Niva Bupa Health Insurance has suspended its cashless treatment facility at all Max Hospitals across India, effective August 16, 2025. This decision was made after the company’s agreement with Max expired in May 2025 and negotiations on tariff revision failed to reach a mutual agreement. As a result, policyholders will no longer be able to access cashless treatment at Max Hospitals, but can still receive treatment on a reimbursement basis. This means that policyholders will have to pay their medical bills upfront and then file for reimbursement with Niva Bupa.
Niva Bupa has stated that it has put in place alternative arrangements to ensure that customers’ treatment continues smoothly, and has enabled a priority reimbursement process for customers who are currently undergoing or seeking treatment at Max Hospitals. The company has also asked its partners to inform customers with chronic conditions about the priority-reimbursement process and guide them to alternative hospitals where cashless facilities are available.
This development may cause inconvenience to thousands of Niva Bupa policyholders who rely on Max Hospitals for their medical treatment. Niva Bupa has a claim settlement ratio of 92.02% for the year 2023-24, but its incurred claims ratio is alarmingly low at 59.92%, indicating that policyholders may not receive the full amount of their claims. The company also ranks amongst the top 5 health insurers with the maximum policyholder complaints regarding complete or partial repudiation or rejection of claims.
It’s worth noting that CARE Health Insurance had also suspended its cashless facility with Max Hospitals earlier this year, although this was restricted to Delhi-NCR. Niva Bupa policyholders can continue to access treatment at Max Hospitals, but will have to pay upfront and file for reimbursement. The company has stated that it will endeavour to process reimbursement claims quickly to minimize hassle for its customers. However, the details of the priority reimbursement process are not yet available, and policyholders may face uncertainty and inconvenience as a result of this change.