Meta Description: Max (Niva) Bupa Group Health Insurance Key Features, Benefits, Policy Details, Network Hospitals, Inclusions, Exclusions, and Claim Procedures.
Your employees are your most worthwhile investment. They are an integral part of any corporation. Employee health is one of the most pressing concerns of any company. Niva Bupa (earlier known as Max Bupa) General Insurance has come up with a new plan, called Group Health Solution, which offers complete coverage to its most valuable resource – employees. It is a comprehensive plan most ideally meant to provide coverage to small and large corporations and organizations.
Niva Bupa Group Health Insurance is the corporate insurance product of Niva Bupa Health Insurance Company Limited and formerly known as Max Bupa Health Insurance Company Limited, an independent health insurance company established in the year 2008. It is a combined venture between Fatal Tone LLP, an Indian private equity firm, and UK-based healthcare services specialist Bupa Singapore Holdings Pte Ltd.
Key Features
- Private single-room hospitalization
- Health checkups
- Maternity benefits
- International Cashless facility
- 24×7 helpline facility
- Vaccination of the newborn also covered
- Also covers checkups for parents and parents-in-law
- Hospital Cash (Optional) Rs 1000/Day
Niva Bupa Group Health Insurance Benefits
No third party is involved
The Niva Bupa group health insurance has an in-house claim settlement department to process and settle the claims of their customers without any involvement from an external third party administrator.
No medical tests are needed
Your Niva Bupa Group Health Insurance does not demand any medical examinations before buying your insurance policy.
A Free health check-up
A Free health check-up every 2 years at a designated Niva Bupa (formerly known as Max Bupa) diagnostic center.
Huge cashless network hospitals
The Niva Bupa group health insurance has a powerful network of cashless hospitals. With approximately 8600+ cashless network hospitals, the insurer has a presence across India.
Income tax benefit
Income tax benefit on the premium paid according to Section 80D of the Income Tax Act, 1961.
Customize your policy
Your Niva Bupa Group Health Insurance is a highly customizable policy as per the requirements of your employees. You can prefer your add-ons and riders and make a tailor-made Niva Bupa group health insurance scheme.
Why prefer Niva Bupa group health insurance as your insurance partner?
These are the many causes why you should go for Niva Bupa group health insurance as your insurance partner.
Process claims in 30 minutes
Niva Bupa group health insurance guarantees to process all health insurance claims queries in just 30 minutes time period.
8600+ Network Hospitals
The Niva Bupa group health insurance has a powerful network of cashless hospitals with more than 8600 network hospitals.
More than 70 lakh happy customers
The company has 70 lakh happy customers across the retail and corporate insurance sectors.
In-house claim settlement
You don’t need to wait for an external TPA to process and settle group health insurance claims. Niva Bupa Group Health Insurance has a team for in-house claim settlement procedures.
Details About Premium
Annual premium depends on the plan chosen. For details please refer to the website.
Policy Details
- Sum Insured: 1-50 lakhs
- Coverage type: Individual/Family
Niva Bupa Group Health Insurance Claim Settlement Ratio
The claim settlement ratio (CSR) in the insurance sector is the ratio between the total number of claims settled by the insurance company to the number of claims requested from the policyholders in a particular financial year.
Here is the claim settlement ratio for Niva Bupa group health insurance for the financial year 2018 and 2019:
| Financial Year | Claim settlement ratio |
| 2019-20 | 89.46% |
| 2018-19 | 84.15% |
Niva Bupa group health insurance network hospitals
Niva Bupa health insurance company has partnered with different hospitals across India providing corporate insurance for employees. These hospitals are referred to as network hospitals. These network hospitals are the hospitals where the policyholders can avail of cashless treatment as the bills are settled directly to the hospital. Niva Bupa group health insurance has 8600+ cashless network hospitals in India. This makes it easier for the policyholders to avail of cashless treatment near their location.
Exclusions
- No treatment covered within first 90 days until it is a case of accident/emergency
- Benefits not applicable on pre-existing diseases
- Cosmetic, aesthetic, or related treatments are not covered.
- Any illness or disease contracted due to the intake of alcohol or other addictive substances will not be covered.
- Treatment involving non-allopathic medicines is not covered under this policy.
Documents Required to Buy the Policy
To purchase the policy, a proposer has to fill up an Application form/Proposal form with proper medical history along with the address evidence. In some cases, a medical examination may be required depending on the sum insured and the age of the individual.
Eligibility
There is No limit on age for Max Bupa (Niva Bupa) Group Health Insurance.
Claim Niva Bupa group health insurance
You can claim your Niva Bupa Group Health Insurance using a cashless claim procedure or reimbursement claim procedure.
Niva Bupa group health insurance cashless claim
Use the following steps to claim your Niva Bupa Group Health Insurance Cashless.
1. Go to your nearest network hospital
Go to your closest Niva Bupa group health insurance network hospital for treatment. Cashless treatment facilities are available only at the network hospitals.
2. Verification
Verify your identity with the help of the following documents: A government photo ID (such as a voter ID, or driver’s license), a health insurance ID card or policy number, and your company ID at a network hospital. Complete the verification procedure.
3. Submit your pre-authorization form
Submit the pre-authorization form to Niva Bupa group health insurance company within 24 hours of hospitalization in case of emergency. For planned hospitalization, submit it at least 3 days prior to hospitalization.
4. Review of request
After submitting the pre-authorization form, your cashless claim request will be reviewed by Niva Bupa Group Health Insurance’s in-house claim settlement team. Claims from network hospitals will be answered within 30 minutes, according to the insurance company.
