Niva Bupa Heartbeat Mediclaim

All You Need To Know

Overview ​​

Our families are the centre of our existence. We all aspire to give them the best life possible. A good health insurance policy is a step in this direction. Not only does it ensure access to the best medical care in times of need, it also safeguards our financial savings. In Heartbeat, you have a plan that understands your family’s healthcare needs and takes care of them just like you would. It comes with a plethora of unmatched features so that your family enjoys the most comprehensive protection at all times. Simple, easy-to-understand and with unbeatable service, this is the one of the best plans available.

Wide Coverage

  • Individual & Family floater sum Insured Options:
    - Gold: Rs 5 Lacs, Rs 7.5 Lacs, 10 Lacs, 15 Lacs, 20 Lacs, 30 Lacs & 50 Lacs
    - Platinum: Rs 15 Lacs, Rs 20 Lacs, Rs 50 Lacs & Rs 1 Crore
  • Family first sum Insured Options
    - Silver:
          - Individual Base Sum Insured: Rs 1 Lac, Rs 2 Lacs, 3 Lacs, Rs 4 Lacs & Rs 5 Lacs
          - Floater Base Sum Insured: Rs 3 Lacs, Rs 4 Lacs, Rs 5 Lacs, Rs 10 Lacs & Rs 15 Lacs
    - Gold:
          - Individual Base Sum Insured: Rs 1 Lac, Rs 2 Lacs, 3 Lacs, Rs 4 Lacs, Rs 5 Lacs, 10 Lacs & 15 Lacs
          - Floater Base Sum Insured: Rs 3 Lacs, Rs 4 Lacs, Rs 5 Lacs, Rs 10 Lacs, Rs 15 Lacs, 20 Lacs, 30 Lacs & 50 Lacs
    - Platinum:
          - Individual Base Sum Insured: Rs 5 Lacs, 10 Lacs & 15 Lacs
          - Floater Base Sum Insured: Rs 15 Lacs, 20 Lacs, 30 Lacs & 50 Lacs

Features

  • In-patient Care (Hospitalisation)
    We cover cost of medical treatment while you or your insured family members are hospitalized for treatment.
  • No Limit on the Hospital Room category under platinum plan, whereas other than suite & above room category for other plans.
  • Pre & Post Hospitalization Medical Expenses
    We reimburse medical expenses incurred due to Illness up to 60 days period immediately before you get admitted to a hospital and 90 days immediately after you get discharged from a Hospital, if We have accepted an Inpatient Care hospitalisation claim.
  • Alternative Treatments
    We will indemnify the Medical Expenses incurred on treatment taken under Ayurveda, Unani, Sidha and Homeopathy (AYUSH)
  • All Day Care Treatment Covered
    We cover all day care Treatment, not a select few. However, such a procedure should not be in the outpatient department of a hospital.
  • Loyalty Additions
    If the Policy is renewed with us without any break, you will get Sum Insured enhancement (10% of base Sum Insured per annum maximum upto 100% of base Sum Insured)
  • Maternity Benefits
    The plan provides you maternity benefits for up to two deliveries. This benefit is available after both you and your spouse 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.
  • Organ Transplant
    Medical Expenses for an organ donor’s treatment for the harvesting of the organ donated is also covered. These expenses are paid once we have accepted an In-patient claim.
  • Domiciliary Hospitalization
    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 hospitalization provided Domiciliary Hospitalization continues for at least 3 consecutive days..
  • Emergency Ambulance
    We also cover the ambulance expenses to transfer the policyholder following an emergency to a hospital. These expenses are paid once we have accepted an In-patient claim.
  • Tax Benefit
    You will save tax under Section 80D of the Income Tax Act when you buy a Niva Bupa Health Insurance Policy. Tax benefits are subject to changes in the tax laws, please consult your tax advisor for more details.
  • 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 own customer services team.
  • Assured Policy Renewal for Life
    Once insured with us, you will always remain our customers. We assure you renewability for life with no extra loadings based on your claim history.
  • Any Age enrollment
    We cover the insured member across every stage of life.
  • 2-year Policy Tenure Option
    You can opt for 2 year tenure and avail discount.
  • Cashless Facility
    You can access cashless facility at your nearest hospital.
  • Hospital Cash (optional cover)
    You can opt for Hospital Cash benefit, under which we will pay the Hospital Cash up to a maximum 30 days of Hospitalization for each continuous period of 24 hours of Hospitalization, provided Insured person has been admitted in a Hospital for a minimum period of 48 hours continuously.
  • 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 within which you can cancel your plan stating the reason.
  • International Treatment support for Specified Illnesses (under platinum plan only): Covers treatment outside India for specified dread diseases upto opted Sum Insured excluding treatment in USA and Canada. Treatment in USA and Canada can also be included by paying a little extra premium.

