Max Bupa (Niva Bupa) Health insurance offers a comprehensive range of health insurance plans to the customers. Let us understand the features of each health insurance plan offered by Niva Bupa Health insurance company in detail:-
ReAssure- Family Health Insurance
Features:
- Sum Insured: 3L to 1Cr
- Relationships covered: Self, spouse, father, father in law, mother and mother in law. Parent & parent-in-law cannot be covered in the same policy
- Room Rent: No Capping
- Day Care Treatment: Covered
- Home care treatment: Covered
- Alternative treatment: Covered
- Domiciliary Hospitalization: Covered
- Organ donor: Covered
- Pre Hospitalization: 60 days
- Post Hospitalization: 180 days
- Annual Health Check-up: Available
- Family combination: Up to 6 members
- ReAssure: Unlimited reinstatement of sum insured for any illness or anyone insured (single claim under this benefit will be payable up to the sum insured)
- Booster Benefit: In case of claim free year, increase of 50% of base sum insured in a policy year, maximum up to 100% (In case of claim, reduction of accumulated cumulative bonus by 50% of base sum insured)
- Health Check-up: For defined list of tests; up to Rs.500 for every 1 Lac sum insured( individual policy; maximum Rs.5k per insured; family floater policy; maximum Rs.10k per policy)
- Live healthy benefit: Collect health points by taking steps counted on Max Bupa Health App and get discount up to 30% on renewal premium.
- Modern treatments: Covered up to sum insured with sub-limit of Rs.1 Lac on few robotic surgeries.
- Second medical opinion: Once for any condition for which hospitalization is triggered.
- Emergency ambulance: Covered up to Rs.2k per hospitalization.
- Air ambulance: For cashless claim; Covered up to sum insured, for reimbursement claim; covered up to Rs.2.5Lacs
- Shared Accommodation cash benefit: Up to 15 Lacs base sum insured: 800 per day (maximum 4,800) Above 15 Lacs base sum insured: 1,000 per day; (maximum 6,000)
- Safeguard: a. Claim safeguard: Non-payable items paid up to sum insured b. Booster benefit safeguard: No impact on Booster benefit if claims in a policy year is up to 50,000 c. Sum insured safeguard: CPI (Consumer Price Index) linked increase in base sum insured
- Hospital cash: Up to 5 Lac base sum insured: 1,000/day 7.5 Lacs to 15 Lacs base sum insured: 2,000/day Above 15 Lacs base sum insured: 4,000/day
- Personal accident cover (for insured aged 18 years & above): 5 times of base sum insured; subject to maximum of 1 Crore
- COVID-19 covered after a waiting period of 15 days from the risk Max Bupa (Niva Bupa)t date.
Benefits:
- Booster Benefit: A benefit specially designed to ensure that your health coverage extends further. With this benefit double your sum insured in just 2 claim free years. This means, if no claims are made in the preceding Policy Year, your Base Sum Insured increases by 50% subject to a maximum of 100%.
- Shared Accommodation Cash Benefit: In case of shared room accommodation during Hospitalization in a Network Hospital, a daily cash amount is paid to the insured person for each continuous and completed period of 24 hours of hospitalization.
- Family Discount: Up to10% discount on premium if 2 or more members are being covered under an individual policy
- Doctor Discount: Get up to 5% additional premium discount if the insured person is a medical practitioner.
- Tax Savings: Income tax* benefit up to INR 42,744 under the Section 80D of the Income Tax Act, 1961.
- ReAssure: 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.
- Live Healthy Benefit: 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.
- Tenure Discount Benefit: 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
- Standing instruction Discount: Get 2.5% discount on premium if standing instruction for auto debit on renewal is provided and the policy is renewed using the same.
- 15 day free look period: If you are not satisfied with the service or terms and conditions or for any other reason, you get 15 days period to cancel the policy. The free look period is 30 days in case of long term policy of 3 years.
- Point of Care Desk (POC): At few selected partner hospitals by the Max Bupa health insurance company, a Niva Bupa representative will be available to assist the insured customer through all the formalities like filling forms, submitting claims etc. so that the insured can be at ease in an unfamiliar hospital environment.
- 30 minutes Cashless Claim Processing:The biggest advantage of Max bupa is that the cashless claim would be processed within 30 minutes so that the patient need not wait for longer time at the hospital.
- In house claim settlement: At Max bupa the claim settlement process is complete in house which means that there is no Third party administrator to settle the claim. In house claim settlement allows the customer to get quick claim as there would be no third party in between the insured and the insurance company.
Add-ons:
- Hospital Cash: Max bupa provides a hospital cash to cover the miscellaneous expenses incurred during the hospitalization. To trigger this add-on there has to be a minimum of 48 hours of continuous hospitalization.
- Personal Accident Cover: Max bupa provides personal accident cover as an add-on in the health insurance policy. Under the personal accident cover insurance insured customer can get compensation in case of death or disability due to any accidental means.
- Claim Safeguard Cover:Max bupa provides claim safeguard cover as an additional benefit in which the insured customer can claim on otherwise non-payable items up to the sum insured in case of hospitalization like conveyance charges, gloves, nebulisation kits, oxygen masks and more.
