• Max Bupa Health Insurance Claims Procedure

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    Max Bupa allows cashless claims and reimbursement claims on the health insurance. Cashless claims facility are available with network hospitals. The network hospital will assist you in completing the formality regarding the cashless request. If you are getting treated in a non-network hospital, then you must clear all the bills at the hospital and then claim for reimbursement. There are over 3,500+ network hospitals that provide cashless hospitalisation benefits.

    Incurred Claim Ratio of Max Bupa Health Insurance:

    ICR or Incurred Claims Ratio for Health Insurance companies in India is published by IRDA each year. ICR is the overall value of the claims the company has paid divided by the total sum of premiums collected for that period. The following is the incurred claim ratio for Max Bupa for the year 2014-15 and 2015-16:

    For 2015-16:

    Net Earned Premium (in lakhs INR) Net Claims Paid (in lakhs INR) Incurred Claims Ratio (Percentage)
    39311 23402 59.53

    For 2014-15:

    Net earned premium (in lakhs) Net claims paid (in lakhs) Incurred claims ratio
    31,524 17,388 55.16%

    Max Bupa has a low incurred claims ratio and thus proving that the company is making a good profit and is in a position to settle claims. The company will not load your premium as they are not incurring any loss.

    Claim Procedure:

    You can make cashless claims or you can reimburse the claim.

    1. Cashless claim:

      In cashless claim, you do not have to settle the bill if you are hospitalised in a network hospital. Max Bupa will be represented by the Third Party Administrator and the TPA will coordinate with the hospital and settle the bill. The process for cashless claim is as follows:

      Cashless Claims Procedure:

      You may be admitted in a hospital due to emergency or it could be planned, you need not worry about paying the hospital bill. If you are planning the hospitalisation, you must contact the service provider 2 days before the admission. Emergency admission has to be notified within 24 hours of hospitalisation. If you have been admitted in a network hospital then you can contact the TPA of Max Bupa and check if cashless claim can be made. You will then have to follow the following procedure to claim:

      • You must get admitted in a network hospital.
      • You must then use the Max Bupa Health card or share your policy detail or PAN card or voter’s ID for identification purposes. You can call at the toll free number 1800-3010-3333 or you can send an email at customercare@maxbupa.com.
      • If you are getting an emergency treatment, you must call at +45 7923 2403 or send an email at emergency@ihi.com.

      Cashless Claims Process:

      • The network hospital will then check your identity and validate.
      • The pre-authorisation request will be submitted to Max Bupa.
      • Max Bupa will review the documents.
      • The confirmation will be communicated to the hospital by fax or e-mail. The claim request will be communicated within 30 minutes.
      • After completing the formalities, the claim will be settled as per the policy terms and conditions.
      • The cashless facility is available at the cashless network hospitals.
    2. Reimbursement of Treatment Expenses:

      You can reimburse your treatment expenses if your cashless claim does not get approved or if you are getting the treatment at a non-network hospital. You will however have to clear the hospital bill first. You will have to notify the service provider within 48 hours of the admission. The following is the procedure to file for reimbursement:

      • Clear out the bill at the non-network hospital.
      • Collect all relevant documents, reports, invoices and discharge certificate from the hospital on discharge.
      • The documents have to be submitted to the service provider along with the duly filled claim form and valid ID and age proof.
      • The claim form is available on the Max Bupa website.
      • The relevant documents must be mailed to: Max Bupa Health Insurance Company Ltd., B-1/I-2, Mohan Cooperative Industrial Estate Mathura Road, New Delhi – 110 044.

      Documents Required:

      While reimbursing your claim, you must submit the following documents:

      • The claim form must be filled.
      • Doctor’s certificate is to be attached.
      • Final hospital discharge summary
      • Original final hospital bill
      • Original investigation report
      • Detail of any other insurance policy that may respond to a similar claim
      • Original consultation notes
      • FIR copy, if required
      • Copy of the Medico Legal Certificate, if required
      • If the claim is for accidental death, then the claim form along with original death certificate, copy of FIR, copy of Medico Legal Certificate, proposer’s income proof, last 3 month’s salary slip, employer’s certificate and audited accounts must be submitted.
      • The claim payment will be made within 30 days from receipt of the documents.

      Claims Process:

      • The claim processing team will check the documents that you have submitted and ask for additional documents if required.
      • The claim request will be reviewed.
      • The approval or rejection of the claim will be then communicated to you.
      • The claim will be settled as per the terms and conditions of the policy and the approved amount will be reimbursed.

    This Insurance Company has not partnered with BankBazaar.com. For more details, please visit its website/branch office. The trademarks, logos and other subject matters of intellectual property belong to their respective owners.

    GST rate of 18% applicable for all financial services effective July 1, 2017.

    Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.

