About Niva Bupa (Max Bupa) Health Insurance:
Niva Bupa Health Insurance Company Ltd. (formerly known as Max Bupa Health Insurance Company Limited) is a joint venture between Fettle Tone LLP (an affiliate of True North Fund VI LLP), a leading Indian private equity firm, and the UK based healthcare services expert, Bupa Singapore Holdings Pte. Limited. “Niva” is a popular Hindi/Sanskrit word and also means SUN – which is a symbol of hope, positivity, energy, and above all life itself healthcare group.
Being one of the most trusted standalone health insurance companies in the country, Niva Bupa Health Insurance has curated a wide range of health insurance policies, such as individual health insurance, family floater insurance policy, and top-up insurance cover, as per the understanding of the Indian market and catering to the consumer's diverse requirements, just the way they like.
While Bupa has six decades of experience in the healthcare industry and a 29 million customer-base in over 190 countries; Fettle Tone LLP (an affiliate of True North Fund VI LLP) is a leading Indian private equity firm, with a focus on investing in and transforming mid-sized profitable businesses into world-class industry leaders. In the last 20 years, Fettle Tone has invested in more than 50 Indian business, and has successfully guided these companies in making the transition into well-established and large businesses that are valuable, enduring and socially responsible.
At Niva Bupa, our purpose is, “To give every Indian the confidence to access the best healthcare”, with a vision , “To become India's most admired Health Insurance Company” by empowering our customers with knowledge, guiding them with expertise, and providing them with a gamut of services that instils confidence and puts control back in their hands- just the way they want every moment of their life to be.
For us, health insurance is not just an annual transaction. Rather, it is about building a long-term relationship with our customers.
The mission of Max Bupa also known as Niva Bupa is to provide customer satisfaction and help customers lead happier and more successful life. Niva Bupa offers customer-centric, digitally enabled, health insurance products and services to their customers, such as preauthorization of cashless claims within 30 minutes, direct claim settlement, and access to ‘Point of Care’ desks at leading hospital chains across the country.
Niva Bupa strives to optimize customer satisfaction by leveraging technology and offer services such as multi-functional Max Bupa health insurance app which has been designed to help customers manage their health along with their insurance policies. The Max Bupa health app allows policyholders to book OPD appointments with a doctor or a pathology lab for running diagnostic tests. This app enables policyholders to take e-consultations and get medicines delivered at home while also providing easy access to Max bupa health insurance plans on the go. Niva Bupa chatbot “CIA”, has assisted more than 73k customers in three months at a time when the COVID-19 pandemic was at its peak by providing assistance in the form of solving queries and giving end-to-end solutions to its customers.
Max Bupa offers comprehensive and innovative health insurance plans to suit the specific requirements of customers such as Go Active plan, a comprehensive plan catering to health and fitness enthusiasts. There are also health insurance products for large families such as Health Premia which provides top of the line care for the families. There are even plans for value seekers such as Health companion and Health Pulse plan. In addition to the health insurance plans, Niva bupa also offers specific plans such as Personal accident cover and Critical illness. Niva Bupa Health Insurance Company has a wide range of network hospitals or tie-up hospitals that provide cashless claims settlement services to their customers all over India. There are more than 7500 cashless hospitals in India and 9 out of 10 claims are processed under 30 minutes with Max bupa health insurance Company. Niva bupa health insurance has employed more than 35k agents to increase the reach of the brand by bringing in many customers from different parts of the country.
Max Bupa (Niva Bupa) Health Insurance Coverage:
Different health insurance plans from Max Bupa (Niva Bupa) health insurance have different inclusions. Some of the common inclusions are mentioned below:-
In-patient hospitalization: Max Bupa (Niva Bupa) health insurance covers the hospitalization expenses of insured including Room rent, boarding charges, ICU charges, Doctor Charges etc., up to the sum insured mentioned under the policy. The in-patient hospitalization requires insured to get admitted in the hospital for treatment for more than 24 hours. The in-patient hospitalization charges cover a big chunk of treatment cost of the insured customer.
