How to raise a cashless claim?
If you’re a Niva Bupa Health Insurance policyholder through Bajaj Finance, you can avail cashless hospitalisation at 8,500+ network hospitals across India. Just follow these simple steps:
Step 1: Notify the Insurer Promptly
Inform Niva Bupa at least 3 days in advance for planned hospitalisation or within 48 hours in case of an emergency admission.
Step 2: Choose a Network Hospital
Visit any Niva Bupa network hospital near you. You can use the online hospital locator to find one quickly.
Step 3: Provide Required Documents
At the hospital’s insurance/TPA desk, share the patient’s policy ID or cashless card along with valid identity proof (such as PAN card, Voter ID, or Passport).
Step 4: Submit Pre-authorisation Form
Fill out the pre-authorisation form available at the hospital desk. You can also download it in advance from the insurer’s website and carry it with you.
Step 5: Get Approval & Start Treatment
Once your details are verified, the insurer will send confirmation within 30 minutes. Your treatment will then proceed on a cashless basis as per your policy terms.How to raise a reimbursement claim
To reimburse your hospital and medical expenses with Niva Bupa Health Insurance, follow these steps:
- Step 1: Contact the insurer within 48 hours of emergency hospitalisation and 3 days before planned hospitalisation.
- Step 2: Settle all medical bills and other costs involved in hospitalisation and treatment at the hospital.
- Step 3: Submit the required documents like the reimbursement claim form, hospital discharge summary, bills and prescriptions, and more to the nearest branch office of the insurer within 15 days after getting discharged from the hospital.
- Step 4: The insurer will review and verify the documents and process the claim as per the policy's terms and conditions.
Documents required for raising a claim request
Here is the list of documents you need to raise a claim request with Niva Bupa Health Insurance:
- Claim form (Part A and B). Part A to be filled by the insured and Part B is to be filled by the hospital
- Doctor's letter for hospitalisation
- Hospitalisation and medical bills
- Reports of lab and radiology tests
- FIR document, in case of an accident
- Post-mortem report, if applicable
What to do if your health insurance claim is rejected
A rejected health insurance claim can be frustrating, but it doesn't have to be the end of the road. Here are the steps you should follow to reinitiate your claim and seek resolution:
Step 1: Understand the Reason for Rejection
Begin by identifying why your claim was denied. Common reasons include missing documents, errors in submitted forms, or the insurer believing the hospitalisation was medically unnecessary. Review your claim documents and hospital bills thoroughly for discrepancies.
Step 2: Contact the Insurer, TPA, and Hospital
If you believe the claim is valid, get in touch with your insurer or the Third-Party Administrator (TPA). You can raise the issue via email or phone, but it's advisable to communicate in writing for official records. Simultaneously, inform the hospital about the dispute for clarification on medical details if needed.
Step 3: Rectify and Gather Supporting Documents
Depending on the rejection reason, here’s what you may need to do:
For document-related errors: Submit the correct and complete paperwork with proper attestation.
For claim form mistakes: Double-check personal and policy details (like name, policy number) and correct them.
For medically “unnecessary” treatment claims: Provide proof such as prescriptions, diagnostic reports, and a doctor’s letter justifying hospitalisation.
Step 4: Reapply for the Claim
Once you’ve gathered all necessary documents:
Write a formal letter to the insurer and TPA explaining why your claim is valid, along with policy details.
Attach all revised and supporting documents, including medical justification from a registered practitioner.
Step 5: Approach the Insurance Ombudsman
If the insurer’s resolution isn't satisfactory, you can escalate the issue to the Insurance Ombudsman within 30 days of receiving a response. This is a government-appointed authority that helps resolve insurance disputes at no cost.
Step 6: File a Case with Consumer Court (If Needed)
As a last resort, you may approach the consumer court if you’re dissatisfied with the Ombudsman’s verdict. However, this could involve legal expenses—so consider whether it's worth pursuing compared to the claim amount.
Niva Bupa Health Insurance offers extensive medical coverage, including hospitalisation, treatment, and critical illness benefits—providing financial protection when it matters most. However, navigating the claim process can sometimes feel overwhelming. To make it simpler, policyholders should understand how to raise both cashless and reimbursement claims, along with the list of required documents.
Staying informed is just as important as filing the claim correctly. That’s why it’s essential to regularly check your Niva Bupa track claim status online. This helps you monitor the real-time progress of your health insurance claim and stay updated on settlement timelines—ensuring there are no surprises during the payout.
By following the right steps and leveraging digital tools like the Niva Bupa app or portal to track your claim status, you can make the entire experience smoother and stress-free.