- Booster Benefit Safeguard:Booster benefit safeguard means there would be no impact on the booster benefit even if there are claim in a policy year. The limit of claims which are allowed under the booster benefit safeguard is Rs.50k below which the booster benefit would be safe.
- Sum insured Safeguard: Sum insured safeguard increases the base sum insured on a cumulative basis each policy year based on inflation rate. Inflation rate would be computed as the average Consumer Price index (CPI) of the entire calendar year published by the Central Statistical Organization (CSO). There is no maximum limit on increase in Sum Insured under this optional cover.
Renewal Process:
- Lifelong renewal: Max Bupa health insurance offers lifelong renewal, regardless of the health status or previous claims made under your policy. Your renewal premium will increase as your age increases but will not alter based on your claim experience.
- Sum insured enhancement: Niva bupa health insurance offers to increase the sum insured at the time of renewal to protect yourself from rising medical expenses. You can increase the sum insured or add family members of your family in the existing policy at the time of renewal. Any additional information for the sum insured enhancement as required by the insurance company should be submitted by the insured at the time of renewal.
- Portability and Migration: Niva bupa health insurance offers to port or migrate your health insurance policy at the time of renewal. For any clarifications regarding this please visit our portal or dial our toll free number 1800-123-4003 to get assistance from our health insurance agents.
Exclusions & Waiting periods:
- 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 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
- Intentional self-inflicted Injury or attempted suicide, Neuro-developmental delays and disorders, Mental retardation
Health Companion- Family Health Insurance:
Features:
- Sum Insured: Rs.2 lacs to Rs.1 Cr
- Room rent: Covered up to Sum insured (except for Suite or above category)
- Relationship covered: 19 relationships covered, refer brochure for more details
- Pre hospitalization: Up to 30 days
- Post Hospitalization: Up to 60 days
- Day care treatment: Covered
- Organ Donor: Covered up to sum insured
- Emergency Ambulance: Up to Rs.3k
- No claim bonus: In case of no claim, increase of 20% of expiring base sum insured in a policy year, maximum up to 100% of base sum insured.
- Refill Benefit: Up to the base sum insured
- Vaccination for animal bite: Up to Rs.7.5k
- Alternative treatments: Covered up to sum insured
- Health check-up: Once in one year/two years as per the plan opted
- Modern treatments: Covered up to sum insured with sub limit of Rs.1 lac on few robotic surgeries
- Hospital Cash: Up to Rs.4000 per day
Benefits:
- No claim bonus: A benefit specially designed to ensure that your health coverage extends further. In case of no claim, increase of 20% of expiring base sum insured in a policy year, maximum up to 100% of base sum insured.
- 15 day free look period: If you are not satisfied with the service or terms and conditions or for any other reason, you get 15 days period to cancel the policy. The free look period is 30 days in case of long term policy of 3 years.
- Point of Care Desk (POC): At few selected partner hospitals by the Max Bupa health insurance company, a Niva Bupa representative will be available to assist the insured customer through all the formalities like filling forms, submitting claims etc. so that the insured can be at ease in an unfamiliar hospital environment.
- 30 minutes Cashless Claim Processing:The biggest advantage of Max bupa is that the cashless claim would be processed within 30 minutes so that the patient need not wait for longer time at the hospital.
- In house claim settlement: At Max bupa the claim settlement process is complete in house which means that there is no Third party administrator to settle the claim. In house claim settlement allows the customer to get quick claim as there would be no third party in between the insured and the insurance company.
- Refill Benefit: The sum insured would be refilled once the sum insured is exhausted in the policy. The sum insured would be refilled up to the base sum insured of the policy. The refilled sum insured is applicable for different illness.
- Treatment only in Tiered network: This option is available only to renewal customers who opted for this cost sharing option in the expiring policy. By selecting this option customers can avail cashless treatment in certain locations with 20% co-payment. Customers opting for this option will get 10% discount.
Add-ons:
- Hospital Cash: Max bupa provides a hospital cash to cover the miscellaneous expenses incurred during the hospitalization. To trigger this add-on there has to be a minimum of 48 hours of continuous hospitalization. Up to Rs.4k per day would be provided to the insured in case of continuous hospitalization for more than 48 hours. Maximum coverage offered for 30 days/policy year/insured person. Payment is made from day one subject to hospitalization claim being admissible.
- Claim Safeguard Cover:Max bupa provides claim safeguard cover as an additional benefit in which the insured customer can claim on otherwise non-payable items up to the sum insured in case of hospitalization like conveyance charges, gloves, nebulisation kits, oxygen masks and more.
- Booster Benefit Safeguard:Booster benefit safeguard means there would be no impact on the booster benefit even if there are claim in a policy year. The limit of claims which are allowed under the booster benefit safeguard is Rs.50k below which the booster benefit would be safe.
- Sum insured Safeguard: Sum insured safeguard increases the base sum insured on a cumulative basis each policy year based on inflation rate. Inflation rate would be computed as the average Consumer Price index (CPI) of the entire calendar year published by the Central Statistical Organization (CSO). There is no maximum limit on increase in Sum Insured under this optional cover.
