The company will verify all the details and documents.

Step 5: After successful verification of the claims, the company will notify the policyholder.

Step 6: Finally the company settles the claim by transferring the amount, to the bank account of the customer.

Niva Bupa Claim Reimbursement: OPD

OPD (Outpatient Department) is the treatment in which the patient visits the hospital for a minor procedure that does not need an overnight stay. In addition, Niva Bupa Health Insurance provides reimbursement for OPD. Let us now take a closer look at this process:

Step 1: Login by the 'My Account' option, locate the 'OPD' tab, and click 'Raise a Claim'.

Step 2: The company will ask to look for the doctor in the search section.

Step 3: Find the search result and click on 'Raise a Claim', against the name of the doctor, with whom you availed the OPD services.

Step 4: Fill out the health claim form correctly, enter all the details about your bank account, and upload all the mentioned documents on the form.

Step 5: Finally, the company will review the insurance claim. And then on successful verification of the details, a query will be raised for the claim settlement.

Niva Bupa Claim Reimbursement: Diagnostic Centre

Niva Bupa Health Insurance provides financial compensation for the expenses incurred during the diagnosis of any disease. Lets us take a closer look at the process:

Step 1: Login in by clicking on the 'My Account ' option, locate the 'Annual Health Checkup' tab, and click on 'Reimbursement Claim'.

Step 2: A form will now open. Enter the important information like the correct bill, bank details and upload the document for the same. Now click on 'Submit'.

Step 3: Niva Bupa's claim processing team will review all the documents submitted and subsequently approve the claim if no issue is found.

Step 4: Then the company finally settles the claim, by transferring the compensation amount to the policyholder's bank account.

Documents Required for Niva Bupa Health Insurance Claim

A few documents that are essential in order to submit a health insurance claim:

  • Duly Filled Claim Form
  • Original Medical Reports
  • Pharmacy Bills and Prescriptions
  • Original Hospital Bills
  • Hospital Discharge Summary
  • Hospital Bill Receipt
  • Doctor's/ Surgeon's Bill Receipt
  • Photo Id Proof
  • Police FIR
  • Post-Mortem Report (if applicable)

Conclusion

Niva Bupa Health Insurance Company offers a user-friendly claim process. With reimbursement and cashless claims, they provide comprehensive coverage for medical expenses. Niva Bupa Health insurance company has a prompt verification and settlement procedure, which develops more confidence in the policyholder towards the company. Niva Bupa's commitment to providing top-notch customer satisfaction makes it a reliable health insurance partner.

Choose Niva Bupa Health Insurance Plan for

Niva Bupa Health Insurance Network Hospital List

Niva Bupa Health Insurance Network Hospitals are present in 32 states nationwide. With a wide network of hospitals, Niva Bupa Health Insurance ensures that you are medically secured, irrespective of the city you reside in.

Explore More Plans from Niva Bupa

Niva Bupa Health Insurance company offers several tailored health plans that are designed to serve you in the best way possible. Take a look:

Top-up plan

A super top-up plan providing extra coverage to you and your family on the basis of deductible with SI options of up to 95 lakhs.

Unique Features

  • No room rent capping
  • Unlimited E-consultation available
  • Pharmacy and diagnostic services

NivaBupa Health Recharge (Pros)

  • Loyalty Additions up to 50%
  • Pharmacy and Diagnostic Services
  • Personal Accident Cover
  • Easy Plan Convertibility
  • Day Care Treatments Coverage

NivaBupa Health Recharge (Cons)

  • Maternity Treatment not covered
  • Pre-existing Diseases not covered
  • Alcoholism not covered
  • Dietary Supplements not covered
  • No COVID-19 cover

NivaBupa Health Recharge (Other Benefits)

  • Intensive Care Unit charges
  • Domiciliary treatment
  • HIV / AIDS Treatment Covered
  • Artificial Life Maintenance Benefit
  • Room Rent (per day) Up to 1%

NivaBupa Health Recharge (Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age - 65 Years
  • SI - 2 Lakh - 95 Lakh
  • Waiting Period - 30 Days

Critical Illness

Buy a cover of up to 2 crores to secure you and your loved ones against 20 major critical illnesses with the Niva Bupa CritiCare plan.

