Sum Insured: Sum insured is the maximum liability of the insurance company in case of hospitalization for the given policy period. The sum insured should be selected Max Bupa (Niva Bupa) fully at the time of purchasing the health insurance policy as the sum insured may dry up if opted inadequately and if opted higher sum insured, you may end up paying more premiums. It is to be noted that the sum insured can only be changed at the time of renewal and no change for sum insured during midterm would be entertained by the insurance company. To provide adequate health insurance coverage to self and family it is important to decide on the coverage amount at the time of purchasing the health insurance policy. Higher the sum insured, higher would be the premium and vice versa.
Features of the plan: There are more than 8 health insurance plans available from the Max Bupa (Niva Bupa) health insurance company which suit the requirements of different set of people. The plans are designed keeping in mind the requirements of customers which change from time to time. Only a few insurance companies provide health insurance coverage to customers with these pre existing conditions. The features of the plan should be understood fully by the insured customer before renewing the plan and try to analyse if the existing health insurance plan from Max Bupa (Niva Bupa) health insurance Company is satisfying the needs of the customer.
Co-payment: Only few health insurance plans from Max Bupa (Niva Bupa) Health Insurance Company have a co-payment condition which would be applicable at the time of claim. At least 10% of the bill amount has to be borne by the insured customer at the time of claim. There are certain senior citizen plans which have 50% co-payment option. Hence it is important to verify the co-payment condition in the existing health insurance plan and decide on the continuity of the plan.
Check for changes in the plan: There might be some changes in the existing health insurance plan which would have been made by the insurance company and intimated to the policyholder well within advance. These changes would sometimes be effective from the next renewal while some changes would be effective immediately. The changes mostly include discontinuation of product, change in premium, additional coverage. It is important for the policyholders to check the product details at the time of renewal and read all the policy related terms and conditions of Max Bupa (Niva Bupa) fully before proceeding to the payment section.
Loyalty Additions: Loyalty additions or Renewal bonus or No claim bonus is the extra sum insured provided to the policyholders at the time of renewal. This bonus needs to be checked by the customer whether the same is reflecting in the policy copy or not. Normally the insurance companies would offer the bonus for each claim free year in the form of increased sum insured to the customer in their health insurance policy. In order to avail the cumulative bonus the policy must be renewed within 30 days of the due date for renewal. The loyalty bonus would be 10% of the base sum insured for each claim free year which is added to the base sum insured of the policy.
Check for Network hospitals: Network hospitals provide cashless claim settlement facility to the customers of Max Bupa (Niva Bupa) Health Insurance Company. It is important to check the list of network hospitals in and around your area before renewing the health insurance policy. There would be many hospitals which get added each year to the list of network hospitals and few hospitals might be deleted from the list due to certain unavoidable conditions.
Grace Period: Grace period is the time given by the insurance company to the customers who were unable to renew the health insurance policy within the given policy expiry date. The grace period would be 30 days from the policy expiry date and the payment has to be done within the grace period for the customer to enjoy the accumulated benefits under the policy. If the policy renewal is not done within the grace period, the health insurance policy will be lapsed and thereby forcing the customer to purchase a new policy and satisfy all the waiting period before making any claim. Max Bupa (Niva Bupa) Health Insurance Company renewal can be made using the online link or dial on our toll free number 1800-123-4003 to get assistance from our health insurance agents.
Max Bupa (Niva Bupa) Health Insurance renewal can be done from the customer portal by entering the policy details as well as the Date of Birth details.
Niva Bupa Health Insurance Add-ons/ Riders:
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. The critical illness cover is given to the insured on payment of additional premium under the same health insurance cover. Upon diagnosis with any of the mentioned critical illnesses the insured would be eligible to receive the critical illness sum insured in addition to the hospital expenses incurred on treatment of the critical illness up to the sum insured mentioned under the policy.
Hospital Cash: Niva bupa provides 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. The hospital cash would be paid as a lumpsum amount on reimbursement basis. The number of days would be limited to 30 days for the purpose of hospital cash payment. Hospital cash amount paid is in addition to the base sum insured incurred for hospitalization.
Personal Accident Cover: Niva 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. Personal accident cover is a separate type of insurance policy which is offered as an add-on under the health insurance policy of Niva Bupa. The personal accident cover compensates the customer or the nominee of the insured in case of death or disability of the insured due to any accidental means. The personal accident sum insured is in addition to the health insurance policy sum insured and is not paid on indemnity basis unlike the health insurance. The premium for the personal accident policy would also depend on the age of the customer, occupation of the customer and the coverage required by the insured.
E-consultation: Niva bupa provides unlimited tele/online consultations under this add-on on payment of extra premium. E-consultation involves getting online consultation from the list of empanelled doctors of Niva Bupa Health Insurance Company. The consultation is on telephone and is unlimited number of times for the customers opting this add-on under their health insurance policy. There is an app called Niva Bupa Health insurance app which can be used by the insured customers for booking OPD appointments with doctors or a pathology lab for running diagnostic tests, it enables the customers to get e-consultations and get the medicines delivered at home while also providing easy access to their health insurance plans on the go. The app also provides information on different health insurance plans offered by Niva Bupa Health Insurance Company.
