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

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

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: 

Cancellation Terms of the Policy

As per IRDAI guidelines, every insurer allows a Free Look Period of 15 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.