Renewal Process:
- Lifelong renewal: Max Bupa health insurance offers lifelong renewal, regardless of the health status or previous claims made under your policy. Your renewal premium will increase as your age increases but will not alter based on your claim experience.
- Sum insured enhancement: Niva bupa health insurance offers to increase the sum insured at the time of renewal to protect yourself from rising medical expenses. You can increase the sum insured or add family members of your family in the existing policy at the time of renewal. Any additional information for the sum insured enhancement as required by the insurance company should be submitted by the insured at the time of renewal.
- Portability and Migration:Niva bupa health insurance offers to port or migrate your health insurance policy at the time of renewal. For any clarifications regarding this please visit our portal or dial our toll free number 1800-123-4003 to get assistance from our health insurance agents.
Exclusions & Waiting periods:
- 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 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
- Intentional self-inflicted Injury or attempted suicide, Neuro-developmental delays and disorders, Mental retardation
Go Active- Family Health Insurance:
Features:
- Sum Insured: Rs.4 lacs to Rs.25 Lacs
- Entry age: Adults 18 years to 65 years and from 91 days to 21 years for children
- Room rent: Up to 1% of the base sum insured or No restriction for higher sum insured options
- ICU Rent: Up to 2% of the base sum insured or up to the base sum insured for higher sum insured options.
- Pre hospitalization: Covered up to 90 days
- Post hospitalization: Covered up to 180 days
- Day Care treatment: Covered up to sum insured
- Organ donor: Covered up to sum insured
- Alternative treatment: Covered up to sum insured
- Emergency ambulance: Up to Rs.3k per hospitalization
- Home health care services and Domiciliary hospitalization: Covered up to sum insured
- Re-fill benefit: Up to base sum insured
- Pharmacy and Diagnostic services: Available through provider network
- Health Check-up: Available
- Diagnostic tests: Up to Rs.2.5k for diagnostic tests applicable in lieu of health check-up through cashless and reimbursement facility.
- Behavioural assistance program: Up to 3 consultations per adult per policy year
- Second medical opinion: Covered, one opinion per insured person per specified illness/ planned surgery/ surgical procedure
- Modern treatments: Covered up to sum insured with sub limit of Rs.1 lac on few robotic surgeries
Benefits:
- No claim bonus: A benefit specially designed to ensure that your health coverage extends further. In case of no claim, increase of 20% of expiring base sum insured in a policy year, maximum up to 100% of base sum insured.
- AdvantAGE: Entry at or before the age of 35 years (as on last birthday) will receive 10% discount in the first policy year base premium and all subsequent renewal base premium
- 15 day free look period: If you are not satisfied with the service or terms and conditions or for any other reason, you get 15 days period to cancel the policy. The free look period is 30 days in case of long term policy of 3 years.
- Point of Care Desk (POC): At few selected partner hospitals by the Max Bupa health insurance company, a Niva Bupa representative will be available to assist the insured customer through all the formalities like filling forms, submitting claims etc. so that the insured can be at ease in an unfamiliar hospital environment.
- 30 minutes Cashless Claim Processing:The biggest advantage of Max bupa is that the cashless claim would be processed within 30 minutes so that the patient need not wait for longer time at the hospital.
- In house claim settlement: At Max bupa the claim settlement process is complete in house which means that there is no Third party administrator to settle the claim. In house claim settlement allows the customer to get quick claim as there would be no third party in between the insured and the insurance company.
- OPD coverage: OPD Consultation can be availed either through a Cashless Facility or on Reimbursement basis through a network. For Reimbursement, the maximum per consultation limit is Rs.600 for Zone 1 coverage and Rs.500 for Zone 2 coverage.
Add-ons:
- Deductible: Up to Rs.10 lacs can be opted as deductible which reflects in the premium to be paid by the insured policyholder
- I-protect: Additional 10% of Base Sum Insured every policy year at renewal for policy lifetime. This option can be opted only at inception. On renewal of the policy, this option can be opted out post which this option will not be available. In such case, the accumulated Increased Sum Insured under I-Protect shall: a. Not increase further and remain constant, if you pay the same additional percentage of premium as paid in the preceding Policy Year for this benefit; OR b. Be reduced to zero, if you do not pay any additional premium for this benefit.
- Health Coach: Personalized health coaching available to Primary insured or primary insured with spouse. Discount in renewal base premium up to 20% shall be provided based on the health score.
- Personal Accident cover: Personal accident cover up to Rs.50lacs can be availed as an add-on under the Niva Bupa Go Active health insurance policy on payment of additional premium. The personal accident covers death, accident permanent total disability, accident permanent partial disability.
Renewal Process:
- Lifelong renewal: Max Bupa health insurance offers lifelong renewal, regardless of the health status or previous claims made under your policy. Your renewal premium will increase as your age increases but will not alter based on your claim experience.
- Sum insured enhancement: Niva bupa health insurance offers to increase the sum insured at the time of renewal to protect yourself from rising medical expenses. You can increase the sum insured or add family members of your family in the existing policy at the time of renewal. Any additional information for the sum insured enhancement as required by the insurance company should be submitted by the insured at the time of renewal.
