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 2016-17 and 2017-18:
Incurred Claims Ratio of Max Bupa Health Insurance for the Year 2016-17:
|Net Earned Premium (in Crore)||Net Claims Paid (in Crore)||Incurred Claims Ratio (in %)|
|544.28 crore||282.81 crore||51.96%|
Incurred Claims Ratio of Max Bupa Health Insurance for the Year 2017-18:
|Net earned premium (in Crore)||Net claims paid (in Crore)||Incurred claims ratio (in %)|
|575.85 crore||289.02 crore||50.19%|
Max Bupa has a low incurred claims ratio and thus proving that the company is making a good profit and is able to settle claims. The company will not load your premium as they are not incurring any loss.
You can make cashless claims or you can reimburse the 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 firstname.lastname@example.org.
- If you are getting an emergency treatment, you must call at +45 7923 2403 or send an email at email@example.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.
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.
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 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.
- 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.
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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.