Health Assurance by Niva Bupa (Formerly known as Max Bupa) is a Fixed Benefit Plan which gives the flexibility to cover the sudden eventualities and unforeseen circumstances. Health Assurance is a combination of three health plans which are Critical Illness, Hospital Cash and Personal Accident Plans.

We will see a brief overview of Niva Bupa (Formerly known as Max Bupa)’s Personal Accident Plan.

Personal Accident Plan

Personal Accident Plan covers a host of risks which is associated with an unforeseen circumstance like accidents. Accidents not only change an individual’s life but members who are associated with the victim also gets affected very badly. Hence one should always look for a complete plan which will not only take care of one own self but also will look after the family members and the associated expenses. The coverage or the specified events under the plan can be summarized as follows:

Accidental Death Plan.
Permanent Total Disability Plan.
Permanent Partial Disability Plan.
Child Education Benefit Plan.
Funeral Expenses.

Let’s look into the above plans individually:

Accidental Death :

In case of Death within 90 days from the occurrence of the accidental bodily injury which is caused due to Accident solely and directly, the sum assured is paid which is specified in the Schedule of Insurance Certificate.

Permanent Total Disability :

This plan will cover upto 125% of principal sum insured under this. Permanent Total Disability under this plan will mean disablement of the Insured Person in performing at least one of the below mentioned actions:

Unable to Work: This means that the insured person will not be able to work ever in his life time in any occupation or employment.
Loss of use of limbs or sight: This means that the insured person suffers from total and irrecoverable loss of the use of two limbs OR both eye sight OR the use of one limb and the sight of one eye.
Loss of independent living: This will include when the insured person is unable to perform three or more tasks independently. The tasks can be classified as :
- Washing
- Dressing
- Feeding
- Mobility
- Toileting
- Transferring.

Permanent Partial Disability :

This plan will cover certain percentage ( As per the Grid below) of the sum insured under Permanent partial Disability if the insured person suffers from Permanent Partial Disability occurring due to solely and directly due to an accident and within 90 days of such unforeseen incident the amount will be paid. The claim will be admitted only when the Permanent Partial Disability continues for a period of atleast 6 calender months from the commencement of Permanent Partial Disability. No amount will be paid if the insured person dies before a claim has been processed under this plan. No further claim will be entertained if a claim has been submitted and processed under this plan. The Permanent Partial Disability grid is as follows:

Serial Nos	Nature of Permanent Partial Disability	% of Sum Insured
1.	Loss or total and permanent loss of use of both the hands from the wrist joint	100%
2.	Loss or total and permanent loss of use of both feet from the ankle joint	100%
3.	Loss or total and permanent loss of use of one hand from the wrist joint and of one foot from the ankle joint	100%
4.	Loss or total and permanent loss of use of one hand from the wrist joint and total and permanent loss of one eye sight.	100%
5.	Loss or total and permanent loss of use of one foot from the ankle joint and total and permanent loss of one eye sight.	100%
6.	Loss or total and permanent loss of use of one foot from the ankle joint and total and permanent loss of one eye sight.	100%
7.	Total and permanent loss of speech and hearing in both ears	100%
8.	Total and permanent loss of hearing in both ears	50%
9.	Quadriplegia	100%
10.	Loss or total and permanent loss of use of one hand from wrist joint	50%
11.	Loss or total and permanent loss of use of one foot from ankle joint	50%
12.	Total and permanent loss of sight in one eye.	50%
13.	Total and permanent loss of speech	50%
14.	Uniplegia	25%

Child Education Benefit :

Applicable for plans where children are covered only. In case of Accidental Death or Permanent Total Disability, 5% of sum assured or Rs 50000/- whichever is lower.

Funeral Expenses :

In case of accidental death, an amount of Rs 5000 is paid towards the funeral expenses of any insured person.

Plan Coverage : Individuals and Family both are covered under the plan.