Pre hospitalization expenses: The cost of treatment incurred by the customer before getting admitted to a hospital as in-patient treatment for treatment is known as pre hospitalization expense. Pre hospitalization expenses for up to 60 days would be paid by Max Bupa (Niva Bupa) Health Insurance Company to the customers in case there is an inpatient claim admissible under the policy.
Post hospitalization expenses: The cost of treatment incurred by the customer after getting treatment as an inpatient is known as post hospitalization expense. The cost of treatment including medicines, diagnostic tests, etc. after getting discharged from the hospital is paid up for a certain number of days. The post hospitalization expenses are paid up to 180 days from the date of discharge from hospital.
Room rent & ICU Charges: Max Bupa (Niva Bupa) health insurance plans cover the room rent and ICU charges as a part of inpatient hospitalization cover. There are certain sub limits for which these charges are provided by the insurance company. Room rent, ICU charges and Nursing charges would be covered up to a percentage of sum insured in the Max Bupa (Niva Bupa) Health insurance plans.
Day Care Treatments: Day Care treatments are those treatments which require less than 24 hours to be operated. Due to the advancement of technology there are many diseases or illnesses which are treated within a few hours and these are covered under the day care treatment section. The maximum coverage under the day care treatment section would be the sum insured or actual whichever is less. It is important to check the list of day care treatments covered under the health insurance plan before purchasing the same.
Daily Allowance: Daily allowance is an amount given to the customer if the hospitalization exceeds a certain number of days. The daily allowance is given up to 5 days per hospitalization. The daily hospitalization amount is different from that of the inpatient charges paid to the customer. Th.ere would be many expenses which were to be made from the pocket of the insured customer at the time of hospitalization and such expenses can be covered under this daily allowance section of the Max Bupa (Niva Bupa) Health Insurance Company. A maximum of 30 days daily allowance is given per policy period per insured under the Max bupa health insurance policy.
Health check-up facility: Max Bupa (Niva Bupa) health insurance provides health check-up facility to the members covered in the health insurance policy. The number of health check-ups and the sub limits are specified in the policy terms and conditions. Health check-ups can be availed at the network diagnostic centres of the Max Bupa (Niva Bupa) Health Insurance Company at free of cost. The health check-up facility is provided as an add-on to the customers who do not claim during the policy period.
Domiciliary hospitalization: Domiciliary hospitalization is the expenses incurred by the customer for getting the treatment at home on the advice of a doctor. The cost of treatment incurred for treatment at home is covered by Max Bupa (Niva Bupa) Health Insurance Company under their health insurance plans. Domiciliary hospitalization is permitted only in two scenarios: In case the treating doctor has recommended availing the domiciliary treatment as shifting the patient to the hospital may endanger his/her life and there are no beds available in the patients place of residence due to the spread of pandemic.
Alternative Treatments: Alternative treatments are medical treatments such as Ayurvedic, Siddha, Homeopathy, Unani and Yoga which are recognised by the Government of India as alternative treatment for diseases. The sum insured covered under this section is mentioned in the policy terms and conditions. Max Bupa (Niva Bupa) Health Insurance Company covers the treatment costs incurred in case of Alternative treatments such as Ayurvedic, Siddha, Homeopathy, Unani and Yoga.
Organ Donor Cover: Organ donor cover includes the cost of operating expenses to carry out organ replacement activity. The cost of harvesting and transplanting the organ to the insured customer is covered by Max Bupa (Niva Bupa) Health Insurance Company in their health insurance plans. It also pays the organ donor costs as well in addition to the cost of insured.
No Claim Bonus: No claim bonus of up to 150% on the sum insured is provided to the customer for each claim free year which is one of the highest percentages in the insurance industry. Max Bupa (Niva Bupa) Health Insurance Company provides no claim bonus to the customers in case of every claim free year as a percentage increase in the sum insured. The no claim bonus would increase each claim year and the total sum insured would be addition of the base sum insured and the no claim bonus under the health insurance plan. There are certain plans in which the no claim bonus would be affected if there was a claim in the previous year and certain plans in which the no claim bonus would not be affected even if there was a claim in the previous policy year.