- Portability and Migration: Niva bupa health insurance offers to port or migrate your health insurance policy at the time of renewal. For any clarifications regarding this please visit our portal or dial our toll free number 1800-123-4003 to get assistance from our health insurance agents.
Exclusions & Waiting periods:
- 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 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
- Intentional self-inflicted Injury or attempted suicide, Neuro-developmental delays and disorders, Mental retardation
Money Saver- Family Health Insurance:
Features:
- Sum Insured: Up to Rs.1 Cr
- Health check-up: Annual
- Family combination: Up to 2 Adults and 4 children
- Hospital Cash: Up to Rs.2k per day
- Day Care treatments: Covered
- Room rent: Up to single private room without any room rent capping under the policy
- Pre hospitalization: Covered up to 30 days
- Post Hospitalization: Covered up to 60 days
- Organ Transplant Cover: Medical expenses for an organ donor’s inpatient treatment for the harvesting of the organ donated are also covered.
- Emergency Ambulance: Covered
- Domiciliary Hospitalization: The policy will reimburse you for the medical treatment taken at home on account of unavailability of a hospital bed or the doctor's advice
- Alternative treatments: Get cover for inpatient treatment under AYUSH (Ayurveda, Unani, Siddha, and Homeopathy) up to sum insured.
- Health check-up: Available under the policy
- Re-fill Benefit: Up to sum insured if the base sum insured is exhausted partially or completely
Benefits:
- No claim bonus: A benefit specially designed to ensure that your health coverage extends further. In case of no claim, increase of 20% of expiring base sum insured in a policy year, maximum up to 100% of base sum insured. Accumulated bonus doesn’t reduce even after making claims under the policy.
- 15 day free look period: If you are not satisfied with the service or terms and conditions or for any other reason, you get 15 days period to cancel the policy. The free look period is 30 days in case of long term policy of 3 years.
- Point of Care Desk (POC): At few selected partner hospitals by the Max Bupa health insurance company, a Niva Bupa representative will be available to assist the insured customer through all the formalities like filling forms, submitting claims etc. so that the insured can be at ease in an unfamiliar hospital environment.
- 30 minutes Cashless Claim Processing:The biggest advantage of Max bupa is that the cashless claim would be processed within 30 minutes so that the patient need not wait for longer time at the hospital.
- In house claim settlement: At Max bupa the claim settlement process is complete in house which means that there is no Third party administrator to settle the claim. In house claim settlement allows the customer to get quick claim as there would be no third party in between the insured and the insurance company.
Add-ons:
- Critical illness: Critical illness cover for illness such as Cancer, Kidney failure etc can be availed depending on the base sum insured on payment of additional premium. The critical illness sum insured is in addition to the base sum insured mentioned under the policy.
- Hospital Cash: Max bupa provides a hospital cash to cover the miscellaneous expenses incurred during the hospitalization. To trigger this add-on there has to be a minimum of 24 hours of continuous hospitalization.
- Personal Accident Cover: Max bupa provides personal accident cover as an add-on in the health insurance policy. Under the personal accident cover insurance insured customer can get compensation in case of death or disability due to any accidental means.
Renewal Process:
- Lifelong renewal: Max Bupa health insurance offers lifelong renewal, regardless of the health status or previous claims made under your policy. Your renewal premium will increase as your age increases but will not alter based on your claim experience.
- Sum insured enhancement: Niva bupa health insurance offers to increase the sum insured at the time of renewal to protect yourself from rising medical expenses. You can increase the sum insured or add family members of your family in the existing policy at the time of renewal. Any additional information for the sum insured enhancement as required by the insurance company should be submitted by the insured at the time of renewal.
- Portability and Migration:Niva bupa health insurance offers to port or migrate your health insurance policy at the time of renewal. For any clarifications regarding this please visit our portal or dial our toll free number 1800-123-4003 to get assistance from our health insurance agents.
Exclusions & Waiting periods:
- 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 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
- Intentional self-inflicted Injury or attempted suicide, Neuro-developmental delays and disorders, Mental retardation
Heart Beat- Family Health Insurance:
Features:
- Sum Insured: Rs.5lacs to Rs.1 Cr
- Room rent: Covered up to sum insured
- Pre Hospitalization: Covered up to 60 days
- Post Hospitalization: Covered up to 90 days
- Day Care treatment: Covered up to sum insured
- Organ donor: Covered up to sum insured
- Alternative treatment: Covered up to sum insured
- Emergency ambulance: Up to Rs.2k per hospitalization for non network hospital and up to sum insured for Network hospital
- Home health care services and Domiciliary hospitalization: Covered up to sum insured
- Re-fill benefit: Up to base sum insured
- Pharmacy and Diagnostic services: Available through provider network
- Health Check-up: Available
- Maternity Benefit: Covered up to Rs.2 Lac depending on the sum insured option selected by the customer
- New Born baby cover: Covered up to sum insured till the end of the policy year
- Vaccination of new born baby: Covered until the new born baby completes one year, vaccinations as per the defined list
- HIV/AIDS: Covered up to Rs.50k
- Emergency assistance services (Only within India): Covered up to sum insured
- Mental disorder treatment: Covered up to sum insured while a sub limit of Rs.50k is applied on few conditions
- Loyalty Additions: Increase of 10% of expiring base sum insured in a policy year; maximum up to 100% of the base sum insured.