    The specified illnesses covered are listed below:

       - Cancers like leukemia, lymphoma and sarcoma excluding all tumours in the presence of HIV infection
       - Heart Attack (Myocardial Infarction)
       - Coronary Artery Bypass Graft (CABG)
       - Major Organ Transplant for heart, lung, liver, kidney, pancreas to treat irreversible end-stage failure of the relevant organ human bone marrow using haematopoietic stem cells is also covered .
       - Stroke
       - Surgery of Aorta including graft, insertion of stents or endovascular repair excluding surgery required due to underlying congenital condition.
       - Coronary Angioplasty subsequent to myocardial infarction or anginal attack.
       - Primary Pulmonary Arterial Hypertension
       - Brain Surgery
  • OPD Treatment and Diagnostic Services (under platinum plan only): Reasonable and customary expenses towards medically necessary consultation as an outpatient with a doctor to assess the Insured Person’s condition.
  • Consultation and Diagnostic Tests Carry Forward (under platinum plan only): If the Policy is renewed with us without any break and there is a unutilized amount under the applicable sub-limit in a Policy Year, then we will carry forward 80% of this unutilized amount to the immediate succeeding Policy Year.
  • Emergency Medical Evacuation and Hospitalization (under platinum plan only): In case of a medical emergency outside India we will provide assistance in medical evacuation of the Insured Person and cover the reasonable and customary costs of transportation of the Insured Person (and an attending Doctor if this is medically necessary). We will also cover Emergency Medical Evacuation within India, if the condition requires air ambulance or commercial flight for evacuation purposes.
  • Childcare benefits (under platinum plan only) 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.
  • Second Medical Opinion (under platinum plan only)
    You can obtain Second medical opinion for Specified Illness / planned Surgery / Surgical Procedure.
  • We will not cover treatment during the first 30 days of the policy, unless the treatment needed is a result of an Accident. This waiting period does not apply for renewal Policy.
  • Benefits will not be available for Pre-existing Diseases until 24 months (for platinum and gold plans) and 48 months (for silver plans) of continuous coverage from first policy start date, provided such Pre-existing Disease is stated in the Proposal and specifically accepted by Us and endorsed thereon.
  • For all Insured Persons who are above 45 years of Age as on the date of inception of the First Policy, some conditions will be subject to a waiting period of 24 months and will be covered in the third policy year only.


Click Here to read the policy wording.

Eligibility Criteria

  • Heartbeat can be issued to an individual customer, a family (family floater) and/or extended family (family first).
  • This policy covers persons of any age. There is no maximum entry age for the insured.
  • The maximum entry age of any dependent as a child in the policy is less than 21 years on the date of commencement of the initial cover under the Policy.