5. Claim settlement
After Niva Bupa Group Health Insurance Company accepts the cashless claim request, the claim is settled straight with the network hospital as per policy terms and conditions.
Niva Bupa group health insurance reimbursement claim
Hospitalisations in a non-network hospital mean you will have to opt for Niva Bupa group health insurance reimbursement claim
1. Intimate the insurance company
Firstly, inform the Niva Bupa group health insurance company about the hospitalization within 24 hours in case of emergency and at least 3 days before planned hospitalization.
2. Pay the bills
After completion of treatment at a non-network hospital, you will have to pay all hospital bills and pharmacy bills with your own money.
3. Collecting the original documents
Once the bill is settled, get all the original copies of documents needed to file a claim for a refund for your Niva Bupa Group Health Insurance Plan.
Documents Needed for Filing Niva Bupa Group Health Insurance Reimbursement Claim:
- Claim form
- Medical papers, pathology reports, X-ray reports, as applicable
- Doctor’s prescription and line of treatment suggested
- Medical bills and cash memos
- Hospital Discharge Card
4. Submit the documents
Submit all the real documents to Niva Bupa group health insurance company to process the reimbursement claim.
5. Claim settlement
Once the claim is confirmed with the supporting documents, the insurance company will pay the reimbursement claim amount straight to your bank account according to policy terms and conditions.
Inclusions – What is covered under your Niva Bupa group health insurance plan?
Your Niva Bupa group health insurance is tailor-made. Hence, you can choose your coverage options. The following will be covered depending on the terms and conditions of your Niva Bupa Group Health Insurance Scheme.
Covid-19 treatments
Cover the cost of treatment for Covid-19 using your Niva Bupa Group Health Insurance Scheme.
Pre-existing conditions
All your pre-existing conditions are covered with zero waiting period in your Niva Bupa group health insurance scheme.
No disease-wise limits
Generally, retail health insurance plans have specific limits to cover particular diseases. But with your Niva Bupa Group Health Insurance, all your diseases are covered under the scheme.
Maternity and newborn coverage
When you choose a maternity insurance rider in your current Niva Bupa group health insurance, then all your maternity expenditures and newborn baby coverage for up to 90 days are covered under the policy.
Exclusions – What is not covered under your Niva Bupa group health insurance?
Cosmetic treatments
Cosmetic treatments such as plastic surgery, liposuction, and Botox are generally not covered by your Niva Bupa Group Health Insurance Scheme.
Gender-changing surgeries
Costs incurred due to sex-reassignment treatments or surgeries are excluded from your Niva Bupa Group Insurance Scheme.
Self-harm injuries
This Niva Bupa Group Health Insurance Policy does not cover injuries due to self-harm like suicide and hospitalization expenses.
Treatments for substance abuse
Treatment expenditures because of substance abuse such as drugs or alcohol are exempt from coverage in your Niva Bupa Group Health Insurance Scheme.
It is important that you calculate the premium for your policy using a health insurance premium calculator. The Niva Bupa Group Health Insurance premium is computed based on the following factors:
Riders and add-ons opted for
When you opt for riders and add-ons with existing Niva Bupa Group Health Insurance policy like maternity insurance riders and dental insurance riders, your group health insurance premium may increase compared to the premium of the last financial year.
Sum insured
The maximum amount that a health insurance company will pay in case of any hospitalization in a financial year is called the sum insured. If the hospitalization expenses exceed the sum assured, the policyholder pays the remaining amount from his/her pocket. Therefore, the more the sum insured, the higher the premiums.
Type of plan
The 3 types of Niva Bupa group health insurance plans available are employee-only (E), employee+spouse+children (ESC), and employee+spouse+children+parents (ESCP) plans. For instance, the number of people covered in the ESCP plan is more than that of the E-only plan, hence one has to pay higher premiums.
Claims history
During Niva Bupa Group Health Insurance policy renewal procedure, the claim history is taken into account to compute the premium for that financial year. If the number of claims requested by the employees in the previous financial year is more, the premium to be paid for the policy during the renewal procedure will be higher.
FAQs- About Niva Bupa Group Health Insurance
1. What is the Niva Bupa group health insurance claim settlement ratio?
Answer: The claim settlement ratio of Niva Bupa group health insurance (formerly known as Max Bupa group health insurance) is 89.46% for the financial year 2019-20.
2. What documents are required for Max Bupa group health insurance renewal?
Answer: Max Bupa group health insurance, now known as Niva Bupa group health insurance requires the following documents for the renewal process.
1. Active data of employees which includes name, age, gender, and details of dependents (as per the type of policy)
2. Claim analysis report
3. Claim dump report from the insurer/TPA
4. Policy copy
3. What is the Max Bupa group health insurance customer care number?
Answer: The customer care number of Max Bupa group health insurance, now known as Niva Bupa group health insurance is 1860-500-8888. They provide you with the necessary information and provide claim assistance. Also, you can email them at [email protected].
4. What are the benefits of Max Bupa group health insurance for employees?
Answer: The benefits of Max Bupa group health insurance for employees, now known as Niva Bupa group health insurance are
1. No waiting period for pre-existing diseases
2. No disease-wise sub-limits for health insurance coverage
3. Maternity cover and newborn baby cover can be added to policy
4. The company settles the claim using the in-house claim settlement team and not an external TPA, making the process more efficient.
5. 8600+ network hospitals pan India, this means the policyholder can make cashless claims at various locations in India.
5. How to find the Max Bupa group health insurance hospital list?
Answer: You can find your Max Bupa group health insurance hospital list, now known as Niva Bupa group health insurance under the ‘Health Network’ section on the homepage of the Niva Bupa website.