Health insurance plans have always been a popular financial tool for safeguarding one’s savings during health scares. However, as lifestyle ailments grew and the pandemic struck, the demand for health insurance policies has increased significantly over the years. This increased demand gave way to new insurer players surfacing in the health insurance industry. While these fresh insurers brought scopes for customisations in their newly launched policies, some seasoned insurers held on to their popularity, considering their already established credibility and brand reputation. This includes Niva Bupa, a popular standalone health insurance provider founded in 2008 as a joint effort of Fettle Tone LLP and Bupa Singapore Holdings.
Niva Bupa is well-known across the health insurance industry for its affordable policies and innovative, industry-first features. While the health insurance plans from this stable are considered popular, we are curious to know if this insurer is as credible as it is marketed. The first step to acknowledging this would be to explore the Niva Bupa Health Insurance Claim Settlement Ratio.
What is the Claim Settlement Ratio?
The Claim Settlement Ratio (CSR) of a health insurance provider is given by -
(Total number of claims settled by an insurer in a year/ Total number of claims received by the insurer for the year) * 100
For health insurance providers, our recommended CSR is 90 and above. However, make sure that this number doesn’t cross the 100 mark because that indicates outstanding claims being settled after a long period. This delay in claims is the last thing you want, whether you are dealing with cashless or reimbursement modes of claim settlement.
What is the Niva Bupa Health Insurance Claim Settlement Ratio for 2024?
| Years | CSR for Niva Bupa Health Insurance | Industry Average of CSR |
|---|---|---|
| 2020 - 2021 | 90.68 | 91.48% |
| 2021 - 2022 | 90.78 | 89.96% |
| 2022 - 2023 | 90.53 | 91.46% |
| Average (2020 - 2023) | 90.66 | 90.97% |
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(Please remember that when looking for the Niva Bupa Health Insurance Claim Settlement Ratio 2024, you must consider the data for the last financial year, 2022 - 2023. However, a single year’s data can be misleading. Thus, we consider the data for the previous 3 years, draw out an average and then tally it against the industry average. This gives a more in-depth view of the overall performance of the insurer and its consistency.)
Overview of Niva Bupa Health Insurance
What is the significance of Niva Bupa Health Insurance Claim Settlement Ratio 2024?
Once you have looked at the Claim Settlement Ratio of Niva Bupa Health Insurance for the last 3 years, you will need expert insight into the significance of these numbers. Here’s what this insight comprises -
- Consistency: Niva Bupa has had a few ups and downs across its Claim Settlement Ratio from 2020 to 2023. Unfortunately, at times, the number remained marginally close to 90. Such numbers over the years, with not much improvement, is not a great sign for its policyholders, considering it indicates a lack of consistency.
- Overall Performance: Niva Bupa’s CSR barely crosses our recommended threshold number on average. Even year-on-year, this CSR fails to match the industry average.
Why is the Claim Settlement Ratio important?
The Claim Settlement Ratio or CSR of a health insurance provider is the first step to measuring the credibility of an insurer, which sets its reputation among policyholders. This data reflects the claim settlement record of an insurer, thus indicating whether the provider settles a majority of its claims, delays them, or rejects them.
While it’s true that a health insurer's CSR is an indicator of its credibility, this can’t be the sole deciding metric when evaluating an insurer. You must also consider its Incurred Claim Ratio (ideally between 50 and 70), complaint volume (as low as possible), and number of partner hospitals (the higher, the better).
What is the Claim Settlement Process for Niva Bupa Health Insurance?
- CASHLESS
STEP 1: Reach out to Niva Bupa 48 hours before the hospitalisation (planned treatment) or within 24 hours of hospitalisation (emergency hospitalisation) via the hospital insurance desk.
STEP 2: Submit the required documents (as mentioned below).
STEP 3: The hospital will request the insurer for their pre-authorisation approval.
STEP 4: The insurer approves the treatment, and you can go ahead with a cashless mode of claim settlement, which will be covered by your insurer when you are discharged.
(Please note that in case your cashless request is denied, you can still go on with the treatment. You will need to pay the bill from your pocket initially and can later file for a reimbursement claim settlement. The process for this is mentioned below.)
- REIMBURSEMENT
STEP 1: Reach out to the insurer at 1860 500 8888 and inform them about your reimbursement claim filing.
STEP 2: Complete the claim form and submit it with the required documents (as listed below) online or at the nearest branch.
STEP 3: After cross-verification of your documents and the hospital desk, the insurer will disburse your claim amount to your bank account.
What are the documents required to settle claims for Niva Bupa Health Insurance?
When planning to file a claim to Niva Bupa Health Insurance, make sure you have the soft/hard (online/offline process) copies of the following documents handy -
- CASHLESS
- Policy number (health insurance card)
- Copy of ID proof
- REIMBURSEMENT
- Copy of duly filled Claim form
- Copy of ID proof of the patient
- Copy of Aadhar and PAN of the proposer
- Copy of Discharge summary
- Copy of investigation reports confirming diagnosis and all doctor consultation papers
- Copy of final bill with detailed breakup
- Copy of payment receipt against the payment made
- Copy of cancelled cheque bearing pre-printed name of the proposer on it or copy of last 3 months bank statement of the proposer bearing bank account number and IFSC code or copy of the first page of bank passbook of the proposer showing bank account details
Please note: Based on the underwriter’s decision, you may be required to submit some additional documents.
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Conclusion
While Niva Bupa offers affordable health insurance plans with industry-first features, its CSR is not encouraging. Additionally, the complaint volume for this insurer stands at 44.52 (average), and the Incurred Claim Ratio is only 57.42. Subsequently, despite having a list of great health insurance plans (Niva Bupa ReAssure 2.0 and Niva Bupa Aspire), Niva Bupa’s metrics are something that could be concerning to some customers.