Re-fill: Sum insured would be refilled or reinstated if the base sum insured is exhausted in a policy year. This option can be availed once in a policy year and the recharged sum insured can be utilised to treat different diseases or illnesses. With Unlimited recharge option you can get your sum insured recharged unlimited number of times as there would be no limit on the number of times the sum insured can be reinstated. Recharge of sum insured would be done after the sum insured is utilised partially or completely depending on the type of health insurance plan chosen by the customer.
Maternity & Baby Cover: Maternity and New born baby cover are available under the Max Bupa (Niva Bupa) health insurance plans which cover the cost of delivery and other costs related to new born baby. These are available as base covers as well as add-ons depending on the health insurance plan selected by the customer. The maternity and baby cover limit can be selected by the customer from the different options available. Normal and Caesarean sum insured options can also be selected by the customer at the time of purchasing the health insurance policy.
Second Opinion: The insured customer can go for a second option from any doctor in the World enlisted under the panel of doctors with the Max Bupa (Niva Bupa) Health Insurance Company related to the treatment and the cost of that would be borne by the insurance company. The second opinion would be available to the customer free of cost and the opinion can be taken without any effect on the no claim bonus at the time of renewal.
Coverage: There are different sum insured options available to the customers. The sum insured ranges from Rs.2Lacs to Rs.1 Cr depending on the type of health insurance plan. Higher the sum insured, higher would be the premium to be paid by the customer. The sum insured range would depend on the product selected by the customer and the premium would vary accordingly. There are more than 8 health insurance plans which provide different sum insured options to the customers to choose from.
Co-payment: Co-pay is the amount of claim that has to be borne by the customer in case of claim during the policy year. Each and every claim would be subjected to a co-pay amount to be paid by the insured customer before the insurance company settles the remaining amount. Most of the health insurance policies of Max Bupa (Niva Bupa) Health Insurance Company have a co-payment section in which the co-pay ranges from 10% to 50% depending on the type of health insurance plan selected by the customer. The co-pay also helps in reducing the premium to be paid by the customer and in turn makes the customer a part in claim settlement process by passing over a bit of responsibility to the customer.
Wellness Benefits: Max Bupa (Niva Bupa) Health insurance offers Wellness program to promote, incentivize and to reward the insured person’s healthy lifestyle through various wellness activities. The wellness activities are designed to help the insured person to earn wellness reward points which will be tracked and monitored by the company. These wellness points can be utilized to gain extra discount in the premium to be paid by the customer. The maximum discount that can be availed under this benefit would be 10% depending on the points accumulated by the insured during the policy period which can be utilized at the time of renewal.
Ambulance Cover: Max Bupa (Niva Bupa) Health insurance provides road ambulance cover as well as Air ambulance cover up to a certain limit during the policy period in which the customer can avail the benefit up to the limit specified in the policy. The maximum coverage under the road ambulance per event or per hospitalization is Rs.2k while the maximum coverage in the air ambulance is Rs.2.5Lacs.
Niva Bupa Health Insurance Exclusions:
- Treatment during the first 30 days of the plan will not be covered, unless the treatment needed is a result of an accident. This waiting period does not apply for renewal policies
- Any pre-existing conditions will be covered after a waiting period of 2/3 years. Whereas, conditions specified in your policy under Personal Waiting Period will be covered after a waiting period of 2 years.
- 2 years exclusion for specified disease/procedures like cataract, pancreatitis, chronic kidney disease, hernia, internal congenital anomaly, spinal disorder, etc
- Investigation & Evaluation, OPD treatment
- Unproven Treatments, Unrecognized Physician or Hospital
Breach of law, Conflict & Disaster, Excluded Providers
- Hazardous or Adventure sports Change-of-Gender treatments, Hormone Replacement Therapy, Cosmetic or plastic Surgery
- Sleep disorders, treatment for alcoholism, drug or substance abuse or any addictive condition
- Dental/oral treatment
- Sterility and Infertility, Maternity Expenses
- Circumcision, External Congenital Anomaly
- Sexually transmitted Infections & diseases (other than HIV / AIDS)
- Any treatment or medical services received outside the geographical limits of India unless permitted under the policy.