For individuals its 100% of sum assured

For Family (Self, Spouse and upto 2 children)

Self -100% of sum assured

Spouse-50% of sum assured or Rs 10 Lakhs whichever is lower.

Children- 20% of sum assured or Rs 2 lakhs whichever is lower.

Eligibility

Individuals aged between 18 years to 65 years are eligible to apply for this plan. And children aged between 5 years to 21 years are covered under this plan.

Features

A Guaranteed Cash Benefit: This plan offers guaranteed cash benefit which is permissible under the plan.
Coverage from day one.
Plan Tenure: One can avail discount and the Policy period is for 2 years.
Direct Claim Settlement: Claims are processed by the company’s services team.
Lifetime Renewability under the Personal Accident Plans.
Under this plan, the coverage is available worldwide.
A freelook period of 15 days is available under this plan.

Exclusions

Following are the exclusions which are applicable under this plan:

Suicide or self injected injury irrespective of the Insured person being sane or insane.
War irrespective of declared or not, invasion, hostilities, civil war, martial law, act of foreign enemy, rebellion, revolution, insurrection, military or usurper power, riot or civil commotion.
Any change in profession after the plan has started and which enhances the company’s risks, if the not accepted and endorsed by the company on the Schedule of Insurance Certificate.
Committing an assault, a criminal offence or any breach of law with that of criminal intention.
Service in the armed force, or any police organization, of any country at war or at peace or service in any force of an international body or participation in any naval, military or air force operation during peace time.
Absorbing accidentally or otherwise, any intoxicating liquor, drug, narcotic, medicine, sedative or poison, except as prescribed by any licensed doctor other than the Policyholder or an Insured Person.
Inhaling as or fumes, accidentally or otherwise, except accidentally in the course of duty.
Participation in any aviation other than as a fare-paying passenger in an aircraft that is authorized by the appropriate authorities to carry out such passengers between established aerodromes.
Taking part in professional sports or any hazardous pursuits like driving or riding or race, underwater activities involving use of breathing apparatus or not, martial arts, hunting, parachuting, mountaineering, bungee-jumping.
Body or mental illness or any disease except where such condition arises directly as a correspondence of an Accident during the Policy Period. However, this exclusion is not applicable to claims made under Permanent Partial Disability benefit.
Disability which arises out of Pre-existing Conditions and if not accepted by the Company.

Premium & Sum Insured

There are four categories of Sum Insured and depending on the same the premium varies. The table can be drawn as under:

Premium is exclusive of service tax and cess.

Age Band	Level 1	Level 2	Level 3	Level 4
Sum Insured	500000	1000000	2000000	2500000
18-65 years	Rs 694	Rs 1382	Rs 2788	Rs 3483

Claims

Simple and hassle free claims are provided by Niva Bupa (Formerly known as Max Bupa) for their insurance plans. The steps for Accidental Death Plan are as follows:

Duly filed claim form.
Original Death Certificate.
Copy of FIR duly attested by the respective police station.
Copy of Post Mortem Report wherever its applicable.
Income proof of proposer which includes last 3 months Salary Slip, last year’s ITR or Form 16, employer’s certificate, and audited accounts
Copy of Medico Legal Certificate duly attested by the concerned Hospital.

The steps for Accidental Permanent Total Disability Plan are as follows:

Duly filed claim form.
Original Certificate of Disability issued by Medical Board duly constituted by the Central and the State Government.
Copy of FIR duly attested by the respective police station.
Original Hospital Discharge Summary and self attested if the same is submitted with another insurer.
Medical consultations and reports.
Income proof of proposer which includes last 3 months Salary Slip, last year’s ITR or Form 16, employer’s certificate, and audited accounts
Copy of Medico Legal Certificate duly attested by the concerned Hospital.

Policy Tenure

One can buy the plan for a period of one year or two years.

