Max Bupa (Now Niva Bupa) Health Premia Individual Plan: Benefits, Premium, Renewal

Niva Bupa (Formerly known as Max Bupa) Health Premia Individual Plan

Niva Bupa (Formerly known as Max Bupa) Health Premia Individual Plan is a truly comprehensive health indemnity plan with enough options to tailor everyone’s preferences. Thus, the Niva Bupa (Formerly known as Max Bupa) Health Premia Individual Plan Insurance Policy delivers a range of plan options and innovative covers that gels with the overall modern lifestyle. High coverage that includes new-age treatments and cashless treatment in 4800+ network hospitals make the plan exceptional. The plan is available in 3 variants: Silver, Gold & Platinum.

Type	Individual
Sum Insured	Up to 3 cr
Standout Benefits	· Annual health check-up · Sum Insured Refill · Loyalty benefit · Maternity benefit
Cashless benefit	Settlement in 30 minutes
Network Hospitals	4800+

Coverage Offered

The insured is provided with a wide range of coverage when deciding to buy Niva Bupa (Formerly known as Max Bupa) Health Insurance. The primary coverage in the Niva Bupa (Formerly known as Max Bupa) Health Premia Individual Plan includes:

Indemnity for medical expenses incurred up to the entire sum insured:
- In-patient Hospitalization:
- Pre and Post Hospitalization Expenses: Covered for 90 and 180 days, respectively.
- Day Care Treatment
- Domiciliary Hospitalization
- Alternative Treatment
- Living Organ donor Transplant
- Newborn baby
- Emergency Services:
Medical Referral
Air-ambulance evacuation
Medical Repatriation
Compassionate Visit
Return of mortal remains

Indemnity for medical expenses with stipulated limits:
Newborn baby vaccination
Ambulance
HIV / AIDS Treatment (waiting Period – 48 months): Rs 50,000
Mental disorder Treatment (waiting Period – 36 months): Rs 50,000
Maternity Benefit (Up to two pregnancies): Variable sub-limits based on the sum insured and the plan

Inclusions of the Plan

It should be noted that many of the inclusions are based on the plan variant, and the sum insured. The insured must consult the prospectus before deciding to buy Niva Bupa (Formerly known as Max Bupa) Health Premia Individual Plan:

New Age Treatments:
Bariatric Treatment (waiting Period – 36 months): Up to Rs 1,00,000
Robotic Surgery: Up to sum insured with 50% co-pay
LASER Treatment (waiting Period – 36 months): Up to Rs 50,000
International Travel:
Covers a single 15 days trip, amounting to Rs 30 Lakh per insured person, excluding the USA and Canada visit
OPD Cover: International sum insured with 20% co-pay
Optional Covers:
Personal Accident
Critical Illness
Enhanced Loyalty Addition
Hospital Cash
Health Coach
International Coverage Extension

Exclusions of the Plan

The insured must be aware of the applicable exclusions, whether the purchase is online Niva Bupa (Formerly known as Max Bupa) Health Premia Individual Plan, or otherwise. The exclusions under this plan are categorized as:

Those with a Waiting Period: Claims for the following are not accepted up to the stipulated exclusion periods.
Pre-Existing Conditions: Coverage after 24 months.
Initial: 30 days in general. For Critical Illness, it is 90 days, followed by 30 days for survival.
Specific Conditions: Covered after 12 months wait
Modern Treatments: covered upon expiry of 36 months.
Permanent Exclusions: A host of medical conditions for which claims are not admissible in the Niva Bupa (Formerly known as Max Bupa) Health Premia Individual Plan Health Insurance. The policy bond must be consulted for the detailed list.

Niva Bupa (Formerly known as Max Bupa) Health Premia Individual Plan Health Insurance: Features & Benefits

Plan Variants: The three options available offer a variable sum insured, starting from Rs 5 Lakh to Rs 3 Crore. They are:
Silver
Gold
Platinum
Zonal Coverage: The premium rates are based on the disparity in healthcare expenses in different parts of the country.
Refill-Benefit: The sum insured is restored after claim settlement within the policy year to ensure that the insured is never short of cover.
Policy Term: The insured can choose longer terms up to 3 years and save on the premium.
International Coverage: It comes with in-built travel insurance and the option to seek various medical facilities when traveling abroad.
Tax Benefit: The premium paid is eligible for a tax deduction under Section 80D of the Income Tax Act, 1961.

Eligibility Criteria

The minimum eligibility criteria to buy this plan are:

Type	Individual
Minimum Entry Age	Children: 90 days Adult: 18 years
Maximum Entry Age	Children: 30 years Adult: 65 years Lifelong Renewal
The Number of people covered:	Up to 19 relationships are covered in the Family First variant in a single policy.
Residential Status	Indian citizens, NRI, and foreign citizens normally residing in India.

Cancellation Terms of the Policy

As per IRDAI guidelines, every insurer allows a Free Look Period of 30 days to review and change the decision, during which they can return the policy if so desired. The insured must consult the policy bond to know more about the cancellation clauses.

FAQs

Q. What is the health check-up facility like in the Niva Bupa (Formerly known as Max Bupa) Health Premia Individual Plan?

Ans: The facility is offered from day one with an annual limit of Rs.10000 for each insured person.
Q. What is co-payment in the Niva Bupa (Formerly known as Max Bupa) Health Insurance?

Ans: It is primarily the percentage share on the approved bill the insured is required to pay for hospital treatment.
Q. How much is the Loyalty Additions in the Niva Bupa (Formerly known as Max Bupa) Health Insurance?

Ans: The sum insured increases by 10% of the base sum insured annually regardless of the previous year's claim. The increase is limited to 100% of the sum insured.
Q. What is the claim settlement promise made in the Niva Bupa (Formerly known as Max Bupa) Health Insurance?

ANs: The insurer offers direct claim settlement with in-house doctors and a quick, cashless claim processing.
Q. What are the modes of claim settlement in Niva Bupa (Formerly known as Max Bupa) Health Insurance?

Ans: The insured can opt for either the cashless treatment in a network hospital or seek medical expenses reimbursement, depending on the circumstances.

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Disclaimer: The list mentioned is according to the alphabetical order of the insurance companies. Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by any insurer. For complete list of insurers in India refer to the Insurance Regulatory and Development Authority of India website www.irdai.gov.in

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