Niva Bupa Health Companion Family First Insurance

Niva Bupa Health Companion Family First insurance plan details

• BenefitsFeaturesExclusions
• Benefits

  Niva Bupa Health Companion Family First Health Insurance

  Family First - Variant (1)(2)	Family First Plan
  Sum Insured (Rs.)	1. Individual Base Sum Insured: 1, 2, 3, 4, 5 & 10 lakhs per Insured Person 2. Floater Base Sum Insured (available on a floating basis over individual cover): 3, 4, 5, 10, 15 & 20 lakhs.
  IN - PATIENT TREATMENT
  Diagnostic procedures	Covered up to Sum Insured
  Medicines, drugs and consumables	Covered up to Sum Insured
  Doctors - fees	Covered up to Sum Insured
  Intravenous fluids, blood transfusion, injection administration charges	Covered up to Sum Insured
  Operation Theatre charges	Covered up to Sum Insured
  The cost of prosthetics and other devices or equipment if implanted internally during a Surgical Operation	Covered up to Sum Insured
  Intensive Care Unit Charges	Covered up to Sum Insured
  Hospital Accommodation	Covered up to Sum Insured
  Pre and Post hospitalization Medical Expenses	Covered up to Sum Insured
  DayCare Procedures	Covered up to Sum Insured
  Health Check-up	Annual
  Organ Donor	Covered up to Sum Insured
  Emergency ambulance	Covered upto Rs.3000
  Domiciliary Hospitalization	Covered up to Sum Insured
  Vaccination (in case of Animal Bite) (3)	Upto Rs.5,000
  Ayush Treatment (4)	Covered up to Sum Insured
  No Claim Bonus	Additional 20% of individual base sum insured upto maximum of 100% of individual base Sum Insured
  CUSTOMER LEVEL ENDORSEMENT
  Top-up plan on annual aggregate basis	Deductible of Rs.1,2,3,4,5 & 10 lakhs
  Treatment only in Tiered Network (5)	Option available to Zone 2 customers
  Hospital Cash (6)	Rs.1,000/day or Rs.2,000/day

  Plan Coverage (Individual/Family)

  1. Individual - 100% of sum assured
  2. Family Floater - 100% of sum assured (Applicable only for 2 Adults, No coverage for children)
  3. Entry Age for Adults - 18 to 65 years

  
  Guaranteed Cash Benefit:

  • Plan offers a guaranteed cash benefit subject to claim being admissible under policy.

  2 year Policy Tenure Option

  • You can opt for 2 year policy tenure & avail discount.

  
  Benefit Table:

  Benefits	Level 1	Level 2	Level 3	Level 4
  Critical Illness cover	3 Lakhs	5 Lakhs	7.5 Lakhs	10 Lakhs
  Baseline Cover Benefits	100% of SA	100% of SA	100% of SA	100% of SA

• Features

  Schedule of Benefits - Individual & Family Floater

  Notes:
  (1) Baseline cover includes a 36 months waiting period for pre-existing conditions, a 2 year waiting period for specific diseases/conditions & a 30 day Initial waiting period from inception. Entry age for adults is 18 years onwards and from 91 days to 21 years for children. New born children can be added to existing policies at renewal.
  (2) No co-payment for insured of any age.
  (3) Vaccination for Animal Bite (Post Bite Treatment) - OPD Benefit upto defined limit as part of overall limit.
  (4) AYUSH Treatment - Inpatient Treatment taken up in authorized Government Hospitals.
  (5) Tiered Network - Zone 2 customers can avail cashless treatment in Niva Bupa's network hospitals in Zone 2 locations. Customers can also avail treatment (reimbursement basis) in Zone 1 hospitals with 20% co-payment. Customer opting for this option will get a 10% discount.
  (6) Hospital Cash - Minimum 48 hrs of continuous hospitalization required. Maximum coverage offered for 30 days/policy year. Payment made from day one subject to hospitalization claim being admissible.
  