Unique Features

  • Daily hospital cash
  • Accident care available
  • Lifelong renewability

NivaBupa CritiCare (Pros)

  • 20 critical illnesses Covered
  • Long-term tenure savings
  • Different pay-out options
  • Tax benefits
  • Direct claim settlement

NivaBupa CritiCare (Cons)

  • Accident Death
  • No Total Disability Cover
  • AIDS Not Covered
  • Child Education Benefit
  • Funeral Expenses

NivaBupa CritiCare (Other Benefits)

  • Flexibility Plan Options
  • Surgeon's Fee Covered
  • Renewal for life
  • Diagnostic Procedures/Therapies
  • Prosthetic Implants Covered

NivaBupa CritiCare (Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age - 65 Years
  • SI - 3 L to 3 Cr
  • Waiting Period - 30 Days

Personal Accident

Offers personal accident cover of up to 2 crores on an individual and family floater basis. Pays 100% of SI to your family in case of accidental death.

Unique Features

  • Global coverage available
  • Child education benefit
  • Permanent Disability Cover

AccidentCare (Pros)

  • Funeral Expenses
  • Accidental OPD
  • Adventure Sports Cover
  • Elderly Care Cover
  • Burns Cover

AccidentCare (Cons)

  • No Alcohol Ailment Cover
  • No Cosmetic Surgery
  • No Obesity Surgery
  • No Suicide Cover
  • No War Injury Cover

AccidentCare (Other Benefits)

  • Air Ambulance
  • Broken Bone/Fracture
  • Head & Spinal Injury
  • Marriage Expenses for Children
  • Comatose Cover

AccidentCare (Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age - No Age Limit
  • SI - 3 L to 5l
  • Waiting Period - 30 Days

Comprehensive and Top-Up plan

NivaBupa Money Saver

A unique health insurance plan that combines the benefits of basic SI and top-up cover to offer enhanced protection to individuals and families.

Unique Features

  • 100% SI restoration
  • Unlimited e-consultation
  • No room rent capping

NivaBupa Money Saver (Pros)

  • All Day Care Procedures covered
  • Accumulated Bonus
  • 100% Refill Benefit
  • 20% cumulative bonus
  • Organ Transplantation Covered

NivaBupa Money Saver (Cons)

  • No Maternity Benefit
  • Adventure Sports not covered
  • STDs not covered
  • Cosmetic Surgery Not Covered
  • Self Inflicted Injuriesnot covered

NivaBupa Money Saver (Other Benefits)

  • Road Ambulance Cover
  • Alternate Treatment
  • Pharmacy and Diagnostic Services
  • Hassle-Free Claims
  • Pre & Post Hospitalisation

NivaBupa Money Saver (Eligibility Criteria)

  • Entry Age - 3 Months
  • Max Entry Age - 65 Years
  • SI - 10.5 L to 1 Cr
  • Waiting Period - 30 Days

Senior Citizen

A plan providing comprehensive protection to senior citizens with multiple coverage options counting from 5 - 25 Lakhs.

Unique Features

  • Coverage for modern treatments
  • Multiple co-payment options
  • Unlimited SI restoration

NivaBupa Senior First (Pros)

  • 3 Variant Available
  • No pre-issuance medical tests
  • Day 1 Health Check-up
  • Safeguard (Add-on)
  • Day Care Treatment

NivaBupa Senior First (Cons)

  • No Critical Illness Cover
  • 50% Co-payment
  • No Specific Diseases Covered
  • No Pre-existing Disease Cover
  • Self Inflicted Injuriesnot covered

NivaBupa Senior First (Other Benefits)

  • ReAssure Benefit
  • Domiciliary Hospitalization
  • Organ Donor Benefit
  • Ayush Benefit
  • Annual Aggregate Deductible

NivaBupa Senior First (Eligibility Criteria)

  • Entry Age - 61 Years
  • Max Entry Age - 75 Years
  • SI - 5 L to 25 L
  • Waiting Period - 30 Days

Comprehensive Plan

Niva Bupa Reassure 2.0 provides insurance holders with a high sum insured through their platinum, titanium, and bronze variants along with a multitude of other features.

