Niva Bupa Health Insurance Claim Settlement Ratio

Niva Bupa (erstwhile Max Bupa) has built a strong presence in the health insurance space since 2008. It offers everything from affordable medical policies to high-end plans with international coverage, maternity cover, and generous wellness benefits.

But when you’re choosing a health insurer, features and benefits only tell half the story. The real test begins when you or your family actually need to file a claim. That’s why understanding how an insurer performs on the Claim Settlement Ratio (CSR) becomes important. 

In this article, we’ll take a closer look at how Niva Bupa fares on this crucial metric and whether its claim performance truly matches the reputation it has built over the years.

Note: The figures are sourced from Insurer’s public disclosures (Form NL 37).

Niva Bupa's Claim Settlement Ratio has been consistently rising over the past three years. This is a positive sign that the insurer is improving its claim processing efficiency and reliability.

How to Calculate a Claim Settlement Ratio?

The Claim Settlement Ratio (CSR) shows the percentage of claims settled out of the total claims they had available to decide in a given year. A higher CSR (above 90%) generally signals smoother claim processing and better dependability. 

At Ditto, we use a uniform, transparent method to calculate this ratio across all insurers:

CSR = (Total claims settled ÷ Total claims available to settle) × 100

The total claims settled includes claims carried forward from the previous year plus new claims reported, minus claims closed without payment and claims still pending at year-end. 

This approach gives a more accurate and outcome-focused picture of an insurer’s true claim performance.

• Average Complaints: Niva Bupa sees a three-year average of 42.85 complaints per 10,000 claims, which is on the higher side compared to some of the top insurers (like Bajaj and HDFC ERGO) that usually report below 15. While there’s been some improvement over the years, this shows there’s still room to enhance post-sale support and claim handling. 
• Incurred Claim Ratio (ICR): The average ICR of 58.40% (FY21–24) puts Niva Bupa comfortably within the healthy 50–80% range. It’s a sign that they’re managing claims prudently while keeping the business sustainable.
• Annual Business / Gross Written Premium (GWP): Niva Bupa’s Gross Written Premium has grown from ₹4,073 crore in FY 2022–23 to ₹6,762 crore in FY 2024–25. This steady rise shows that more and more people are trusting the brand, and it reflects a growing presence in a competitive health insurance market.
• Network Hospitals: Niva Bupa lists 10,000+ hospitals in its network, which generally offers wide access to cashless treatment across many cities and towns. 

Quick Note:

As of September 2025, Niva Bupa has suspended cashless facility at all Max Hospitals, a significant provider in its network. This serves as a reminder that network-wide numbers don’t always guarantee access at every hospital, so policyholders should always check the up-to-date hospital-list before undergoing treatment.

Here’s how Niva Bupa compares with other major insurers, based on their average CSR over the past three financial years.

Insights: Niva Bupa doesn’t appear in the top 10 health insurers by Claim Settlement Ratio, which shows there’s room for improvement compared to the industry leaders. With a three-year average CSR of 91.62%, it performs reasonably well, but several insurers consistently settle claims at 95–99%.

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Niva Bupa Health Insurance CSR (Ditto’s Take)

Since the transition from Max Bupa, Niva Bupa has faced several operational issues leading to inconsistencies in claim handling and a noticeable rise in complaints. This is why we don’t actively recommend its plans as a first choice (even though it’s a partner insurer).

That said, Niva Bupa does offer competitively priced policies with some interesting features.  When picking a health plan, it’s important to consider CSR, other insurer metrics, claim experience, policy benefits, and pricing together. 

If you run into any issues, Ditto’s expert advisors are always ready to help, you can book a free consultation for unbiased guidance.