- Intentional self-inflicted Injury or attempted suicide, Neuro-developmental delays and disorders, Mental retardation
FAQ’s - Max Bupa (Niva Bupa) Health Insurance:
Which company changed its name to Niva Bupa health insurance?
Max Bupa Health Insurance Company has changed its name to Niva Bupa health insurance Company due to the change in the ownership of the company. Except for the change in name everything else remains same in the new entity and the company strives to serve its customers as usual.
Are Max Bupa and Niva Bupa health insurance same?
Yes. Max bupa health insurance Company is rebranded as Niva Bupa Health Insurance Company. The name change doesn’t affect the credibility of the company as the service continues to remain the same despite name change.
Is there any capping on room rent in Niva bupa?
Yes. There is a capping on the room rent section in Niva bupa health insurance Company. One can avail a single private room subject to the terms and conditions. The room rent is capped at 1% of the sum insured and the ICU rent is capped at 2% of the sum insured.
Can I take two health insurance policies from Max Bupa?
Yes, you can take two health insurance policies from Max bupa, but it is very much important to disclose the first health insurance policy details at the time of taking second health insurance policy. Instead of taking two health insurance policies, you can take top up health insurance policy from Max bupa. Even though you take two health insurance policies, it doesn’t mean that you can get the claim from two health insurance policies more than what you spent for hospitalization.
How many claims can I make under my Max bupa health insurance policy?
You can make any number of claims under your max bupa health insurance policy as long as your sum insured is intact. There is no limit on the number of claims that can be made under the max bupa health insurance policy as the sum insured would be refilled in case the base sum insured expires.
Can I take health insurance from Max Bupa (Niva Bupa) if I have an employer sponsored health insurance?
The employer sponsored health insurance would be valid only till then time you are employed in the company whereas the personal health insurance policy taken would be valid till the time it is renewed. You can take a health insurance plan from Max Bupa (Niva Bupa) Health Insurance Company even though you have employer sponsored health insurance plan. The individual health insurance plan would be beneficial if the claim bill exceeds the sum insured provided by the employer health insurance plan.
How does reimbursement work for Pre & post Hospitalization?
The medial expenses incurred prior to the hospitalization are known as Pre hospitalization expenses while the expenses incurred post hospitalization are known as Post hospitalization expenses. Pre and Post hospitalization expenses should be reimbursed after the specified period which is 60 days for pre hospitalization and 180 days for post hospitalization.
Do Max Bupa (Niva Bupa) health insurance plans provide Income Tax exemption?
Health insurance premium paid for Max Bupa (Niva Bupa) health insurance plans are eligible for income tax deduction under the section 80D of the Income tax act. The limits are as mentioned below:-
||Exemption category wise
|Self & Family
|Self & Family + Parents (Not Senior Citizens)
||Rs.25,000 + Rs.25,000
|Self & Family + Parents (Senior Citizens)
||Rs.25,000 + Rs.30,000
|Self & Family (Senior Citizen) + Parents (Senior Citizens)
||Rs.30,000 + Rs.30,000
Is there cashless facility under Max Bupa (Niva Bupa) health insurance policies?
Yes. Max Bupa (Niva Bupa) health insurance has tied-up with almost 6700 hospitals across India, and all these hospitals provide cashless claim settlement service to the Max Bupa (Niva Bupa) health insurance customers. The cashless facility can be availed by enquiring on the toll free number 1860-500-1000. Cashless facility can only be availed only at the network hospitals and treatment taken outside network hospitals would be reimbursed.
List network hospitals with care health Insurance Company?
There are more than 6700 network hospitals to provide cashless facility to the Care health insurance customers. The detailed list of tie-up hospitals can be found at.