    Max Bupa Health Insurance Claims Procedure Reviews

  • Page 1 of 5 1 2 3 4 5
    • Max Bupa Health Insurance
      "Good Protection for Health"
      0.5 4.0/5 "Great!"
      Max Bupa gives the medical cover around Rs. 2 lakhs its covers only for me. I paid around Rs. 2500 as premium amount for one year. They do have tie up with good hospital. I hope Max Bupa is providing tax benefits and no claim bonus on the health policy.
      Was this review helpful? 0
      , bangalore
      Reviewed on Feb 20, 2018
    • Max Bupa Health Insurance
      "Good"
      0.5 4.0/5 "Great!"
      I do hold the health insurance policy with the Max bupa general insurance company and am with them from the last six years of time. I dont have any claim experience with this company till date. Everything is better one with the Max bupa general insurance company.
      Was this review helpful? 0
      , chandigarh
      Reviewed on Jan 20, 2018
    • Max Bupa Health Insurance
      "Average policy to use"
      0.5 3.0/5 "Satisfactory"
      Having an accidental coverage health insurance policy with Max bupa and I have paid Rs,3500 to get this policy. This policy has the medical coverage up to Rs,1,00,000 and it has the tenure of one year. I never have any claim experience with this policy.
      Was this review helpful? 0
      , salem
      Reviewed on Jan 18, 2018
    • Max Bupa Health Insurance
      "Very good insurance"
      0.5 4.0/5 "Great!"
      I have a health insurance policy with Max Bupa from last 1 year and it is a good insurance policy to use. I pay a premium of Rs 3000which has to be paid every year for this insurance. I have not taken any cashless treatment and i do not have claim experience. The coverage and benefits are good in this policy.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Jan 05, 2018
    • Max Bupa Health Insurance
      "Pathetic customer service"
      0.5 0.5/5 "Unacceptable"
      They have all of sudden added permanent exclusion in my policies which i hold for my parents. Each year after no claims they increase my premium by 20%. They have highest premium and provide worst customer service. Their customer care executives have not been able to solve my concerns even in a month and they keep on passing the buck. There is no accountability and responsibility that anyone takes. I ask for their senior's number they don't provide me any of that. I feel completely cheated and till now I have not even gone through the claims settlement process. I have been their user for around 4 years now.
      Was this review helpful? 0
      , gurgaon
      Reviewed on Jan 02, 2018
    • Max Bupa Health Insurance
      "Excellent"
      0.5 5.0/5 "Blown Away!"
      I don't have any claim experience with Max Bupa. If customer wanna claim, the approval will be taken within 30mins. Th medical coverage and cashless treatment is excellent. It depends upon the customer need how much they ensured for. They are providing a good service to the customers.
      Was this review helpful? 0
      , noida
      Reviewed on Nov 25, 2017
    • Max Bupa Health Insurance
      "Good health insurance policy"
      0.5 5.0/5 "Blown Away!"
      I hold a health insurance policy with MAX BUPA from last 3 years. This policy has to be renewed every year in order to continue. I pay a premium of Rs 9000 on annual basis through online. I am convenient with the payment options which they are giving. I did not have a claim experience so far. I am also satisfied with the coverage and benefits of this policy.
      Was this review helpful? 0
      , new delhi
      Reviewed on Nov 22, 2017
    • Max Bupa Health Insurance
      "Excellent"
      0.5 5.0/5 "Blown Away!"
      My health insurance was taken with Max Bupa. It was taken 3 years back. It was a good service with Max Bupa. I make the payment of 13000 rupees per annum, its covers my wife and children. The customer service is good. The claim experience is very good. They provide cashless facility.
      Was this review helpful? 0
      , bangalore
      Reviewed on Nov 16, 2017
    • Max Bupa Health Insurance
      "Good Policy to hold"
      0.5 4.0/5 "Great!"
      I have a health insurance policy with MAX BUPA Insurance. I have been using this health insurance for the past 2 years. I pay annually Rs. 17000 for this insurance. I have a claim experience last year which the service is very good and fast and within half an hour they have given my claim.
      Was this review helpful? 0
      , new delhi
      Reviewed on Oct 28, 2017
    • Max Bupa Health Insurance
      "Claim is good"
      0.5 4.0/5 "Great!"
      I felt this Insurance to be having high incentives, The claim options are very good and plan benefit is very high. I have been using this Insurance for the past 4 years. Yearly I pay around Rs.13000 to Rs.14000, which seems pretty decent compared to the coverage I get.
      Was this review helpful? 0
      , chennai
      Reviewed on Oct 16, 2017
    • Max Bupa Health Insurance
      "Beware of MaxBupa - Its a scam!!!"
      0.5 0.5/5 "Unacceptable"