- OPD and diagnostic services: Covered up to Rs.50k
- Child care benefits: Covered up to sum insured as per the defined list in case of vaccinations for children up to 12 years including one consultation for nutrition and growth during the visit for vaccination.
- Emergency medical evacuation: Covered up to sum insured for worldwide excluding USA, CANADA & INDIA.
- Emergency Hospitalization: Covered up to sum insured for worldwide excluding USA, CANADA & INDIA.
- Specified Illness Cover: Covered up to sum insured for worldwide excluding USA, CANADA & INDIA.
- Second Medical opinion: Covered one opinion per insured person per specific illness/ planned surgery/ surgical procedure.
Benefits:
- No claim bonus: A benefit specially designed to ensure that your health coverage extends further. In case of no claim, increase of 10% of expiring base sum insured in a policy year, maximum up to 100% of base sum insured.
- 15 day free look period: If you are not satisfied with the service or terms and conditions or for any other reason, you get 15 days period to cancel the policy. The free look period is 30 days in case of long term policy of 3 years.
- Point of Care Desk (POC): At few selected partner hospitals by the Max Bupa health insurance company, a Niva Bupa representative will be available to assist the insured customer through all the formalities like filling forms, submitting claims etc. so that the insured can be at ease in an unfamiliar hospital environment.
- 30 minutes Cashless Claim Processing:The biggest advantage of Max bupa is that the cashless claim would be processed within 30 minutes so that the patient need not wait for longer time at the hospital.
- In house claim settlement: At Max bupa the claim settlement process is complete in house which means that there is no Third party administrator to settle the claim. In house claim settlement allows the customer to get quick claim as there would be no third party in between the insured and the insurance company.
- Treatment only in Tiered network:This option is available only to renewal customers who opted for this cost sharing option in the expiring policy. By selecting this option customers can avail cashless treatment in certain locations with 20% co-payment. Customers opting for this option will get 10% discount.
- No specific waiting period for insured up to 45 years of age
Add-ons:
- Critical illness: Critical illness cover for illness such as Cancer, Kidney failure etc can be availed depending on the base sum insured on payment of additional premium. The critical illness sum insured is in addition to the base sum insured mentioned under the policy. Critical illness cover will be equal to the base sum insured, subject to a maximum of Rs.10lacs
- Hospital Cash: Max bupa provides a hospital cash to cover the miscellaneous expenses incurred during the hospitalization. To trigger this add-on there has to be a minimum of 48 hours of continuous hospitalization. Up to Rs.6k per day would be paid as hospitalization benefit and the maximum coverage is for 30 days/policy period/ insured person. Payment made from day one subject to hospitalization claim being admissible.
- Personal Accident Cover: Max bupa provides personal accident cover as add-on in the health insurance policy. Under the personal accident cover insurance insured customer can get compensation in case of death or disability due to any accidental means. Personal accident cover will be equal to 5 times the base sum insured subject to a maximum of Rs.50 lacs.
- E-consultation:Niva bupa provides unlimited tele/online consultations under this add-on on payment of extra premium
- Premium waiver: Max bupa provides one time premium waiver if the policyholder who is also an insured person dies or suffers from specified illness
- Enhanced Geographical Scope for International Coverage: USA & CANADA included for Emergency medical evacuation, emergency hospitalization & specified illness cover.
Renewal Process:
- Lifelong renewal: Max Bupa health insurance offers lifelong renewal, regardless of the health status or previous claims made under your policy. Your renewal premium will increase as your age increases but will not alter based on your claim experience.
- Sum insured enhancement: Niva bupa health insurance offers to increase the sum insured at the time of renewal to protect yourself from rising medical expenses. You can increase the sum insured or add family members of your family in the existing policy at the time of renewal. Any additional information for the sum insured enhancement as required by the insurance company should be submitted by the insured at the time of renewal.
- Portability and Migration:Niva bupa health insurance offers to port or migrate your health insurance policy at the time of renewal. For any clarifications regarding this please visit our portal or dial our toll free number 1800-123-4003 to get assistance from our health insurance agents.
Exclusions & Waiting periods:
- 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 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
- Intentional self-inflicted Injury or attempted suicide, Neuro-developmental delays and disorders, Mental retardation
Super Saver- Family Health Insurance:
Features:
- Sum Insured: Up to Rs.1 Cr
- Room rent: Single private room
- ICU Charges: Covered up to sum insured
- Cost of prosthetics and other devices or equipment if implanted internally during surgery : Covered up to sum insured
- Pre Hospitalization: Covered up to 30 days
- Post Hospitalization: Covered up to 60 days
- Day Care treatment: Covered up to sum insured
- Domiciliary treatment: Covered up to sum insured
- Organ donor: Covered up to sum insured
- Alternative treatment: Covered up to sum insured
- Emergency ambulance: Up to Rs.2k per hospitalization per hospitalization
- Pharmacy and Diagnostic services: Available through provider network
- Health Check-up: Available on Annual basis from 2nd policy year onwards
- Mental disorders treatment: Covered as per the policy terms and conditions
- E-consultation: Unlimited tele/ online consultations
- HIV/AIDS: Covered as per policy terms and conditions
- Co-payment: No Co-payment applicable
Benefits:
- 15 day free look period: If you are not satisfied with the service or terms and conditions or for any other reason, you get 15 days period to cancel the policy. The free look period is 30 days in case of long term policy of 3 years.
