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By clicking Start Now, you authorize Niva Bupa to Call/SMS/Whatsapp on your registered mobile overriding DNCR.Third Party Administrator
A Third Party Administrator (TPA) in health insurance acts as an intermediary between insurers and policyholders, managing claims, cashless hospitalisation, and customer support to ensure smooth and efficient service during medical emergencies.
Network of 10,400+ cashless Hospitalisation
30 Mins Cashless Claim Policy
1.4 Crore+ Happy customers
Why Choose Niva Bupa?
Trusted by over 1.4 crore+ happy customers, Niva Bupa (formerly known as Max Bupa Health Insurance) provides a wide range of health insurance plans to suit every need
30 min
Cashless Claim Processing 1
15 Lakh+
Claims paid since inception 2
1.4 Crore+
Happy customers served till date
Custom Health Insurance Plans designed for You
A plan that rewards you for starting young
Starts from
₹8,6321
Annual Premium
₹5,00,000
Sum Insured
- Lock the age, pay premiums as per entry age till you claim
- Don’t lose what you don’t use. Carry forward the balance sum insured
- Maternity coverage including IVF, Adoption and more
- Use and get back your base coverage. Unlimited times and forever
Nothing Seems Impossible. The Most Comprehensive health insurance plan.
Starts from
₹7,8212
Annual Premium
₹5,00,000
Sum Insured
- Save as you age. Pay as per entry age, until you claim.
- Use and get back your base coverage. Unlimited times and forever.
- Don’t lose what you don’t use. Carry forward the balance sum insured
- Up to 30% discount on renewal premium basis step count
A Health Insurance Plan that works your way
Starts from
₹4,8043
Annual Premium
₹5,00,000
Sum Insured
- Pay Apne Hisaab se! Flexible or One Time. Sooner the payment, higher the discount
- Get 50% of your premium back, accumulate it, and even get 10% bonus for life. No waiting periods or exclusions on this amount.
- Get ₹5,000, if treatment taken in any Govt. hospital and claim not paid under this policy
- Access unlimited digital consultations with general physicians through our mobile app.
A comprehensive health insurance plan,with coverage for you and your family according to your needs and lifestyle.
Starts from
₹11,5714
Annual Premium
₹5,00,000
Sum Insured
- Comprehensive coverage up to ₹3 Cr
- In-built travel insurance coverage for multiple trips in a year
- Modern Treatments coverage
- Maternity (worldwide) and new born baby cover
The Smart Health Insurance Plan with Smart Feature to keep your family protected
Starts from
₹11,7755
Annual Premium
₹5,00,000
Sum Insured
- No Room Rent Capping
- Modern Treatments Covered up to Sum Insured
- Hospitalisations of 2 hours or more covered
- One time refill of Base Sum Insured, even for same illness.
Quick Links
Network Hospital
Find hospitals near you that are covered under our insurance network for hassle-free cashless treatment
Family Health Insurance
Get comprehensive coverage for your entire family under a single health insurance plan.
Claim Settlement Ratio
Check our track record for successfully settled claims, ensuring peace of mind when you need it most.
Premium Calculator
Calculate your insurance premium easily to choose a plan that fits your budget.
Best Insurance Plans
Explore our top-rated insurance plans that offer extensive benefits for various healthcare needs.
How does Our Claim Process work?
Get to know the steps involved in the claim Process, Whether it is a planned or emergency hospitalisation. Filling a claim is made easy by choosing any of the following ways:
Hospital Admission:
Get admitted to a Niva Bupa network hospital.
Identification:
Present your Niva Bupa Health Card or policy number along with valid ID (Passport/PAN card/Voter’s ID) to the hospital staff.
Pre-authorisation:
The hospital will verify your details and submit a pre-authorisation request to Niva Bupa.
Niva Bupa Confirmation:
After verification, Niva Bupa will confirm coverage to the hospital via fax and email, and notify you by text and email, typically within 30 minutes of the request.