      If you want to secure the health of your family then never ever take any health policy from Max Bupa Health Insurance. You know why our country is still developing? Because British might have left the country but they are still looting us through companies like Max Bupa. But the sad part is there is no one who will listen to you... Words you will hear when taking the claim: a.) Fraud b.) Pre-existing disease which you didn't declare c.) Room out of your policy d.) Fake Documents My Case: Admitted to the Hospital: Dec 2015 Applied for Reimbursement: Jan 2016 Claim Rejected: Feb/Mar 2016 Claim Rejection Reason: Fake Documents Policy Renewal: End of Mar 2016 (otherwise they wont settle) Admitted Hospital: Jun 2016 Cashless Approval: Day of Admission Cashless Rejection: Day of Discharge Applied for Reimbursement: Jun/Jul 2016 Claim Rejected: Sep 2016 Claim Rejection Reason: Pre-Existing Disease Policy Renewal: End of Mar 2017
      Was this review helpful? 0
      , new delhi
      Reviewed on Oct 04, 2017
    • Max Bupa Health Insurance
      "Good overall"
      0.5 4.0/5 "Great!"
      I have taken a health insurance from Max Bupa and the process to get my insurance was smooth. I did not have to follow a huge process. The coverage is good, it is around four to five lakhs. The premium is normal and till date I have not had any claims.
      Was this review helpful? 0
      , greater noida
      Reviewed on Sep 28, 2017
    • Max Bupa Health Insurance
      "Average"
      0.5 3.0/5 "Satisfactory"
      I have taken a health insurance from Max Bupa and I had a claim experience once. But it was not a convenient process as the customer services was not up to the mark. The premiums are paid on a yearly basis. The insurance only cover the major illness alone.
      Was this review helpful? 0
      , coimbatore
      Reviewed on Sep 27, 2017
    • Max Bupa Health Insurance
      "Excellent benefits & coverage"
      0.5 5.0/5 "Blown Away!"
      It is a family floater at Max Bupa. I have taken a health insurance policy from them. The premium is of 3k and it is paid on a annual basis. My family and I have a medical coverage of five lakhs on a yearly basis and the best factor is the no claim bonus feature.
      Was this review helpful? 0
      , jalandhar
      Reviewed on Aug 30, 2017
    • Max Bupa Health Insurance
      "Max Bupa Max Fraud Company "
      0.5 0.5/5 "Unacceptable"
      Max Bupa Health Insurance Fraud Company MaxBupa's famous tagline "Your Health First" is as fake as all their policies and assurance. They are very well known for fooling innocent customers by luring them by advertisement. Never believe on positive reviews always check negative reviews to know the truth. To read more genuine reviews just Google 'Max bupa fraud' and see the results. Name : Chandan Thakur My policy number is 30568647201600 and claim id is 259868.
      Was this review helpful? 0
      , mumbai
      Reviewed on Aug 28, 2017
    • Max Bupa Health Insurance
      "Economical premium"
      0.5 4.0/5 "Great!"
      I have taken a health insurance from Max Bupa. It is for my family and I. Fortunately I have no claim till date. The premium is economical and they have provided a good medical coverage. The company also has a tie up with a good net work of hospitals.
      Was this review helpful? 0
      , thane
      Reviewed on Jun 16, 2017
    • Max Bupa Health Insurance
      "could be better"
      0.5 4.0/5 "Great!"
      I am having the health insurance policy with the Max Bupa general insurance company and I choose them because they are not charging anything as hidden like everything is very hidden. I have not faced any claims with them till now and they are having good tie up with all the affiliated hospitals.
      Was this review helpful? 0
      , ghaziabad
      Reviewed on Jun 10, 2017
    • Max Bupa Health Insurance
      "Fabulous"
      0.5 5.0/5 "Blown Away!"
      I am having the health insurance policy with the Max Bupa general insurance company and the coverage value is around 25 lakh Rupees and the premium is around 28000 Rupees. I got this policy through the reference of my relatives. Claim settlements are nil with them and customer service is good one with them.
      Was this review helpful? 0
      , mumbai
      Reviewed on Jun 08, 2017
    • Max Bupa Health Insurance
      "Good policy"
      0.5 3.0/5 "Satisfactory"
      I have never had claim experience so far with this health insurance policy. I hold a Max Bupa health insurance policy. The medical coverage is really good with this insurance policy. I pay Rs.4000 yearly to renew the policy. This policy covers only myself. It is also called as self insurance policy. Overall, I am satisfied holding this policy. I can say it is a good health insurance policy.
      Was this review helpful? 0
      , panchkula
      Reviewed on Jun 07, 2017
    • Max Bupa Health Insurance
      "Good "
      0.5 4.0/5 "Great!"
      I have taken the health insurance policy with the Max bupa general insurance company and I have not done up with any claims. The coverage value is around five lakh Rupees with the premium of around 500000 Rupees per annum, also it provides coverage except plastic surgery and dental treatment.
      Was this review helpful? 0
      , mysore
      Reviewed on May 09, 2017
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