- Point of Care Desk (POC): At few selected partner hospitals by the Max Bupa health insurance company, a Niva Bupa representative will be available to assist the insured customer through all the formalities like filling forms, submitting claims etc. so that the insured can be at ease in an unfamiliar hospital environment.
- 30 minutes Cashless Claim Processing:The biggest advantage of Max bupa is that the cashless claim would be processed within 30 minutes so that the patient need not wait for longer time at the hospital.
- In house claim settlement: At Max bupa the claim settlement process is complete in house which means that there is no Third party administrator to settle the claim. In house claim settlement allows the customer to get quick claim as there would be no third party in between the insured and the insurance company.
- Unlimited E-consultation: If the insured person is diagnosed with an illness or is planning to undergo a planned surgery or a surgical procedure, the insured person can obtain an e-consultation during the policy period.
- Modern treatments:Modern treatments such as oral chemotherapy, robotic surgeries, intravitreal injections, deep brain stimulation, etc. will be covered either as inpatient care or as part of day care treatment in a hospital subject to sub-limit for specific conditions as specified in the policy contract.
- Multiyear discount:Opt for multiyear payment and avail a discount of 7.5% on 2nd year’s premium and 15% on 3rd year’s premium.
- Renewal for Life:Get assured renewal of the policy for life with no extra loadings based on your claim history.
Add-ons:
- Critical illness: Critical illness cover for illness such as Cancer, Kidney failure etc can be availed depending on the base sum insured on payment of additional premium. The critical illness sum insured is in addition to the base sum insured mentioned under the policy. Critical illness cover will be equal to the base sum insured, subject to a maximum of Rs.10lacs
- Hospital Cash: Max bupa provides a hospital cash to cover the miscellaneous expenses incurred during the hospitalization. To trigger this add-on there has to be a minimum of 48 hours of continuous hospitalization. Up to Rs.6k per day would be paid as hospitalization benefit and the maximum coverage is for 30 days/policy period/ insured person. Payment made from day one subject to hospitalization claim being admissible.
- Personal Accident Cover: Max bupa provides personal accident cover as add-on in the health insurance policy. Under the personal accident cover insurance insured customer can get compensation in case of death or disability due to any accidental means. Personal accident cover will be equal to 5 times the base sum insured subject to a maximum of Rs.50 lacs.
- E-consultation:Niva bupa provides unlimited tele/online consultations under this add-on on payment of extra premium.
- Enhanced No Claim Bonus: Get enhanced No claim bonus of 20% of expiring base sum insured subject to a maximum of 200%.
- Modification of Room Rent: If your room rent in the base plan is capped at 1% of base Sum Insured per day, you can modify it to a single private room; covered up to Sum Insured (available only for deductible more than INR 50,000 and Sum Insured up to INR 4 Lacs).
- Enhanced Refill Benefit:Get enhanced refill benefit up to 150% of the base sum insured.
Renewal Process:
- Lifelong renewal: Max Bupa health insurance offers lifelong renewal, regardless of the health status or previous claims made under your policy. Your renewal premium will increase as your age increases but will not alter based on your claim experience.
- Sum insured enhancement: Niva bupa health insurance offers to increase the sum insured at the time of renewal to protect yourself from rising medical expenses. You can increase the sum insured or add family members of your family in the existing policy at the time of renewal. Any additional information for the sum insured enhancement as required by the insurance company should be submitted by the insured at the time of renewal.
- Portability and Migration:Niva bupa health insurance offers to port or migrate your health insurance policy at the time of renewal. For any clarifications regarding this please visit our portal or dial our toll free number 1800-123-4003 to get assistance from our health insurance agents.
Exclusions & Waiting periods:
- 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 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
- Intentional self-inflicted Injury or attempted suicide, Neuro-developmental delays and disorders, Mental retardation
Health Premia- Family Health Insurance:
Features:
- Sum Insured: From Rs.1 Cr to Rs.3 Cr
- Room rent: Single private room
- ICU Charges: Covered up to sum insured
- Cost of prosthetics and other devices or equipment if implanted internally during surgery : Covered up to sum insured
- Pre Hospitalization: Covered up to 90 days
- Post Hospitalization: Covered up to 180 days
- Day Care treatment: Covered up to sum insured
- Domiciliary treatment: Covered up to sum insured
- Organ donor: Covered up to sum insured
- Alternative treatment: Covered up to sum insured
- Emergency Assistance services: Covered up to sum insured which include medical referral, emergency medical evacuation in air ambulance, medical repatriation, compassionate visit, care and/or transportation of minor children, return of mortal remains.