Enhanced No Claim Bonus: Get enhanced No claim bonus of 20% of expiring base sum insured subject to a maximum of 200%. No claim bonus is a form of discount offered by the insurance company to the customer for having a claim free policy year. The no claim bonus is offered in the form of loyalty additions in which the insured would get 10% increase in the sum insured for every claim free year. The increased sum insured would be added to the base sum insured increasing the sum insured each claim free year. The no claim bonus can be increased by 20% each claim free year until the no claim bonus sum insured is equal to the base sum insured selected under the policy. The NCB sum insured cannot be more than the base sum insured under the policy. In case of claim the base sum insured would be utilised first after which the no claim bonus sum insured would come into picture.
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). There are limitations for room rent under the Niva bupa health insurance policies which can be modified by selecting the modification of room rent add-on. The room rent can be modified and upgraded to a single private room where there is a condition of deductible which has to be satisfied under the policy before this coverage kicks in.
Enhanced Refill Benefit: Get enhanced refill benefit up to 150% of the base sum insured. Refill benefit is utilised in case of exhaustion of sum insured under the health insurance policy. Under this add-on the sum insured would be restored up to 150% of the base sum insured under the health insurance policy. The enhanced sum insured can be utilised at the time of claim settlement where the base sum insured would get exhausted. The refill of sum insured happens only after the base sum insured is exhausted under the health insurance policy. The refill sum insured would be applicable from the second claim under the health insurance policy.
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. The co-payment can be reduced at the time of claim settlement by availing modification of co-payment add-on. Under this add-on the co-payment can be reduced up to 20% on each and every claim from 50%. Co-payment is the amount of claim that has to be borne by the insured at the time of claim settlement.
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.
Niva Bupa Cashless Claim Settlement Process:
Niva Bupa Health insurance provides cashless treatment to its customers in more than 6700 network hospitals across India. These hospitals are tied-up to offer comprehensive cashless services to the Niva Bupa health insurance company customers. The procedure to claim cashless treatment from the network hospitals is listed below:-
Step 1: In case of planned cashless treatment intimate the insurance company on their toll free number 1860-500-1000 and register the treatment for which the cashless service would be availed. In case of emergency hospitalization, it is required to intimate the insurance company before the treatment Niva Bupa. The insurance company would provide go ahead to the hospital and the claim would be settled on cashless basis.
Step 2: The second step is to fill and submit the Claim intimation form / pre-authorization form available with the hospital. The E-card or the insurance policy copy should also be submitted along with the pre-authorization form to enable the insurance company to process the claim.
Step 3: The next step is to submit the cashless claim form along with all the other documents as required processing the claim.
Step 4: The form and the other documents submitted would be verified by the insurance company and if found satisfactory, a go ahead will be given by the insurance company for cashless claim.
Step 5: Once the treatment is done and the cashless request is accepted by the insurance company, Niva Bupa Health Insurance Company would transfer the claim amount directly to the hospital without any involvement of the insured customer.
For any other claim related query please contact on the toll-free number 1800-123-4003 to get the required assistance.
Niva Bupa Reimbursement Claim Settlement process:
There are certain documents required by the Niva Bupa health insurance company to process the claims other than cashless. Any treatment taken in non-network hospital would be settled on reimbursement basis as the process involves the customer to pay the bill and then claim for the reimbursement after submitting all the necessary documents. The process of claim settlement under reimbursement basis would be as below:
Step 1: The first step under reimbursement claim process is to intimate the insurance company within 24 hours of admission in the hospital. For pre planned treatment intimation can be given even 48 hours prior to the admission in the hospital.
Step 2: The next step is to duly fill the claim intimation form and sign it. There are certain documents which are to be submitted to the insurance company along with the claim intimation form which are mentioned below:-
- Details of the hospital in which the insured has undergone treatment which includes the details of patient, treatment undergone etc.
- Policy copy or the Health card of the insurance company to prove the validity and the coverage.
- Date of admission and date of discharge.
- Discharge Summary.
- Estimated claim amount for the treatment undergone at the hospital.
- Authorization from doctor advising hospitalization/ diagnostic tests/ consultation.
- Original hospital bills and the discharge summary.
- Pathological reports and any other reports taken as a part of the treatment.
- Police FIR and Post mortem report (for death claims)
- Any other documents as requested by the insurance company.
- Cancelled cheque leaf of the insured customer.
Step 3: The last step is where the insurance company would settle the bill after thorough enquiry and the quantum of claim would be decided by the insurance company subject to the terms and conditions mentioned under the policy. The insurance company would transfer the claim amount to the bank details submitted by the customer and any other bank details other than that of customer’s would not be accepted by the insurance for claim settlement.