There are two ways to make claim under a Health Insurance Policy: on cashless basis and on reimbursement basis. In simple terms, for making a claim on cashless basis, the treatment must be done only at a network hospital of the insurance company servicing your policy. For availing the treatment, you would have to first seek an authorization as per the procedures laid down and in the prescribed form. In case of claims on reimbursement basis, the insurance company has to be informed as per their prescribed procedures. The policyholder has to ensure that documents such as claim form, discharge summary, prescriptions and bills to be submitted for the claim on reimbursement are obtained after hospitalization.
Max Bupa Health Insurance has a well-defined claim processing system.
Cashless Service: seeking Pre-Authorization
- Complete the pre-authorization form available at the hospital’s insurance/TPA Desk.
- Send the completed form via email or fax.
- Approved letter will be sent by the claim management team. Remember that the claim management team could send an inquiry to the hospital or you before authorization.
- In case the authorization is rejected, initiate the treatment and file for reimbursement claim.
Reimbursement Claim: Claim Submission
- Complete the necessary form and submit along with required documents, as per the policy terms and conditions.
- Necessary documents include discharge summary, prescriptions, bills etc.
- Approved letter will be sent by the claim management team. Remember that you will be answerable to any queries raised by the claim management team before the letter is issued.
- In case the claim is rejected, the reasons will be communicated by the team.
In case of any emergencies, you need to inform Max Bupa within 24 hours of the admission. In case of planned emergencies, the notification has to reach the company 48 hours prior to the hospitalization. The claim intimation can be done via Max Bupa's toll free number 1800-3010-3333. The same could also be emailed to firstname.lastname@example.org .
Note: If you are a Coverfox customer, you can directly reach out to us for all your claim-related issues and queries.
Frequently Asked Questions
- Does Max Bupa offer any plan with Maternity and New Born Child Benefits?
Yes. Max Bupa's Family Floater plans offer Maternity benefits where you can get unparalleled maternity benefits for up to 2 deliveries, provided both you and your spouse have been covered under the policy for two continuous years. Similarly, you can also protect the health of your new-born baby from birth without any additional premium. This is valid till the next policy renewal, once you have paid the maternity claim.
- I am looking for an Individual Health plan. Can I get any discount on premium?
Max Bupa's Health Individual Health Insurance gives you option to choose either 10% or 20% co-payment to avail discount on premium, if you are less than 65 years. Similarly, if you take a policy for two years, you get 12.5% discount on the premium of 2nd year.
- Is Organ Donation covered under any of Max Bupa's Health coverage?
Medical expenses for an organ donor's treatment for harvesting of the organ are covered.
- What is Health Relationship Program that Max Bupa offers?
Health Relationship Program is a loyalty program offered by Max Bupa with two options of rewards to choose from, irrespective of claim:
1. Earn & Redeem You can earn points worth 10% of your last paid annual premium after you renew your policy. You can redeem these points on Max Bupa's website for various health and lifestyle products and services.
2. Increase Sum Insured You will get 10% additional Sum Insured each policy year of expiring base sum insured. The additional Sum Insured can be accumulated up to 50% of renewal base sum insured.
- Which all hospitals are covered under Max Bupa's cashless network?
Cashless services are available at a network hospital. To locate a Max Bupa network hospital near you, click here.
Review of Max Bupa Health Insurance Company Ltd.
If you are looking to invest in a plan that has no age restrictions, no sub-limits on room rent, offers a decent No Claim Bonus up to 100% and Maternity and New Born Child benefits, Max Bupa is one of the top 5 picks. With no involvement of TPA, they claim to have a quicker resolution process including claims handling. However, if you do not appreciate the element of co-payment, you may get disappointed.