Does my Max Bupa (Niva Bupa) health insurance policy provide free annual check-up?
Yes, most of the health insurance policies from Max Bupa (Niva Bupa) Health Insurance Company provide with free annual health check-up to all the individuals covered under the policy. The list of medical check-ups available differs from one plan to the other. The free medical check-up option is available for customers who do not make any claim during the previous policy year.
What is the eligible age to buy Max Bupa (Niva Bupa) health insurance plan?
The minimum age to buy health insurance from Max Bupa (Niva Bupa) Health Insurance Company is 18 years which is the legal age in India. There are certain plans where even a 91 day child can be included in the health insurance plan subject to one or both the parents already covered under the plan.
What is the maximum sum insured offered under Max Bupa (Niva Bupa) health insurance plans?
The maximum sum insured offered under pre underwritten Max Bupa (Niva Bupa) health insurance plans is Rs.3 Cr for general health insurance plans. Higher sum insured can also be offered to customers after satisfactory underwriting from the insurance company. Pre underwritten plans are those where the premium is fixed for any particular sum insured.
Does Max Bupa (Niva Bupa) health insurance offer health plans for Senior citizens?
Yes. Max Bupa (Niva Bupa) Health Insurance Company has introduced health insurance plans specifically for senior citizens. The minimum entry age for this plan is 60 years and the maximum entry age is 75 years under this plan. There is a 24 months waiting period for Named ailments and 12 months for pre-existing diseases under this plan. This plan is designed to provide maximum benefit to senior citizens aged above 60 years. Under this plan there would be a co-payment of 50% which has to be borne by the customer at the time of claim settlement.
My S.I is Rs.4 Lacs but my hospital bill is Rs.5 Lacs. How much would Max Bupa (Niva Bupa) Health Insurance pay?
The maximum claim amount that would be paid in case of any hospitalization would be the claim amount or the sum insured, whichever is less. For instance, if your sum insured is Rs.4 L and your hospital bill is Rs.5 L, insurance company would pay Rs.4 L which is the maximum liability of the insurance company. Any claim amount above the sum insured has to be borne by the insured, hence it is advisable to estimate the sum insured required at the time of policy purchase or renewal.
What is Point of Care desk in Max bupa health insurance?
Max bupa (Niva Bupa) is offering a concept of Point of care desk in which the customers can avail the help from Max representatives at the time of claim settlement. The point of care person helps you with the claim settlement process such as filling up of forms, filing the claim etc. The list of point of care desk can be obtained from the link Documents of POCs.
What is ReAssure benefit in Max bupa health insurance?
ReAssure benefit offers unlimited reinstatement of sum insured for any illness for anyone insured in a policy year, so that you never run out of sum insured. Unlimited Sum insured reinstatements is triggered with the first paid claim itself and is available for all subsequent claims in a Policy Year, so that you can claim as many times as needed. The reassure benefit offers unlimited reinstatement of sum insured to the customer in case the base sum insured is exhausted due to hospitalization.
What is Live Healthy benefit in Max bupa health insurance?
Get an additional renewal premium discount of up to 30% basis the heath points collected by you on Max Bupa Health App. To avail this benefit, all you have to do is collect health points by taking steps counted on Max Bupa Health App. The more the number of points accumulated by the customer during the policy period, the more would be the discount available to the customer.
What is Tenure discount benefit in Max bupa health insurance?
Get discount of 7.5% on the premium of second policy year if you pay for a 2-year policy term in advance, and additional 15% discount on third year’s premium if you choose a 3-year policy term. Higher the tenure of the health insurance policy, higher would be the discount under the health insurance policy from Niva bupa health insurance.
What is standing instruction benefit in Max bupa health insurance?
Get 2.5% discount on premium if standing instruction for auto debit on renewal is provided and the policy is renewed using the same. The standing instruction for auto debit of health insurance premium is a win-win situation for the insurance company and the insured customer as the customer would get continuous coverage without any break-in while the insurance company would retain the customer.
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