Permanent Exclusions

  • Ancillary Hospital Charges
  • Hazardous Activities
  • Artificial life maintenance
  • Autoimmune Disorders
  • Behavioral, Neurodevelopmental and Neurodegenerative Disorders
  • Circumcision
  • Complementary & Alternative Medicine
  • Conflict & Disaster
  • Congenital Anomaly, Hereditary or Genetic Disorders
  • Convalescence & Rehabilitation
  • Cosmetic and Reconstructive Surgery
  • Dental/oral treatment
  • Eyesight & Optical Services
  • Experimental/Investigational or Unproven Treatment
  • HIV, AIDS, and related complex
  • Hospitalization not justified
  • Inconsistent, Irrelevant or Incidental Diagnostic procedures
  • Mental and Psychiatric Conditions
  • Non-Medical Expenses
  • Obesity and Weight Control Programs
  • Off- label drug or treatment
  • Puberty and Menopause related Disorders
  • Reproductive medicine & other Maternity Expenses: Any assessment or treatment method
  • Robotic Assisted Surgery, Light Amplification by Stimulated Emission of Radiation (LASER) & Light based Treatment
  • Sexually transmitted Infections & diseases
  • Sleep disorders
  • Substance related and Addictive Disorders
  • Traffic Offences & Unlawful Activity
  • Treatment received outside India
  • Unrecognized Physician or Hospital
  • Any costs or expenses specified in the list of expenses generally excluded at Annexure IV of policy wording
  • For complete list of exclusions, please refer policy terms and conditions.

    Commission on General Insurance

Frequently Asked Questions

Policy holder may purchase medicines and diagnostic services from Our empanelled Service Provider
through Our mobile application or website. The cost for the purchase of the medicines or diagnostic services shall be borne by policyholder.

After 3 years of waiting period Expenses incurred for inpatient treatment for mental illness are

Covered under the policy subject to sub-limit of Rs. 50,000 for specific conditions.

Yes, 2 year option is available. 12.5% discount will be provided on 2nd year premium.

The customers can opt for 10% or 20% co-payment in their policy. (this is applicable for all variants of the product.

Customers opting for Silver and Gold Variant, will also have the option of choosing zone based loading where co-payment will be applicable if treatment is taken in Mumbai (including Navi Mumbai & Thane), Delhi NCR, Kolkata and Gujarat state.

We will cover Pre-Hospitalization Medical Expenses for 60 days immediately preceding the Insured
Person’s admission to Hospital for Inpatient Care and it is covered up to sum insured.

This Policy provides a host of value added Emergency Medical Assistance and Emergency personal Services on cashless Facility basis in India geographical boundaries.
Emergency Assistance Service:

  • Medical referral
  • Emergency medical evacuation
  • Medical repatriation
  • Compassionate visit
  • Care and/or transportation of minor children
  • Return of mortal remains

Yes, even if Base Sum Insured has been partially exhausted due to claims made and paid or claims
made and accepted as payable for any Illness / Injury during the Policy Year, then We will provide a Re-fill amount of maximum up to 100% of the Base Sum Insured which may be utilized for claims arising in that Policy Year.

After 4 years of waiting period, covered under the policy subject to sub-limit of Rs. 50,000.

All the benefits under the Policy and any treatment taken unless the treatment needed is the result

of an Accident that occurs during the Policy Period will be subject to a waiting period of 30 days since the inception of the First Policy with Us. Please note that Waiting Periods shall not apply to Health Checkup, Pharmacy and diagnostic services, Personal Accident Cover, Critical Illness Cover, e-Consultation and Premium waiver.

Yes, covered in all the variants (silver, gold and platinum) as per the defined limit ranging from Rs. 20000 to 2 Lac)

• Accidental Death within 365 days of accident
• If the Injury due to Accident solely and directly results in the Permanent Total Disability of the Insured Person which means that the Injury results in one or more of the following conditions within 365 days from the occurrence of an Accident, We will make payment of 125% of the Personal Accident Cover Sum Insured as specified in the Policy Schedule
• Accidental Permanent Partial Disability(PPD) - If the Injury due to Accident solely and directly results in the Permanent Partial Disability of the Insured Person within 365 days from the occurrence of such Accident, we will make a payment in accordance to the grid mentioned in the policy document.