Unique Features

  • Booster+ Benefit
  • Lock premiums at entry age
  • Health check-ups from day 1

Health ReAssure 2.0 Plan (Pros)

  • Personal accidents covered
  • Acute Care
  • Emergency Ambulance
  • Three Plan variants
  • Home Care Treatments

Health ReAssure 2.0 Plan (Cons)

  • No OPD Cover
  • No Maternity Cover
  • No Sleep Disorder Covered
  • Pre-Existing Diseases after 3 yrs.
  • Alcoholism not covered

Health ReAssure 2.0 Plan (Other Benefits)

  • Air Ambulance
  • Modern Treatments
  • Second Opinion
  • Booster Benefit
  • Shared Accommodation Benefit

Health ReAssure 2.0 Plan (Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age - No Age Limit
  • SI - 5 L to 1 Cr
  • Waiting Period - 30 Days

Suraksha Plan

Niva Bupa Saral Suraksha Bima

A personal accident insurance policy that offers a lump sum compensation in case of permanent disability or death resulting from an accident.

Unique Features

  • Large Sum Insured
  • High sum insured
  • Up to 50 % Cumulative Bonus

Saral Suraksha Bima (Pros)

  • Accidental Death Covered
  • Pay Rs 296 monthly as premium
  • Education Grant to children
  • Temporary Total Disablement
  • Hospitalisation due to an accident

Saral Suraksha Bima (Cons)

  • No Maternity Benefit
  • No Disablement Claims
  • War Injuries not covered
  • Accident through intoxication
  • COVID-19 death not covered

Saral Suraksha Bima (Other Benefits)

  • 30-minute cashless claims
  • Paperless Reimbursement
  • Road Ambulance Covered
  • Emergency Treatment Covered
  • Hassle Free Renewal Process

Saral Suraksha Bima (Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age - 65 Years
  • SI - 2.5 L to 1 Cr
  • Waiting Period - 30 Days

Corona Plan

Niva Bupa Corona Kavach

The plan covers you and your family against COVID-19, covers the Comorbidities arising out of COVID, and imposes no room rent capping.

Unique Features

  • Ventilator Expenses Included
  • PPE Kit expense Included
  • Covers ICU Charges

Niva Bupa Corona Kavach (Pros)

  • Home Care Treatment Expenses
  • Hospitalisation Coverage
  • Pre and Post Hospitalisation
  • Hassle-free Claims
  • AYUSH Treatments Coverage

Niva Bupa Corona Kavach (Cons)

  • OPD and Day Care Treatment
  • Evaluation and Investigations
  • Rehabilitation
  • Dietary supplements
  • COVID Claim

Niva Bupa Corona Kavach (Other Benefits)

  • Coverage for Parents & PILs
  • Coverage for Dependent Children
  • Road Ambulance Covered
  • Hospital Daily Cash
  • Spouse Cover Available

Niva Bupa Corona Kavach (Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age - 65 Years
  • SI - 50 Thousand to 5 Lakh
  • Waiting Period - 30 Days

Comprehensive

A complete health insurance policy that covers you and your family with a wide range of SI (3 Lakh to 1 Crore) and continues to give you more benefits.

Unique Features

  • Covers a maximum of 6 members
  • Unlimited SI restoration
  • Coverage for modern treatments

Health Reassure Plan (Pros)

  • Booster benefit
  • Organ donor transplant
  • ReAssure
  • Live Healthy Benefit
  • Second Medical Opinion

Health Reassure Plan (Cons)

  • No OPD Cover
  • No Maternity Cover
  • No Sleep Disorder Covered
  • No Suicide Cover
  • No War Injury Cover

Health Reassure Plan (Other Benefits)

  • Air Ambulance
  • Hospital Cash
  • Personal Accident Cover
  • Domiciliary hospitalization
  • Day care treatment

Health Reassure Plan (Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age - No Age Limit
  • SI - 3 L to 1 Cr
  • Waiting Period - 30 Days

Comprehensive

An individual and family plan that covers all day care treatments, modern treatments, comes with a safeguard add-on and provides annual health check-ups.

