Niva Bupa Health Premia

All you need to know

FEATURES

Niva Bupa’s Health Premia is an all-inclusive plan, made-to-fit you and your loved ones. It not only understands your changing health needs due to your changing lifestyle, but also gives you the flexibility to change & choose the right cover basis your needs. In addition, you also get to choose from a comprehensive list of benefits and rewards basis your requirements.

Now, your health is truly in your hands with the all-new Health Premia.

• In-patient Care (Hospitalisation)

We cover cost of medical treatment when you or your insured family members are hospitalised for treatment.

• Hospital Accommodation

Silver plan (Individual / Family Floater): No limit on the hospital room rent. Room rent is covered up to Sum Insured except suite and above room category. ICU charges are covered up to Sum Insured.

Silver plan (Family First): One of the following two options can be chosen for room accommodation:

1: Customer can opt for Rs 3000 per day room or Shared room whichever is lower

2. Customer can opt for Rs 5000 per day or single private room whichever is lower

Gold plan: No limit on the hospital room rent. Room rent is covered up to Sum Insured except suite and above room category. ICU charges are covered up to Sum Insured.

Platinum plan: No limit on the hospital room category.

• Pre & Post Hospitalisation Medical Expenses

We reimbursepre & post hospitalisationmedical expenses incurred due to illness/injury. The period of the treatment covered is90 days before you get admitted to the hospital and 180 days after you get discharged from the hospital. This is subject to Niva Bupa accepting the In-patient Carehospitalisation, Day Care or Domiciliary hospitalisation claim.

• Day care treatments covered

We cover day care treatments under the product. Please refer to Annexure III of the policy document to know the day care procedures covered under the product.

• Domiciliary Hospitalisation

In case a bed in the hospital is unavailable or on advice of the attending medical practitioner, treatment is administered at home; we pay for medical treatment taken at home, which would otherwise have required hospitalisation. Such treatment shouldcontinue for at least 3 consecutive days and confirmation from treating medical practitioner/insured that insured person could not be transferred to the hospital or hospital bed was unavailable, as the case may be.

• Alternative Treatments

We will indemnify the medical expenses incurred on the insured person’s hospitalization for Inpatient Care on treatment taken under Ayurveda, Unani, Siddha and Homeopathy.

• Organ Transplant

Medical expenses for an organ donor’s In-patient treatment for the harvesting of the organ donated is also covered provided the organ is for the use of the insured person.

• Emergency Ambulance

We also cover the road ambulance expenses to transfer the insured following an emergency to the nearest hospital. We also provide ambulance coverage if the medical condition requires immediate ambulance services from the existing Hospital to another Hospital with advanced facilities for management of the current Hospitalization.These expenses are paid up to Sum Insured (network hospitals) or up to Rs 2,000 (non-network hospitals) only if we have accepted the In-patient claim.

• e-Consultation

Unlimited tele / online consultations available under this product.

• Maternity Benefit

The plan provides you maternity benefits for up to two deliveries. This benefit can be availed worldwide excluding USA and Canada under platinum plan.

Family floater plan: This benefit is available after both you and your spouse have been covered under the policy for two continuous years.

Family First plan: This benefit is available to female insured person of age 18 years or above. Such person should have been covered under the policy for two continuous years.

• Newborn Baby

The new born baby will be covered as an insured person from birth without additional premium, till the next policy year, if the maternity claim is admissible under the policy. We also cover vaccination expenses of the new born baby for the first year if you add the baby in the policy for the next policy year.

• Health Checkup

You can avail health checkup for Diagnostic Tests purposes from Day 1 for any insured person (including children), so that you live a healthier and happier life.

• Refill Benefit

In case you have exhausted your Base Sum Insured and Loyalty Additions / Enhanced Loyalty Additions (if any) partially or completely, you are entitled for an additional sum insured equal to the base sum insured for a subsequent claim in the same year. This benefit can be availed for both same and different illnesses. (Not available under Family First plan)

• Premium waiver

Automatic free of charge extension for 1 year if the Policyholder (who should also be an Insured Person) dies or is diagnosed or undergoes treatment for the first time, with any of the Specified Illness during the Policy. (Not available for individual cover)

• Pharmacy and Diagnostic Services

You may purchase medicines and diagnostic services from the empanelledservice provider through our mobile application or website. The cost for the purchase of the medicines or diagnostic services shall be borne by you.

• Loyalty Additions

Irrespective of your claim history, you will get an increase of 10% of expiring base Sum Insured every year, subject to maximum of 100% of base Sum Insured.

• HIV / AIDS

Expenses incurred for hospitalization (including day care treatment) due to condition caused by or associated with HIV / AIDS are covered under the policy subject to sub-limit as specified in the policy contract. This benefit is provided subject to a waiting period of 48 months from inception of the cover with Us, with HIV / AIDS covered as a benefit.

• Emergency assistance services

Coverage for Medical referral, Emergency medical evacuation, Medical repatriation, Compassionate visit, Care and/or transportation of minor children & Return of mortal remains. The services are provided when Insured Person(s) is/are traveling within India to a place which is at a minimum distance of 150 kilometers from the residential address, and the travel is for less than 90 days period.

• Mental Disorder Treatment

Expenses incurred for inpatient treatment for mental illness are covered under the policy subject to sub-limit for specific conditions as specified in the policy contract.This benefit is provided subject to a waiting period of 36 months from inception of the cover with Us, with Mental illness covered as a benefit.

