Niva Bupa (earlier Max Bupa) health insurance company key highlights, features, popular health plans, inclusions and common exclusions

Niva Bupa, formerly known as Max Bupa, is a standalone health insurance provider in India. The company is a joint venture between Fettle Tone LLP and Bupa Singapore Holdings Private Limited. Fettle Tone LLP is an affiliate of True North Fund VI LLP and is a private equity firm of India. Bupa, on the other hand, is a leading healthcare provider globally. Together, both these companies, come to offer comprehensive health insurance solutions for the Indian masses.

Niva Bupa’s health insurance plans are meant for individuals, families, senior citizens as well as corporates. You can buy any suitable policy as per your needs and get good coverage. 

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Key Highlights of Niva Bupa Health Insurance Company

Here are some of the key highlights of the company 

Niva Bupa Health Insurance Awards and Accolades

The company has won many awards in the industry for its innovative products, services and performance. Here’s a look at some of them –

• For its Active Customer Engagement, Niva Bupa received the CII Customer Obsession Awards
• Best Campaign in Consumer Health Fitness awarded by the Economic Times Kaleido Awards 2019
• In 2019, the company won the Golden Peacock Award in Risk Management 
• The company was also considered a Great Place to Work in 2020

Key Features of Niva Bupa Health Insurance Plans

The health insurance plans of the company are quite comprehensive. Here are some of the most common coverage benefits found in its plans –  

Common Exclusions in Niva Bupa Health Insurance Policy – Things Not Covered

Even though the policy covers certain medical conditions, Niva Bupa has a list of exclusions that won’t be covered. It is possible to find the exact exclusion list in the policy wordings. Nevertheless, some common exclusions include the following:

• When purchasing a policy, if you suffer from any illness or condition, it will be considered as a pre-existing illness and excluded for a specific waiting period
• There may be a 2-year waiting period before certain illnesses or treatments are covered. There are many examples of such treatments like cataracts, joint replacement treatments, fissures, piles, etc.
• There is no coverage for illnesses that occur within the first 30 days of purchasing the insurance
• There is no coverage for cosmetic treatments or weight-loss surgeries
• The following claims are excluded: war, nuclear threats, mutiny, rebellion, etc.
• Adventure sports, hazardous activities, and crimes, as well as the claims arising from them, are excluded from coverage
• Instances of suicide attempts, self-inflicted injuries, and alcohol and drug abuse excluded from this list as well
• No coverage is provided for treatments that are unscientific or do not follow the doctor’s advice
• No reimbursement is provided for lenses, hearing aids, spectacles, etc.

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Top 3 Health Insurance Plans Offered by Niva Bupa:

Niva Bupa has a wide variety of health insurance plans in its kitty. Some of the leading policies of the company, also available at PayBima, include the following – 

1. Niva Bupa Reassure Health Insurance

A comprehensive health insurance plan available both on an individual and family floater basis, Reassure can provide all the coverage benefits that your family needs. Here are some of the salient features of the policy –

Features of Niva Bupa Reassure Health Insurance

• Unlimited sum insured reinstatement: The plan allows unmatched coverage by allowing unlimited sum insured reinstatement. If you suffer multiple claims in a year and your sum insured gets used up, the plan would refill the sum insured, as many times as you want.
• Healthy living benefits: The plan has a wellness program wherein you can accumulate reward points every time you go walking and take a specified number of steps. Your steps would be tracked and depending on the count you can accumulate your reward points. These points can then be used to claim a discount on the premium on renewal.
• Double your sum insured in just 2 years: The plan has the booster no claim benefit wherein the sum insured would increase by 50% if you don’t make a claim in a policy year. So, if you don’t claim for two successive policy years, you can double the sum insured and that too is free of cost.
• Air ambulance cover: Coverage for air ambulance expenses is also allowed if you require such transportation for hospitalisation. In the case of cashless claims, coverage is allowed up to the sum insured. However, for reimbursement claims the coverage limit is Rs.2.5 lakhs.
• Range of optional benefits: There are different types of optional coverage benefits under the policy that can help you enhance the coverage as per your needs at affordable premiums.

Eligibility Conditions of Niva Bupa Reassure Health Insurance

2. Niva Bupa Health Companion Plan

This is also an indemnity-based health insurance policy that covers your actual medical costs. The policy has the following salient features – 

• Different coverage variants: The plan has four coverage variants with different coverage benefits, limits and sum insured levels. You can choose a variant that best matches your coverage needs and affordability.
• Refill benefit: The plan allows the sum insured refill benefit wherein if your sum insured is used on a previous claim in the same policy year, the sum insured would be refilled to the original amount to pay for any subsequent claims.
• Vaccination cover: In the case of animal bites, coverage for the cost of vaccines is allowed.
• Coverage for modern treatments: The plan covers modern and robotic surgeries and treatments up to the sum insured. However, in the case of some treatments, coverage is allowed up to Rs.1 lakh.