Unique Features

  • No room rent capping
  • 20% no-claim bonus on SI
  • 100% SI restoration

Health Companion V2022 (Pros)

  • 5% Doctor Discount
  • 10% Family discount
  • Tenure Discounts of upto 15 %
  • Annual Aggregate Deductible
  • Home Care Treatments

Health Companion V2022 (Cons)

  • No OPD Cover
  • No Maternity Cover
  • Cosmetic Surgery Uncovered
  • Specific Diseases after 2 yrs
  • No Alcoholism Cover

Health Companion V2022 (Other Benefits)

  • Air Ambulance
  • Modern Treatments
  • Vaccination on Animal Bite
  • Organ Donor Benefit
  • Domiciliary treatments

Health Companion V2022 (Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age - No Age Limit
  • SI - 3 L to 1 Cr
  • Waiting Period - 30 Days

Comprehensive

A policy for you and your family which covers modern treatments, laser surgery, e-consultations, annual health check-ups, and coverage of 3 Crores.

Unique Features

  • Maternity Cover
  • International coverage
  • In-Built travel insurance

NivaBupa Health Premia (Pros)

  • Refill benefit for any illness
  • 10% Loyalty Additions in SI
  • Tenure Discounts of upto 15 %
  • Worldwide Maternity Benefit
  • In-patient care

NivaBupa Health Premia (Cons)

  • No OPD Cover
  • No HIV/AIDS Covered
  • 20% co-payment
  • Pre-existing Diseases after 2 yrs
  • Treatment for Alcoholism

NivaBupa Health Premia (Other Benefits)

  • Zonal Coverage available
  • Pharmacy and diagnostic services
  • Opt for additional features
  • Living Organ Donor Benefit
  • Premium waiver and portability

NivaBupa Health Premia (Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age - 65 Years
  • SI - 3 L to 1 Cr
  • Waiting Period - 30 Days

Affordable

A budget-friendly health insurance plan that offers coverage to individuals and families with tailor-made benefits and great value for money.

Unique Features

  • No room rent capping
  • Up to 100% of SI restoration
  • 20% No Claim Bonus

NivaBupa Health Pulse (Pros)

  • Optional benefits available
  • 150% Refill Benefit
  • Annual Health Checkup
  • Emergency Ambulance
  • Living Organ Donor Benefit

NivaBupa Health Pulse (Cons)

  • Conflict and Disaster cases
  • 20% co-payment
  • No Maternity Benefit
  • Cosmetic surgeries
  • Treatment for Alcoholism

NivaBupa Health Pulse (Other Benefits)

  • Operation Theatre Coverage
  • Modern Treatments
  • Personal Accident Cover
  • e-Consultation
  • Daily Hospital Cash

NivaBupa Health Pulse (Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age - 65 Years
  • SI - 3 L to 25 L
  • Waiting Period - 30 Days

Digital

NivaBupa Go Active

A modern-day digital insurance plan offering you cashless OPD and diagnostic services along with basic coverage and healthcare benefits.

Unique Features

  • Early age enrolment discounts
  • Annually 10 OPD consultations
  • No room rent capping

NivaBupa Go Active (Pros)

  • Pharmacy and Diagnostic Services
  • Domiciliary hospitalization
  • Personal Accident Benefit
  • Refill Benefit
  • Daily health coaching

NivaBupa Go Active (Cons)

  • Maternity Benefit Not available
  • Adventure Sports not covered
  • HIV/AIDS not covered
  • Cosmetic Surgery Not Covered
  • War Injuries not covered

NivaBupa Go Active (Other Benefits)

  • Behavioural Assistance Program
  • Alternate Treatment
  • I-Protect option to increase SI
  • 2 % ICU Cover (per Day)
  • No Room Rent Sub Limit

NivaBupa Go Active (Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age - 65 Years
  • SI - 4 L to 25 L
  • Waiting Period - 30 Days

Comprehensive

A complete health plan, providing a wide range of medical benefits along with global emergency coverage.

