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  • Max Bupa Health Insurance Claims Procedure

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    Cashless Treatment

    Customer Service

    Medical Coverage

    Claim Experience

    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 Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance policy with MAX BUPA from last 6 years, i am happy with the coverage value of this insurance policy. I have no claim experience so far with this insurance and i get no claim bonus every year. The coverage value for this insurance is Rs 15-20 lacs.
      Was this review helpful? 0
      , faridabad
      Reviewed on Sep 12, 2018
    • Max Bupa Health Insurance
      "Good health insurance policy"
      0.5 4.0/5 "Great!"
      I have taken this health insurance policy for my family. I have taken this policy 2 years before and i have not experienced of any of the claim still now. Its a claim amount of Rs. 2 lakhs worth-able policy. I have to pay the premium amount of Rs. 3500. I never called the customer care service. I will make the payment through credit card and debit card.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Jul 29, 2018
    • Max Bupa Health Insurance
      "Very Good Service"
      0.5 4.0/5 "Great!"
      I had taken this insurance policy almost an year back for me and my wife. I had been making all the payments online and it had been easy. Their cashless treatment and the medical coverage had been very good as well. There has not been any hassle faced with the services of them. I have not yet made any claims with this policy.
      Was this review helpful? 0
      , new delhi
      Reviewed on Jul 26, 2018
    • Max Bupa Health Insurance
      "Very Good Service"
      0.5 4.0/5 "Great!"
      I had taken this insurance policy almost one year back for my Mother. It has been a good policy where the medical coverage and the cashless treatments has been good. I had been paying all the premiums online and it had been easy. Most of the hospitals are covered with this policy and i had not yet claimed any of their claims or availed any of their cashless treatment facilities.
      Was this review helpful? 0
      , new delhi
      Reviewed on Jul 26, 2018
    • Max Bupa Health Insurance
      "Don't buy health insurance from Max Bupa"
      0.5 0.5/5 "Unacceptable"
      I have taken policy for brother. while playing he suffered from knee injury. During hospitalization doctor suggested for ligament operation. After that we applied for cashless but max bupa rejected cashless and suggested for reimbursement. After hospitalization we submitted all claim document. max bupa send message that within 21 days claim will approved. Now after 40 days also claim is not approved and showing Suspense status . after that i checked review from many website, i come to know that max bupa claim ration is zero. This is fake company who not settle any claim. Below are my claim details: Claim Number: 339012 Final Status: Suspense Claim Decision Date: Saturday, June 9, 2018 12:00 AM
      Was this review helpful? 5
      , pune
      Reviewed on Jul 12, 2018
    • Max Bupa Health Insurance
      "Worst Service"
      0.5 1.0/5 "Really Bad"
      I've been using the health insurance policy from the Max Bupa for a while. I pay a premium of 4000 per year, on one occasion my father got hospitalized . They rejected the claim because it was only covered for myself. They wasted 3 days for the claim process. I am not at all happy with their services.
      Was this review helpful? 1
      , visakhapatnam
      Reviewed on Jun 25, 2018
    • Max Bupa Health Insurance
      "Good service"
      0.5 3.0/5 "Satisfactory"
      I got the health insurance policy from the MAX BUPA around 3months ago, this policy has the tenure of 3years. This policy covers 2 members in my family,. I can claim up to Rs,50,000 with this health insurance policy . I would say it gives a good service.
      Was this review helpful? 0
      , hyderabad
      Reviewed on May 31, 2018
    • Max Bupa Health Insurance
      "Good policy to use"
      0.5 5.0/5 "Blown Away!"
      I got the MAX BUPA health insurance policy around 3months ago. This policy covers around 3members in my family. I have paid Rs,13,000 to avail this policy. The plan benefits and the coverage is good from this policy. The claim coverage is available up to 5,00,000 and I am satisfied with it.
      Was this review helpful? 0
      , chennai
      Reviewed on May 14, 2018
    • Max Bupa Health Insurance
      "Average Policy"
      0.5 3.0/5 "Satisfactory"
      I had my health insured with MAX BUPA 2 years back, i did not had any claim experience so far with this insurance policy. The premium amount was very high when compared to other insurance, it is for Rs 18000. I have a coverage value of Rs 10 lakhs for this insurance policy.
      Was this review helpful? 0
      , hyderabad
      Reviewed on May 07, 2018
    • Max Bupa Health Insurance
      "Best policy"
      0.5 5.0/5 "Blown Away!"
      I have my health insured with Max Bupa health insurance from last 4 years, i have a coverage value of Rs 30 lakhs for this insurance policy. My claim experience was very good and i claimed 100% of the billed amount. I have also taken the cashless treatment from this insurance policy.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Apr 26, 2018
    • Max Bupa Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have my health insured with MAX BUPA insurance from last 1.5 years, I have a very good coverage value of Rs 4 lakhs for this health insurance. I am not aware of the premium amount as my company pays it. I have not taken any cashless treatment and there is no claim experience so far.
      Was this review helpful? 0
      , chennai
      Reviewed on Apr 16, 2018
    • Max Bupa Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I hold a health insurance with Max Bupa from last 6 months and it is one of the good policy to use. This policy has to be renewed every year and i pay a premium of Rs 5000 for this insurance. I do not have claim experience so far with this insurance and i have a coverage of Rs 3 lakhs for this insurance.
      Was this review helpful? 0
      , bangalore
      Reviewed on Mar 13, 2018
    • 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
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