• Weight loss (Bariatric) surgery

Expenses incurred for undergoing medically necessary bariatric surgery where the insured person’s MBI is greater than 35 are covered under the policy subject to sub-limit as specified in the policy contract.This benefit is provided subject to a waiting period of 36 months from inception of the cover with Us, with bariatric surgery covered as a benefit. Surgeries which are cosmetic in nature are not covered under this benefit. This cover is available under gold & platinum plan only.

• Cyber knife/ Robotics surgery

Expenses incurred for inpatient treatment for the removal and/or treatment of a malignant tumor through cyber knife or robotic Surgery are covered under the policy.A co-payment of 50% (under gold plan) / 20% (under platinum plan) is applicable for this benefit. This cover is available under gold & platinum plan only.

• LASER surgery cover

Expenses incurred for undergoing LASER assisted surgeries are covered under the policy subject to sub-limit as specified in the policy contract. This benefit is provided subject to a waiting period of 36 months from inception of the cover with Us. Lasik surgery for correction of refractive error would be covered if the Insured Person has a refractive index of plus/minus 8 or more and is prescribed by an ophthalmologist. This cover is available under gold & platinum plan only.

• Second Medical Opinion

Second medical opinion can be obtained once by an insured person during a policy year for the same specified illnesses or planned Surgery. This cover is available under platinum plan only.

• Child Care Benefits

We cover specified vaccination expenses for insured children until they have completed 12 years. We also cover consultation for nutrition and growth provided to the child during a visit for vaccination. This cover is available under platinum plan only.

• Specified Illness Cover

Insured persons are eligible for treatment of specified illnesses outside India except USA & Canada on a preauthorized cashless basis. This cover is available under platinum plan only.

• OPD Treatment and Diagnostic Services

We cover expenses incurred for OPD Treatment and/or Diagnostic Services and/or prescribed medicines for the OPD Treatment taken within India for up to Rs 50,000 (individual / family floater) or Rs 35,000 (family first). This cover is available under platinum plan only.

• International coverage

1. Coverage is provided for Emergency Hospitalization, Emergency Medical Evacuation, OPD cover (with a co-payment of 20%), Compassionate visit, Loss of Passport, Care and/or transportation of minor children, Loss of checked-in baggage, Return of mortal remains, Trip Cancellation & Interruption, Trip Delay, Delay of Checked-in Baggage, Medical Referral and Medical Repatriation; subject to sub-limits as specified in the Policy.

2. Gold plan: One Single trip of up to Rs. 30 Lacs per insured for maximum 15 days per insured outside India except USA & Canada is covered under this benefit. For activating this benefit, You have to get the Policy Schedule issued by Us at least 7 days prior to your trip.

3. Platinum plan: Annual multi trips (maximum 45 days in a single trip) of up to Rs. 1 Crore per insured outside India except USA & Canada is covered under this benefit.

• Personal Accident Cover (Optional)

Personal Accident coverage can be opted for any adult insured against accidental death, permanent total and partial disability.

• Critical Illness Cover (Optional)

Critical illness coverage for any adult insured against major illnesses like cancer, CABG, open heart replacement, kidney failure, stroke, major organ/bone marrow transplant etc.

• Enhanced Loyalty Additions (Optional)

Irrespective of your claim history, enhanced cumulative bonus of 20% of expiring base Sum Insured every year, subject to maximum of 200% of base Sum Insured.

• Hospital Cash (Optional)

Daily hospital cash benefit for a defined amount per day in case of hospitalization. Minimum 48 hours of continuous hospitalization required, however claim wouldbe paid from day one subject to hospitalization claim being admissible. Maximum coverage offered for 30 days/policy year/insured person.

• International coverage extension (Optional)

With the help of this benefit, You can double the sum insured of international coverage benefit. Available under gold & platinum plans.

• Health Coach (Optional)

Keeping in mind that the present age customers are fitness conscious, you have an option to choose a personal health coach who will guide and motivate to achieve personal health goals. This facility can be opted by any adult insured persons for 90 calendar days in a policy year.

• Enhanced Geographical Scope for international coverage (Optional)

Would like to inform you that by adding this benefit extends cover to USA & Canada for Maternity Benefit (under platinum plan), Specified Illness (under platinum plan) and international coverage base benefit (under gold & platinum plan).

• Co-payment

There will be no co-payment if you choose Zone 1 coverage. If you chooseZone 2 coverage, you will be entitled for a premium discount but will have to bear a 20% co-payment for treatment in Mumbai (including Navi Mumbai and Thane), Delhi NCR, Kolkata & Gujarat state.

• Tax Benefit

Save tax under Section 80D of the Income Tax Act when you buya Niva Bupa health insurance policy. Tax benefits are subject to changes in the tax laws, please consult your tax advisor for more details.

• Assured Policy Renewal for Life

Once insured with us, you will always remain our customers subject to continued payment of premium. We assure you renewability for life with no extra loadings based on your claim history.

• Direct Claim Settlement

We believe you should focus on the treatment of your loved ones rather than running after claim settlement. Therefore, all claims are processed directly by our customer service team.

• Cashless Facility

Cashless Facility can be availed only at our Network Providers or Service Providers. Please contact us for more details.

• Free Look Period

​​​​​​​We endeavor for transparency and complete satisfaction and therefore, our policies are transparent and easy to understand. If you are not satisfied, we provide a 15-day free look period (30 days if the policy has been sold through distance marketing)within which you can cancel your plan stating the reason.

• Information at your fingertips

Get quick and easy access to your claims history, your health information, your health profile, including records of tests and other details on our website.

Click Here to read the policy wording.

Commission on General Insurance