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  • Bupa Claim Form

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P.1 BUPA CLINICAL CLAIM FORM Only completed original claim form is accepted To be completed by Member Claim Form No. Membership No. of Patient (16 digits) Must be completed Name of Subscriber / Employer.

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How to fill out the Bupa Claim Form online

The Bupa Claim Form is essential for users seeking reimbursement for medical expenses. This guide provides clear and detailed instructions to help you complete the form effectively online.

Follow the steps to successfully fill out your claim form.

  1. Click the ‘Get Form’ button to access the Bupa Claim Form and open it for editing.
  2. Enter your membership number in the designated field. This is a crucial detail that ensures your claim is linked to your account.
  3. Fill in the subscriber's name or the employer’s name as necessary. This should be the individual or entity under which the claim is filed.
  4. Provide the daytime contact telephone number. This allows Bupa to reach you for any follow-up regarding your claim.
  5. Complete the patient’s details, including their name and date of birth. If the patient is not the subscriber or employee, use the appropriate fields.
  6. List the nature of your claims by marking the appropriate checkboxes for the type of treatment received, such as physiotherapy or specialist treatments.
  7. Detail the treatment date and any relevant identifiers or numbers in the specified fields. Include specifics that relate to the assessment of your claim.
  8. Document the amount indicated on your medical receipts in the respective field. Ensure that this matches the total from the receipts provided.
  9. Indicate when the patient's symptoms first appeared. This information may be vital for the assessment of your claim.
  10. Complete any sections that apply to hospital visits, referrals, and any previous claims under Bupa or another insurer.
  11. Review the 'Declaration and Authorisation' statements closely and confirm by signing and dating the form. This step confirms the accuracy of your information.
  12. Before submission, ensure all attachments are included, such as original medical receipts, referral letters, and any other required documents.
  13. Check everything again for completeness and accuracy. You can then choose to save your progress, download, print, or share the completed form.

Complete your Bupa Claim Form online today to expedite your reimbursement process.

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Reimbursement Claim Procedure Whether you take the treatment in a non-network hospital inform the insurer within 48 hours of the treatment. Now fill the claim form and sign it before sending it to the insurer. Submit all the documents with your age proof and valid ID proof.

Reimbursement Claim refers to the type of claim wherein an insured must pay for the medical costs and treatment out of their pocket and later claim the bill from the insurance provider. For this kind of claim, the insured can visit any hospital for treatment and not necessarily the empanelled cashless hospital.

For Cashless Claims Step 1: Get admitted to any one of Niva Bupa network hospitals. Step 2: Use your Niva Bupa Health Card or share your policy number with the concerned team at a hospital along with your Passport/PAN card/ Voter's ID as identification proof.

You can use the Niva Bupa Health Card to avail of a lump-sum payment for the treatment of an illness, including hospitalisation expenses, doctor's consultations, tests, and more. The card can also be used for cashless claims in the case of a medical emergency.

Typically, your doctor's office will submit a claim and you will not need to be involved in the process. Your doctor will send a bill to your insurance company for any charges you did not pay during a visit or submit a claim for the services they provided to you during your visit.

Download the Bupa Touch app today. Take care of your healthcare anywhere with Bupa Touch. Get the treatment you need, stay on top of your claims and see your documents whenever you need them. Download the Bupa Touch app for convenient healthcare on the go or manage your cover online.

You can call at the toll free number 1800-3010-3333 or you can send an email at customercare@maxbupa.com.

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