Eligibility conditions of Niva Bupa Health Companion Plan

3. Health Recharge Plan

Health Recharge is a super top-up policy that has a sum insured and a deductible. If your aggregate claims exceed the chosen deductible, the policy pays the excess claim. Some of the highlights of the policy are as follows –

• The facility of online consultations: You can avail of multiple online and teleconsultations with expert medical practitioners. You just have to get in touch with a networked service provider and then consult with a doctor free of cost.
• Coverage for treatments due to mental disorders: If you are hospitalised due to mental disorders, the costs incurred on treating such disorders would be covered by the policy. Moreover, there is no coverage restriction as you can enjoy coverage up to the sum insured
• Loyalty benefit: Every year that you don’t claim your policy, you earn a loyalty benefit of a 5% increase in the sum insured without any additional premium. You can continue accumulating the increase for each claim-free year up to a maximum of 50%.
• Coverage for HIV/AIDS and artificial life maintenance: Coverage for HIV/AIDS as well as for maintaining artificial life is allowed under the plan while other plans might not include it. Moreover, you can avail of coverage up to the sum insured

Eligibility conditions of Health Recharge Plan

How to Buy Niva Bupa Health Insurance Online? 

Purchases of Niva Bupa Insurance Plans can be made either online or offline. PayBima offers a simple online purchase mode and the process to buy through PayBima is as follows:

• Visit PayBima and choose ‘Health Insurance’ – Click on ‘health insurance’ on the PayBima website to start the process of purchasing a health plan.

• Fill out the form – For PayBima to find you appropriate health plans based on your eligibility and insurance requirements, it will ask you for certain personal and medical details once you choose health insurance. Please provide your name, address, pin code, phone number, gender, age, number of dependents, and medical information regarding health status, medical history, and pre-existing conditions. PayBima also offers personal consultations to help you select a health plan.

• Comparison of health insurance plans – Once all the details are entered in the form, a list of insurance plan names, features, and premiums will be displayed. You can compare plans based on their benefits and premiums, and select the one that best suits your needs.

• Submit the proposal form – Complete the proposal form after shortlisting your policy. Providing complete and accurate details in the form will prevent your claim from being rejected in the future.

• Payment of premium – You can pay the premium online using the available online payment methods. With its secure premium payment options, PayBima ensures a hassle-free payment experience.

• Issuance of the policy – Your health plan will be issued instantly on payment of the premium if the proposal form does not contain any adverse information regarding your lifestyle habits and medical history and if the plan does not require you to undergo any pre-entrance health check-up.

• A pre-entrance medical checkup is mandatory – Depending on your health status, age and sum insured selected, Niva Bupa might require you to undergo a pre-entrance health check-up. This check-up is important for the policy to be issued. You can avail of a free check-up at any networked facility of the company.

The Process to Renew Niva Bupa Insurance Policy

PayBima provides the facility of purchasing a health insurance policy, as well as renewing it on its website. Niva Bupa offers lifetime renewals. So if you renew on time, you can keep your coverage uninterrupted.

By providing your policy number and other details, you can renew your health insurance policy online. During the renewal process, you can review your plan details and make any necessary changes. There may be a separate premium required if the plan changed or need change. Alternatively, you can contact PayBima via email at paybima.care@mahindra.com or by phone at 1800 267 67 67 for more information about renewing your Niva Bupa Insurance Plan.

How to Claim Niva Bupa Insurance Plan?

PayBima makes it very easy to file a claim under the Niva Bupa Insurance Plan. You just need to complete the following steps:

• Finding a network hospital: You can make a cashless claim only at a hospital that is networked with Niva Bupa. Go to the insurance company’s website to find the nearest network hospital to make a cashless claim. You can also contact the company’s claim department and locate a hospital for cashless claims.

• Admission: Upon finding a networked hospital, you can be admitted by showing your ID proof and health card.

• Pre-authorization Claim form: The insurance company must receive a pre-authorization claim form to process a cashless settlement of your claim. The pre-authorization form is available online or at the nearest branch. In the case of planned hospitalization, the form must be submitted at least three to four days before the event. During an emergency, the form can also be submitted within 24 hours after hospitalization.

• Cashless approval: Based on the details entered in the pre-authorization claim form, Niva Bupa would approve the cashless claim. You can, then, receive treatments and the costs would be handled directly by the company.

• Reimbursement Claim Facility: If you are admitted to a hospital that is not in the company’s network, your claim will be reimbursed. Alternatively, if your cashless claim is not approved, you can claim on a reimbursement basis. You must notify your insurance company before you plan to be admitted to a non-network hospital. You can notify the insurance company after you have been admitted and before you are discharged if you have an emergency admission. You will need to pay the medical bills incurred. When you submit a claim form along with original receipts, bills, and medical records, the hospital will reimburse you after it assesses your claim and validates your documents.

PayBima has been settling customer claims smoothly and efficiently. You can contact PayBima for assistance with claim settlement by calling 1800 267 67 67 or by emailing paybima.care@mahindra.com. 

Documents Required at the time of Claiming Niva Bupa Health Insurance

Certain documents must be provided for a claim to be settled. Included Documents in this list are:

• You must complete and sign the claim form
• Reimbursement claims would require a cancelled cheque copy for bank details
• Policy bond
• Identity proof of the insured
• All medical bills and hospital reports
• A pre-authorization form must be completed for cashless claims
• For reimbursement claims, the supporting documentation includes original bills and receipts, consultation notes, prescriptions, and hospital reports.

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Niva Bupa Health Insurance Review 

• The company offers the facility of comparing the different plans that it offers. You can compare the plans and choose those that give the best protection as per your needs
• The company does not have any TPAs for claim handling. It handles its claims internally to give you the smoothest settlement
• You can contact the company 24*7 for any complains or queries
• Most health plans cover COVID 19 claims 

 

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