Overview
With a vision to become Indias most admired Health Insurance Company, Max Bupa Health Insurance Company Ltd came into being in 2010. It is a joint venture between True North, a leading Indian private equity firm, and the UK’s 70-year-old healthcare services expert, Bupa. While on the one hand, Bupa brings its vast and varied experience, on the other hand, True North adds the insights and understanding of the Indian healthcare market and its capability of transforming business. Together, they strive to make Niva Bupa one of the best medical insurance companies in the country
Highlights for Niva Bupa Senior First Gold
No sub-limits on common health condition
Safeguard
Annual Aggregate Deductible
Modification in co-payment
Features
Sub-limits
Room Rent
Room rent for in-patient hospitalisation
Ambulance
Transportation of the patient to the hospital and back home
Modern Treatments
All advanced treatment with upgrade in technology.
Pre-Hospitalisation : 60 days
The amount of expenses incurred during this period prior to hospitalisation such as diagnostic tests, doctor fees, medicines, etc. for investigiation purpose are also payable by the insurer
Post Hospitalisation : 180 days
The amount of expenses incurred during this period after discharge from hospitalisation for the purpose of recovery such as follow-up tests, doctor fees, medicines, etc. are also payable by the insurer
Pre existing Disease cover : Pre-existing diseases covered after 24 months of renewal.
Coverage for all Pre-Existing Diseases covered after a certain specified waiting period with continuous renewal.
Waiting Period- Initial : 30 days
No claims are accepted within this period except due to accidents/ injury.
Waiting Period- Specific : 2 Years
Listed specific illness
Waiting Period- PED : 24 Months
No pre-existing ailment related claims are accepted within this period.
Room Rent : Shared Room no capping
Room rent for in-patient hospitalisation
ICU Charges : No
Charges for ICU hospitalisation
Co pay : Mandatory 20%, 30%, 40% or 50%
% of the claim that the policyholder needs to pay out-of-pocket
Restore Benefit/ Recharge/ Refill : No
If the sum insured is exhausted due to hospitalisation expenses of one or more members, there is an automatic restoration of the sum insured for related or unrelated ailments.
Health Check up : No
Free annual health check-up for all insured members according to the list of tests specfied in the policy document.
No Claim Bonus : No
% of the sum insured that rises every claim free year.
Video/telephone consultation : No
E-consultation with expert doctors empanelled with the insurer for a second opinion.
Domiciliary hospitalization : Upto Sum Insured
Home care treatment where there are no beds in the hospital or paitient is not in a condition to be moved to the hospital, This treatment is provided under the supervision of a registered medical practitioner.
Ambulance : Hospitalization covered up to 2,000; Air Ambulance Cover Cashless: Up to Sum Insured; Reimbursement: Up to 2.5 Lacs.
Transportation of the patient to the hospital and back home
Convalescence benefit : No
A specific fixed amount of money paid as a recovery benefit for extended hospitalisation.
Organ Donor : Upto Sum Insured
The costs for a surgical procedure of removal or damaged organ from the patient's body which could otherwise be fatal.
Bariatric cover : No
Expenses related to obesity-related conditions such as high BP, sleep apnea, arthiritis asthma, etc.
Daycare : Upto Sum Insured
Covers in-patient hospitalisation expenses where the stay is <24 hours under a specified list of treatments
AYUSH : Upto Sum Insured
Alternative treatment coverage such as ayurvedic, unani, sidha and homeopathy which leads to hospitalisation.
Congenital Coverage : No
Covers medical expenses related to diagnosis and treatment of heriditary and internal congenital ailments/ conditions/ traits that exist from birth.
Modern Treatments : Upto Upto Sum Insured(sub-limit of INR 1 Lac per claim for some robotic surgeries).
All advanced treatment with upgrade in technology.
Health Management/ Wellness : No
Benefits provided for staying fit and managing health
Maternity Benefit : No
All expenses related to childbirth or legal medical termination of pregnancy, usually upto a specified limit.