  1. In-patient treatment - (Up to Sum Insured)
     • Medical practitioners fees, Diagnostics tests, Medicines, Drugs and Consumables, Nursing charges, Intravenous fluids, Blood transfusion, Injection administration charges, Operation theatre charges, The cost of prosthetics and other devices or equipment if implanted internally during a Surgical procedure,Intensive Care Unit charges
  2. Hospital Accommodation
     • Reasonable and customary charges for hospital accommodation upto Sum Insured
  3. Pre & Post Hospitalization Expenses - (Up to Sum Insured)
     • Reimbursement of claim amount, 30 days for pre-hospitalization and 60 days for post-hospitalization
  4. All Day-care Procedures – (Up to Sum Insured)
     • Including Chemotherapy, Radiotherapy, Hemodialysis, or any procedure which needs a period of specialized observation or care after completion of the procedure
  5. Organ donor
     • Expenses for an organ donor’s treatment for the harvesting of the organ donated covered upto Sum Insured
  6. Emergency Ambulance
     • Covered upto Rs. 3,000 per hospitalization for all hospitalization (network/non-network)
  7. Domiciliary Treatment
     • Covered upto Sum Insured
  8. Free Heath Check-ups
     • Once in 2 years for 4 lakh coverage, once a year for others. Insured Person whos age is of 18 years at the time of Renewal shall be eligible for a health check-up.
  9. No Claim Bonus
     • 20% increase on the expiring Base Sum Insured up to a maximum of 100% of the Base Sum Insured of that Policy Year. NCB once accrued does not get reduced in case of claim
  10. Refill Benefit for New Illness (Individual/Family Floater Only)
      • If the base sum insured and No Claim Bonus is partially or completely exhausted (in case of Individual and Floater),We will provide Refill Sum Insured upto 100% of Base Sum Insured.
  11. Vaccination and Immunization Post an Animal Bite
  12. AYUSH Benefit
      • Reimbursement of medical expenses for alternative treatment taken under AYUSH provided the treatment has been undergone in a government hospital or in any institute recognized by government and/or accredited by Quality Council of India/National Accreditation Board on Health(Ayurvedic, Homeopathic, Sidda & Unani)
  13. No Copayment
      • No Mandatory or Optional Co-payment for any age
  14. High Deductible Top-up Option Discount
      • Customers can opt to start utilizing Niva Bupa Cover after exhausting their existing over with other company.
  15. Option Available with 10% Discount.
  16. Hospital Cash Option
      • Optional
  17. Discount for 2 year Policy
      • 12.5% on 2nd year premium
  18. Disease Based Risk Loading
      • Newly introduced
  19. Waiting Periods And Exclusions
      • 30 days waiting period except accidents. 48m Pre-Existing Disease in Variant 1(upto 4 lac),36m PED in Variant 2, 3 & Family First
  20. Pricing
      • Best In the Industry.
  21. Cashless facility is available across quality hospitals in our network.
• Exclusions
  • Addictive conditions and disorders
  • Ageing and puberty
  • Artificial life maintenance
  • Circumcision
  • Conflict and disaster
  • Congenital conditions
  • Convalescence and Rehabilitation
  • Cosmetic surgery
  • Dental/oral treatment
  • Drugs and dressings for OPD Treatment or take-home use
  • Eyesight
  • Unproven/Experimental treatment
  • Health hydros, nature cure, wellness clinics etc
  • HIV and AIDS
  • Hereditary conditions
  • Alternative treatment
  • Psychiatric and Psychosomatic Conditions
  • Obesity
  • OPD Treatment
  • Reproductive medicine - Birth control & Assisted reproduction
  • Self-inflicted injuries
  • Sexual problems and gender issues
  • Sexually transmitted diseases
  • Sleep disorders
  • Speech disorders
  • Treatment for developmental problems
  • Treatment received outside India
  • Unrecognized physician or Hospital
  • Unlawful Activity
  • Policy will not cover any treatment during the first 30 days unless the treatment needed is a result of an accident.
  • Pre-existing disease for a sum-insured upto 4 lakhs will be covered after 48 months and for 5 lakhs onwards pre-existing condition will cover after 36 months.