Life Insurance October 17, 2020

Max Bupa is a renowned health insurance company with a wide range of plans for customers like you. While checking the sum insured, premium payment, additional benefits of MAX Bupa Health Insurance Policy should be your primary concern, having an eye on its claim settlement ratio will help you know how much claims the company has settled. The Insurance Regulatory and Development Authority of India (IRDAI) has made it mandatory for insurers like Max Bupa to publish their claim settlement ratio on its website. Read this post that tells you the MAX Bupa Claim Settlement Ratio.

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Let’s Check First the Claim Settlement Ratio Calculation

The IRDAI calculates the claim settlement ratio of a company using the below formulae.

Claims Settlement ratio = No. of paid claims during the period / (No. of paid claims during the period + No. of rejected claims during the period)

What is the Claim Settlement Ratio of Max Bupa?

For the year 2019-20, the claim settlement ratio of Max Bupa is 99.22% as per the IRDAI annual report data. However, you should not rely on this value alone as there are other factors too that will decide whether your health insurance is good or not. You must check such factors on the insurance company’s website, such as the features and benefits of the insurance plan, before making a choice.

Insurance Claim Procedure of Max Bupa

Max Bupa understands the importance of having a health cover against the diseases or ailments you may get affected with in the future. That’s why it believes to provide the best coverage possible to the insured. The team of expert claim assessors follows the guide which is the ‘Fairest, Fastest and Friendliest’. The Max Bupa claim settlement process includes the following steps:

  1. Claim Registration
  2. Document Submission
  3. Claim Evaluation
  4. Claim Decision
  5. Settlement

The company’s dedicated claims relationship officer guides the beneficiaries or claimants at different steps of the claims process. Following is the formulae by which the company claim paid ratio is calculated.

Claim Paid Ratio = (Total Paid Claims / Total Received Claims)

Max Bupa Claim Settlement Ratio offers the information on the number of claims that were paid successfully by the insurance company to the customers among the total received claims during that year.

Unique Claim Settlement Process of Max Bupa

At Max Bupa, the company claim settlement process is personalized as per the following factors –

Speed: Quick claim in 24 hours under InstaClaim, which is subject to the following conditions –

  1. The claim amount on eligible policies is upto INR 1Crore
  2. The policy has been in force for a minimum of 3 years
  3. All the documents must be submitted before 3.00 pm at any of the Max Bupa offices (Monday to Friday)
  4. The claim does not warrant field verification

Trust: For the year 2019-20, Max Bupa’s claim settlement ratio is 99.22.

Ease: On Max Bupa official website, you can claim the policy by providing some necessary information. You can either download the claim form or visit the nearest branch office.

Dedicated officers: Max Bupa has a dedicated Claims Relationship Officer (CRO) on the next working day of claim submission. Having a CRO is useful in the case of a death claim settlement where your nominee will receive the health insurance benefits.

Support: Gives you a speedy resolution to your queries and grievances. Max Bupa’s customer support services aim to maintain one of the lowest customer incidences.

Documents Required for Max Bupa Claim Settlement

The following are the listed documents which the policyholder or nominee might need at the time of claim procedure:-

  1. Policy documents
  2. Original or attested copy of  the insured death certificate which is issued by the local municipal authority
  3. Death claim application form (Form A)
  4. NEFT mandate form attested by the bank authorities with a cancelled cheque or bank account passbook
  5. Nominee’s photo identity proof
  6. Discharge or Death summary attested by hospital authorities Post Mortem Report or viscera report (in the case of accidental death)

Importance of a Claim Settlement Ratio

The claim settlement ratio (CSR) is a calculation that reveals the percentage of insurance claims which the insurer has settled during a financial year. In other words, it is the ratio of the total number of insurance claims paid compared to the total number of received claims.

For example, if a company’s claim settlement ratio is 95%, this implies that:

  1. The insurance company paid 95 insurance claims out of every100 claim received in that year
  2. The remaining 5% are rejected by the insurer
  3. The risk management ability of the insurer is good
  4. The insurance company implemented the essential processes to identify faulty claim applications

The higher the claim settlement ratio is, the more confidence the policyholders will have in the insurer. It reflects the insurance company’s commitment to policyholders. For the financial year 2019-20, Max Bupa claim settlement ratio is 99.22% for a health insurance plan.

High Claim Settlement Ratio Benefits

When you purchase an insurance plan from an insurer with a high claim settlement ratio, you will get the following advantages

  1. Your claim disbursement will be simple, convenient, and transparent
  2. For an unexpected mishap, your loved ones will get a quick disbursal of the insurance benefit.

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