Various ways and steps involved in purchasing the plans

The Niva Bupa (Formerly known as Max Bupa) Plans can be purchased through various channels for example Niva Bupa (Formerly known as Max Bupa)’s direct sales person, Niva Bupa (Formerly known as Max Bupa)’s telesales team, or independent advisor or through the official website, licensed brokers and agents. However the most common ones are as under:

One can buy the plans online which do not require further underwriting and medical check up.
One can also call at the toll free no of the company between 9 am- 6 pm from Monday to Saturday.
One can also visit one of the branch.
Every customer will be given a Unique Customer Identification number on the Niva Bupa (Formerly known as Max Bupa) System.
The customer has to provide the following details:
- Insured’s name, address and date of birth.
- As above for all the dependants to be covered by the plan.
- Selection of Health Assurance Benefit and Sum Assured.
- Existing health plans details and claim history if applicable.
- Medical history of the proposed insured.
- Disclosure of any pre existing diseases with details.
- Height, weight and BMI

Underwriting process will be carried out for processing the forms.

In Personal Accident Cover plans, the sum insured is decided on the income of the proposed primary insured. The proof of income will be verified at the time of claim:

Maximum Sum Assured offered for a salaried individual will be upto 8 times the annual salary of the primary insured.
Maximum Sum Assured offered for a self employed individual will be upto 8 times the annual net profit as filed in the Income Tax Return by the primary insured individual.

Lets take two examples :

Example 1: Mr Arvind Gupta has an annual salary/ annual net profit of Rs 2 lakhs. So the maximum sum assured which Mr Gupta can avail is the 8 times of Rs 2 lakhs which is Rs 16 lakhs. And since Personal Accident Plans have the sum assured of Rs 5 lakhs, Rs 10 lakhs, Rs 20 lakhs and Rs 25 lakhs, maximum sum assured which Mr Gupta is eligible for are Rs 5 lakhs and Rs 10 lakhs.

Example 2: Mrs Arundhati Sen has an annual salary/ annual net profit of Rs 50000. So the maximum sum assured which Mrs Sen can avail is the 8 times of Rs 50000 which is Rs 4 lakhs. Since the lowest sum assured available under Personal Accident Plans is Rs 5 lakhs, hence Mrs Sen will be eligible for Rs 5 lakhs of Sum Assured.

Niva Bupa (Formerly known as Max Bupa) Personal Accident Insurance - FAQs

1. How to pay a premium? What are the modes of payment available?

The Niva Bupa (Formerly known as Max Bupa) Health General Insurance company Ltd. offers 4 modes of premium payment namely:

Cash payment at the branch
Online Payment
Tele payment
DST payment

For the online payment mode, the policyholder can pay via;

Credit Card,
Debit Card
Net banking

2. How can I check policy status for Niva Bupa (Formerly known as Max Bupa) personal accident insurance?

You need to visit the website and click on the Login portal with your username and password.

3. What is the policy renewal process for Niva Bupa (Formerly known as Max Bupa) personal accident insurance ?

Registered users can pay online,

Step1: Enter your Client ID and Date of Birth to login into e-portal

Step2: Choose the policy and payment option – Debit/Credit Card or Net Banking

Step3: Upon successful payment, save/print the premium deposit receipt

Alterantively, you can pay via cash/cheque at any of the nearest branch.

4. What is the company’s process to settle claim for Niva Bupa (Formerly known as Max Bupa) personal accident insurance ?

You just need to admit at any of the network hospitals and provide your Niva Bupa (Formerly known as Max Bupa) Health Card or you can provide the policy number and PAN card copy, Passport copy, Voter ID copy as ID proof. The hospital will send the pre-authorization form to Niva Bupa (Formerly known as Max Bupa) Health General Insurance Companyand in 4 hours the company will settle the claim.

5. What is the policy cancellation process for Niva Bupa (Formerly known as Max Bupa) personal accident insurance ?

For cancellation of the policy you just need to visit the nearest branch with your policy documents and surrender form, and submit it at the service desk. The policy will be cancelled and payments refunded within 7 bsuiness days.

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