Unique Features

  • Maternity & New born coverage
  • No room rent capping
  • 10% increase in SI annually

NivaBupa Heart Beat (Pros)

  • Additional Coverage
  • 10% Loyalty Benefit
  • Annual Health Check ups
  • Refill benefits
  • Coverage out of hospitals

NivaBupa Heart Beat (Cons)

  • Obesity Treatment not covered
  • Hazardous Activities not covered
  • HIV/AIDS not covered
  • Cosmetic Surgery unavailable
  • Injuries due to breach of law

NivaBupa Heart Beat (Other Benefits)

  • OPD Consultations
  • Alternative Treatments
  • New Born Baby Cover
  • Pharmacy and diagnostic services
  • No WP up to 45 years

NivaBupa Heart Beat (Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age - 65 Years
  • SI - 5 L to 1 Cr
  • Waiting Period - 30 Days

Affordable

NivaBupa Super Saver

An individual and family health plan, providing a cover of up to 1 crore at affordable premiums combined with advanced features and benefits.

Unique Features

  • Up to 200% of SI as NCB
  • Up to 150% of SI restoration
  • Unlimited e-consultation

NivaBupa Super Saver (Pros)

  • Day 1 Health check-up
  • No pre-issuance medical tests
  • Ambulance cover up to Rs 2000
  • ReAssure Benefit
  • No sub-limits

NivaBupa Super Saver (Cons)

  • No Maternity Benefit
  • Adventure Sports not covered
  • STDs not covered
  • Cosmetic Surgery Not Covered
  • Self Inflicted Injuriesnot covered

NivaBupa Super Saver (Other Benefits)

  • Air Ambulance Cover
  • Health Checkup
  • Organ Donor Benefit
  • Ayush Benefit
  • Room selection Option

NivaBupa Super Saver (Eligibility Criteria)

  • Entry Age - 61 Years
  • Max Entry Age - 75 Years
  • SI - 5 L to 25 L
  • Waiting Period - 30 Days

Niva Bupa Claim Process : FAQ's

1. Where can I get the claim form and pre-authorization form?

Claim forms and pre-authorization forms can be downloaded from the official website of the company.

2. How long before, the policyholder must inform the hospital in case of a Niva Bupa Reimbursement Claim?

For planned hospitalization, policyholders must inform the company 48 hours before being admitted to the hospital. In case of emergency hospitalization inform them within 24 hours of admission in the hospital.

Health Insurance Companies

Read Reviews & Ratings

Customer Review Image

Bhawani Singh Chikliya

Kolkata

February 16, 2024

I highly recommend reaching out to PolicyX.com before buying health insurance. They are great at what they do, and they& 039;ve helped me get an all-in-one Niva Bupa health insurance for my sen...

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Akash Soni

Gandhinagar

February 16, 2024

I am really happy with the customer service of PolicyX. I got my health insurance policy from Niva Bupa, and the members of the team helped me prepare my mind and finances for the policy.

Customer Review Image

Simran Pahuja

Ludhiana

February 16, 2024

I want to purchase a health insurance plan that will cover my wife and kids. I am so grateful to PolicyX who helped me choose Niva Bupa Aspire Plan.

Customer Review Image

Tushar

Rajkot

February 16, 2024

The Niva Bupa Aspire Health plan helped us with our IVF journey which we were not expecting to be covered by a health insurer. This incredible health plan was suggested by PolicyX insurance exp...

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Sahil Mudgal

Agra

February 16, 2024

No wonder Niva Bupa provides very good health plans as compared to other big insurance companies in the market. But buying a policy becomes more convenient with PolicyX.

Customer Review Image

Sunaina Jain

Chennai

February 14, 2024

I got a complete detail about the existing health insurance policies in India. They provided me with the comparison sheet and helped me choose the right policy for me and my family which is Niv...

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Sangram Sinha

Hyderabad

February 14, 2024

I started looking for a health insurance policy when I turned 20. Then I came across PolicyX.com. They helped me choose the right individual policy

Customer Review Image

Varun Goila

Kolkata

February 2, 2024

I’m just 23 and on the suggestion of PolicyX experts I bought a newly launched NivaBupa Young Aspire plan which I think is a good purchase for youngsters like me.

View All Niva Bupa Health Insurance Reviews

Bindiya Sinha

Written By: Bindiya Sinha

Bindiya is a seasoned content writer specializing in keeping readers acquainted with the insurance industry, term insurance developments, and life insurance sector shifts. With an experience of 3 years in insurance, Bindiya ensures that her readers stay well informed with the insurance developments and factually correct information.