Final Settlement:
Upon completion of treatment and necessary formalities, the hospital will settle the claim with Niva Bupa according to your policy terms.
What is a Third Party Administrator (TPA)?
Third-party administrators (TPA) are organisations that run duties like claim processing, managing employee benefits as per contracts, etc., generally for employee benefits and insurance. Health insurance companies outsource to TPAs for enrolment and claim processing. TPAs serve an entirely administrative function and have no legal or financial obligation. They are not authorised to accept or reject a claim without the insurance company’s approval. And, the risk of loss, however, remains with the employer.
What is a TPA in Health Insurance?
A third-party administrator is a licensed outsourcing entity selected by a medical insurance company and regulated by the Insurance Regulatory and Development Authority of India (IRDAI). TPA works with the employer and the insurer to establish clear communication between the two, process claims, enrolment and many other two-days activities.
Role of TPA in Health Insurance
TPA plays a crucial role in the total processing of medical insurance claims. The role of TPA begins immediately after the insurer issues the best health insurance policy. Some of the essential functions that TPA in insurance include:
The role of TPA in health plan can be understood with the points below:
Connecting Link: In most hospitalisation claims, the policyholder directly or indirectly meets the TPA. The TPA provides the policyholder with a Unique Identification Number and ID card, which aids in claim settlement.
Record Maintenance: TPA helps maintain vital records related to policyholders when admitted as patients.
Claim Settlement: TPA ensures smooth coordination between the hospital and insurance company during cashless claim settlement. TPA offers back-end support in such cases.
Full-time Support: Most TPAs have a 24/7 customer support system where the policyholders can raise their queries and get feedback.
Additional Services: Most TPAs can also provide other services like extra beds, ambulances, medical supplies, etc., to policyholders.
Benefits of Third Party Administrator in Health Insurance for Policyholders
While the more prominent insurance companies have their in-house claims department, they also engage with TPAs to share the workload. Therefore, when choosing a medical insurance plans, you may also have to look at the TPA facility to understand the process better. The parameters below can help you choose a TPA for processing claims:
Hand-holding during hospitalisation.
Providing ID cards to policyholders/patients.
Assistance regarding the right kind of documentation.
Efficient Cashless Claims settlement process.
24×7 customer support.
Simplification of the entire claim settlement process.
List of TPAs in India for Medical Insurance
Here's a thorough list of TPAs for health plan that has been sourced from the Insurance Regulatory and Development Authority of India's (IRDAI) official website:
How TPA Works in India?
A TPA acts as an intermediary between the policyholder and the insurance company. Their work is to simplify the claim settlement procedure under health insurance policies. As we know, there can be two processes of claim settlement:
Cashless Settlement
Reimbursement Settlement
How to Cancel TPAs in Medical Insurance?
TPAs act as facilitators. And if there is any delay between the services being provided, you can contact the insurer, and they shall coordinate with the TPA and let you know about the progress. In addition, if you feel you want to cancel a TPA or switch to another TPA, you can discuss a change in service with the insurance company. Here are the steps to cancel a TPA in health plan:
Step 1: Reach out to your insurer via email or call.
Step 2: Communicate policy details and unique ID (UID), if any.
Step 3: Explain your reason for TPA cancellation.
Step 4: Select another TPA from the list if the insurer approves the change.
Frequently Asked Questions
Our Satisfied
Customers
Watch what our customers are saying. REAL STORIES with REAL IMPACT!
Vippan Kapur
It is unbelievable how Niva Bupa claim team came to my aid, Monday to Sunday no day off.
Meenakshi Khanna
Within few hours we got the claim number and in the next three days the amount was reflected in our bank account.
Vijay Kapoor
With the help of Niva Bupa Health Insurance, I was able to get my son treated without worrying about the high medical cost.
Diviay Chadha
Whenever we have filed for a claim with Niva Bupa, the process was very smooth and people were very helpful.
Parveen Singh
The Niva Bupa team was extremely helpful, be it day or night, someone was always available.
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