- New Born baby cover: Covered until the new born baby completes one year, vaccines as per pre defined list
- HIV/AIDS: Covered up to Rs.50k after a waiting period of 4 years
- Weight Loss (Bariatric) surgery: Covered up to rs.1.5Lacs after a waiting period of 3 years
- LASER surgery cover: Covered up to Rs.1 Lac after a waiting period of 3 years
- Cyber Knife/ Robotics surgery: Covered up to sum insured with a co-pay of 20%
- Mental disorder treatment: Covered up to sum insured with a sub limit of Rs.1 Lac applicable on few conditions after a waiting period of 3 years
- Second Medical opinion: Covered worldwide, one opinion per insured person/per policy period/ specified illness/ planned surgery
- Premium Waiver: One time premium waiver if the policyholder suffers or dies from specified illness
- Emergency ambulance: Up to Rs.2k per hospitalization
- Pharmacy and diagnostic services: Available through empanelled service provider
- E-consultation: Unlimited tele/online consultation
- International coverage: Annual multi trip (Max 45 days coverage in a single trip); International sum insured up to Rs.1 Cr per person. The coverage is valid outside the geographical boundaries of India excluding USA & CANADA.
- OPD Cover: Covered up to international sum insured with a co-payment of 20%
- Loss of passport: Covered up to Rs.20k
- Loss of checked-in baggage: Covered up to Rs.10k
- Trip cancellation and interruption: Covered up to Rs.25k
- Trip Delay: Covered up to Rs.10k
- Delay of checked-in baggage: Covered up to Rs.5k
- OPD Treatment and Diagnostic services: Covered up to Rs.50k per policy
- Health check-up: Annual, tests covered up to worth Rs.10k per insured person
- Maternity benefit: Covered up to Rs.2 lacs (excluding USA & CANADA) and covered for up to 2 pregnancies or terminations
Benefits:
- 15 day free look period: If you are not satisfied with the service or terms and conditions or for any other reason, you get 15 days period to cancel the policy. The free look period is 30 days in case of long term policy of 3 years.
- Point of Care Desk (POC): At few selected partner hospitals by the Max Bupa health insurance company, a Niva Bupa representative will be available to assist the insured customer through all the formalities like filling forms, submitting claims etc. so that the insured can be at ease in an unfamiliar hospital environment.
- 30 minutes Cashless Claim Processing:The biggest advantage of Max bupa is that the cashless claim would be processed within 30 minutes so that the patient need not wait for longer time at the hospital.
- In house claim settlement: At Max bupa the claim settlement process is complete in house which means that there is no Third party administrator to settle the claim. In house claim settlement allows the customer to get quick claim as there would be no third party in between the insured and the insurance company.
- Unlimited E-consultation: If the insured person is diagnosed with an illness or is planning to undergo a planned surgery or a surgical procedure, the insured person can obtain an e-consultation during the policy period.
- Modern treatments:Modern treatments such as oral chemotherapy, robotic surgeries, intravitreal injections, deep brain stimulation, etc. will be covered either as inpatient care or as part of day care treatment in a hospital subject to sub-limit for specific conditions as specified in the policy contract.
- Renewal for Life:Get assured renewal of the policy for life with no extra loadings based on your claim history.
- Loyalty Additions:Increase of 10% of expiring base sum insured in a policy year; maximum of up to 100% of the base sum insured.
- Re fill benefit:Get the sum insured reinstated in a policy year which would be applicable for same and different illnesses as well.
Add-ons:
- Critical illness: Critical illness cover for illness such as Cancer, Kidney failure etc can be availed depending on the base sum insured on payment of additional premium. The critical illness sum insured is in addition to the base sum insured mentioned under the policy. Critical illness cover will be equal to the base sum insured, subject to a maximum of Rs.1Cr.
- Hospital Cash: Max bupa provides a hospital cash to cover the miscellaneous expenses incurred during the hospitalization. To trigger this add-on there has to be a minimum of 48 hours of continuous hospitalization. Up to Rs.7.5k per day would be paid as hospitalization benefit and the maximum coverage is for 30 days/policy period/ insured person. Payment made from day one subject to hospitalization claim being admissible.
- Personal Accident Cover: Max bupa provides personal accident cover as add-on in the health insurance policy. Under the personal accident cover insurance insured customer can get compensation in case of death or disability due to any accidental means. Personal accident cover will be Rs.1Cr sum insured.
- E-consultation:Niva bupa provides unlimited tele/online consultations under this add-on on payment of extra premium.
- Enhanced No Claim Bonus: Get enhanced No claim bonus of 20% of expiring base sum insured subject to a maximum of 200%.
- International Coverage Extension: Get double sum insured for international coverage benefit outside the geographical boundaries of India for worldwide excluding USA & CANADA.
- Enhanced Geographical Scope for International Coverage: USA & CANADA included for Maternity benefit, specified illness and international coverage.
- Health Coach:Get personalised health coach for insured aged 18 years and above for any 90 days per policy year
Renewal Process:
- Lifelong renewal: Max Bupa health insurance offers lifelong renewal, regardless of the health status or previous claims made under your policy. Your renewal premium will increase as your age increases but will not alter based on your claim experience.
- Sum insured enhancement: Niva bupa health insurance offers to increase the sum insured at the time of renewal to protect yourself from rising medical expenses. You can increase the sum insured or add family members of your family in the existing policy at the time of renewal. Any additional information for the sum insured enhancement as required by the insurance company should be submitted by the insured at the time of renewal.