  • Personal Accident cover (for insured aged 18 years & above on individual basis)
  • Critical illness cover (for insured 18 years & above on individual basis)
  • E-consultation
  • Premium Waiver (Applicable in Family Floater/Family First)
  • Enhanced Geographical Scope for International cover-age (Applicable in Platinum Plan)

For all Insured Persons who are above 45 years of Age as on the date of inception of the First Policy with us, the medical conditions and/or surgical treatment listed below will be subject to a Waiting Period of 24 months unless the condition is directly caused by Cancer (covered after Initial Waiting Period of 30 days)or an Accident (covered from day 1) and will be covered in the third Policy Year as long as the Insured Person has been insured continuously under the Policy without any break:

  • Pancreatitis and Stones in Biliary and Urinary System,
  • Cataract, Glaucoma and other disorders of lens, disorders of Retina,
  • Hyperplasia of Prostate, Hydrocele and spermatocele,
  • Abnormal Utero-vaginal bleeding, female genital Prolapse, Endometriosis/Adenomyosis, Fibroids, PCOD, or any condition requiring dilation and curettage or Hysterectomy,
  • Hemorrhoids, Fissure or Fistula or Abscess of anal and rectal region,
  • Hernia of all sites,
  • Osteoarthritis, Systemic Connective Tissue disorders, Dorsopathies, Spondylopathies, inflammatory Polyarthropathies, Arthrosis such as RA, Gout, Intervertebral Disc disorders,
  • Chronic kidney disease and failure
  • Varicose veins of lower extremities
  • Disease of middle ear and mastoid including Otitis Media, Cholesteatoma, Perforation of Tympanic Membrane
  • All internal or external benign or In Situ Neoplasms/Tumours, Cyst, Sinus, Polyp, Nodules, Swelling, Mass or Lump
  • Ulcer, Erosion and Varices of Upper Gastro Intestinal Tract
  • Tonsils and Adenoids, Nasal Septum and Nasal Sinuses
  • Internal Congenital Anomaly.

Note : If the Insured Person is suffering from the above Illness/condition as a Pre-existing Diseases (if disclosed by the Insured Person and accepted by Us), any claim in respect of that Illness/condition shall not be covered until 24 months (under Gold and Platinum plans) / 48 months (under Silver plan) of continuous coverage have elapsed since the inception of the First Policy with Us.

In Heartbeat, we cover 536 day care procedures.

If any Insured Person who is a child and has completed Age 22 years at the time of Renewal, then such Insured Person will have to take a separate policy.

OPD and diagnostics services are covered only in platinum variant.
(For Individual and Family floater)
For 15 lacs S.I – covered up to Rs. 15000
For 20 lacs S.I – covered up to Rs. 20000
For 50 lacs S.I – covered up to Rs. 
(For Family First) – covered up to Rs. 35000

Same in all variants

  • Network Hospital: Covered up to Sum Insured
  • Non-network Hospital: Covered up to Rs. 2,000 per event

If the Insured Person is required to be admitted in a Hospital in an Emergency condition, We will compensate the Medical Expenses specified in the Policy Schedule. Any claim incurred before death of such Insured person shall be admissible subject to terms and conditions under this Policy.

In Platinum Plan (Family Floater/Family First) vaccinations for children up to 12 years are covered including one consultation for nutrition and growth during the visit for vaccination

Any Insured Person on the commencement of that Policy can avail health checkup post completion of 1st policy year.

We will Cover Post-Hospitalization Medical Expenses for 90 days immediately following the Insured
Person’s discharge from Hospital and it is covered up to sum insured.

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 (mentioned in the policy document), During the Policy Period, the cover under the Policy shall be automatically extended for a tenure of 1 Policy Year starting from the end of that Policy Period.

Conditions in Premium Waiver:
I. This optional benefit is provided once in the lifetime in the Policy regardless of the number of years the Policy has served with Us.
II. The symptoms of the Specified Illness first occur or manifest itself during the Policy Period and after completion of the 90 day from the inception of the First Policy with Us.
III. The Specified Illness is diagnosed by a Medical Practitioner during the Policy Period and after completion of the 90 day from the inception of the First Policy with Us.
IV. If We have admitted a claim under this optional benefit during the Policy Period, this optional benefit shall not be renewed for any subsequent Policy Period

Note : This benefit is not available under Individual Policy.

Answer: If the Insured Person is diagnosed with a Specified Illness as defined in the policy document or is planning to undergo a planned Surgery or a Surgical Procedure for any Illness or Injury, the Insured Person can, at the Insured Person’s sole direction, obtain a Second Medical Opinion.