How are claims settled under a cashless health insurance plan?

Cashless health insurance plans enable insurance holders to make cashless claims at insurer-network hospitals, allowing them to get treatment without out-of-pocket expenses. In 2024, nearly every major health insurance provider will offer cashless health insurance to their customers, allowing them to secure their health and financial well-being. But while this fantastic benefit exists, only a few people know how to avail of one or how to benefit from it, leading to hassle at the last moment when already at the hospital. 

This article will guide you through requesting cashless claims, from selecting the right hospital or healthcare provider for your needs to submitting the claim.

What are cashless claims in health insurance?

Cashless claims in health insurance are a type of claims process that enables policyholders to claim settlement for their medical expenses without paying anything to the hospital directly. This is because the insurer will take care of it for you when you get treated at a network hospital. In cashless claims, your insurance provider will coordinate and settle the bill based on your policy coverage. 

What are the benefits of cashless claims?

There are several benefits of availing cashless claims instead of going through the reimbursement claims process. 


  • Sometimes, health just takes a toll, resulting in hospitalisation. While suffering from this, it is beneficial not to worry about making out-of-pocket expenses for medical treatment. 
  • Niva Bupa, one of India’s leading health insurance providers, offers instant cashless claims with claims processing in just 30 minutes.
  • Cashless claims require minimal documentation, allowing you to secure your and your loved one’s health without worrying about gathering documents when getting treatment.
  • With cashless claims, you will not have to dip into your savings to pay the hospital bill while waiting for future reimbursement.

How to select the right hospital for your health insurance needs?

As cashless claims are only offered when a policyholder avails treatment at an associated network hospital, policyholders need to be aware of nearby and preferable network hospitals for planned hospitalisation. Insurance companies like Niva Bupa Health Insurance provide a mix of hospitals and other healthcare providers ranging from primary caregivers to multi-speciality and super-speciality hospitals, allowing you to choose the best hospital for you and your needs. To check the list of network hospitals for Niva Bupa, visit >Health Network.

How do you request health insurance claims?

The process for requesting health insurance claims depends on the specific insurance provider your policy is from. Whether you purchase a policy from leading insurers like Niva Bupa or smaller insurance providers, the process can checked at their specific websites.
Here are the steps to submit cashless claims with Niva Bupa. Keep your documents ready to get your claim approved as soon as possible. 

For Planned Hospitalisation

  • Visit the TPA desk of the hospital two days in advance or earlier
  • Complete Pre-Authorisation form
  • Cashless health insurance claims can be availed during hospitalisation as well


Documents required

  • Health card number
  • Photo ID of patient
  • OPD prescription
  • Investigation reports confirming the diagnosis


Documents Required for KYC (Claims over ₹1 Lakh)

  • A recent photo of the patient
  • Aadhaar Card or Driver’s License or Passport copy


Once you have submitted the request, you will receive an email notification and SMS alert with the decision within 30 minutes of Niva Bupa receiving the documents. Once this is done, it takes up to 2 hours for Niva Bupa to process the claim amount to the hospital.

While choosing and going to a network hospital to get the best benefit of cashless health insurance is preferable, it is not always possible. This is why, in case of emergency, go to the nearest hospital, and once your health is stable, check if the hospital is partnered with Niva Bupa. 

You can ask the TPA Desk for this information or use the link in the “How to select the right hospital for your health insurance needs?” section to check out all the hospitals networked with Niva Bupa. If the hospital is part of the network, follow the same process. If not, you can request a reimbursement claim by visiting the Niva Bupa website. 


Cashless health insurance provides an excellent way for policyholders to request health insurance claims without having to worry about making out-of-pocket expenses for medical treatment. Not only this, but cashless claims require minimal documentation, making the claims process a lot more convenient without having to dip into savings in the hope of reimbursement.

As every insurer’s claims process differs, it might be necessary for policyholders to ask the insurer their policy is from for more information, visit their website, or speak with an insurance agent if you have purchased your policy from them. However, individuals with health insurance from Niva Bupa can follow the above-given health insurance claims process for cashless claims for reference. 


Leave a Comment