- Portability and Migration:Niva bupa health insurance offers to port or migrate your health insurance policy at the time of renewal. For any clarifications regarding this please visit our portal or dial our toll free number 1800-123-4003 to get assistance from our health insurance agents.
Exclusions & Waiting periods:
- 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 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
- Intentional self-inflicted Injury or attempted suicide, Neuro-developmental delays and disorders, Mental retardation
Senior First- Family Health Insurance:
Features:
- Sum Insured: From Rs.5lacs to Rs.25 Lacs
- Entry Age: 61 to 75 years
- Family Combination: 1A or 2A.
- Room Rent: Single private room/Shared room
- Pre Hospitalization: 60 Days
- Post Hospitalization: 180 Days
- Day Care treatment: Covered up to sum insured
- Modern treatments: Covered up to Sum Insured with sub-limit of INR 1 Lac per claim on few robotic surgeries
- Road Ambulance: Up to Rs.2k per hospitalization
- Air ambulance: Up to Rs.2.5 Lac per hospitalization
- AYUSH treatments: Up to sum insured
- Domiciliary treatment: Covered up to sum insured
- Organ Donor: Covered up to sum insured
- No claim bonus: In case of claim free year, increase of 10% of expiring Base Sum Insured in a Policy Year; maximum up to 100% of Base Sum Insured (In case of claim, no reduction in No Claim Bonus)
- ReAssure: Unlimited up to base Sum Insured (Applicable for both same & different illness)
- Health check-up: Annual (From Day 1); For defined list of tests; up to INR 500 for every INR 1 Lac Base Sum Insured (Individual policy: maximum INR 5,000 per Insured; Family Floater policy: maximum INR 10,000 per policy)
- Co-payment: 50%
Benefits:
- 15 day free look period: If you are not satisfied with the service or terms and conditions or for any other reason, you get 15 days period to cancel the policy. The free look period is 30 days in case of long term policy of 3 years.
- Point of Care Desk (POC): At few selected partner hospitals by the Max Bupa health insurance company, a Niva Bupa representative will be available to assist the insured customer through all the formalities like filling forms, submitting claims etc. so that the insured can be at ease in an unfamiliar hospital environment.
- 30 minutes Cashless Claim Processing:The biggest advantage of Max bupa is that the cashless claim would be processed within 30 minutes so that the patient need not wait for longer time at the hospital.
- In house claim settlement: At Max bupa the claim settlement process is complete in house which means that there is no Third party administrator to settle the claim. In house claim settlement allows the customer to get quick claim as there would be no third party in between the insured and the insurance company.
- Modern treatments:Modern treatments such as oral chemotherapy, robotic surgeries, intravitreal injections, deep brain stimulation, etc. will be covered either as inpatient care or as part of day care treatment in a hospital subject to sub-limit for specific conditions as specified in the policy contract.
- Safeguard:For a truly Cashless Experience. i. Coverage for non payable items like PPE kits, gloves, masks and more. ii. Inflation protection coverage – Increase in base sum insured on a cumulative basis each policy year based on Inflation Rate. iii. No Impact on No Claim Bonus – There will be no impact on your No claim bonus, if claims in a policy year are up to INR 50,000.
- Tenure discount: 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.
- Standing instructions discount:Get 2.5% discount on renewal premium if standing instruction for auto debit on renewal is provided and the policy is renewed using the same.
- Tax Savings: Income tax benefits up to INR 21,372 under the Section 80D of the Income Tax Act, 1961%. Claim additional tax-saving benefit under 80D, if you pay premium on your parent’s behalf.
Add-ons:
- Modification in Co-payment: Co-payment can be reduced from 50% to 40%/30%/20% on payment of additional premium. The reduced co-payment would be applicable for each and every claim made under the policy in a policy year. Customer can avail the reduction in co-payment with this add-on by paying additional premium.
- Annual Aggregate deductible: Annual aggregate deductible of Rs.1Lacs/2lacs/3lacs/4lacs/5lacs can be opted by the insured in lieu for the co-payment under the policy. The annual deductibles option can be as per your requirements and enjoy a co-payment free health cover. The aggregate deductible states that the claim would be payable only if the claim amount cross a particular deductible amount in a policy year.
Renewal Process:
- Lifelong renewal: Max Bupa health insurance offers lifelong renewal, regardless of the health status or previous claims made under your policy. Your renewal premium will increase as your age increases but will not alter based on your claim experience.
- Sum insured enhancement: Niv bupa health insurance offers to increase the sum insured at the time of renewal to protect yourself from rising medical expenses. You can increase the sum insured or add family members of your family in the existing policy at the time of renewal. Any additional information for the sum insured enhancement as required by the insurance company should be submitted by the insured at the time of renewal.
- Portability and Migration:Niva bupa health insurance offers to port or migrate your health insurance policy at the time of renewal. For any clarifications regarding this please visit our portal or dial our toll free number 1800-123-4003 to get assistance from our health insurance agents.
Exclusions & Waiting periods:
- 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 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
- Intentional self-inflicted Injury or attempted suicide, Neuro-developmental delays and disorders, Mental retardation