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Niva Bupa Health Premia insurance plan details

• Unique features of Niva Bupa Health Premia Health Insurance

  • High Coverage option
  • income tax benefit upto INR 42,744 under the section 80D.
  • Tenure Discount: If you pay 2 year policy term,you get a discount of 7.5% on the premium of second policy year.On the other hand.
  • If you choose 3 year policy term, you get an additional discount of 15% on the third year's premium.
  • 15 Day Free look period.
  • Pre and post hospitalisation expensex are covered up to the sum insured, 90 days prior and 180 days post hospitalisation.
  • Worldwide Maternity benefit cover.
  • Direct claim settlement, no third party involved.
  • Re-fill Benefit:When the same or different illness strikes in the same policy year,your base sum insured is re-filled and made available to you.
  • Cashless hospitalization across network of quality hospitals.
  • Life long renewal.

• Information to be kept ready while intimating the claim:

  • Policy Number
  • Insured/Claimant contact details (phone no. , email id, address, landmark etc.)
  • Name of Insured/ claimant person, who is hospitalised
  • Relationship of insured with the person who is hospitalised.
  • Name of the hospital
  • Health Claims - Nature of ailment
  • Commencement date of the symptom of ailment
  • Accident Claims
    • Nature of accident
    • Date & time of accident
    • Location of accident

  Claims Procedure of Niva Bupa Health Insurance

  Assistance Contact Numbers:

  For Health Claims
  Call at : Toll Free 1860-500-8888
  Call at : 011-66326666
  Fax at : 011-30902010
  Email ID : customercare@maxbupa.com
  Write at : Niva Bupa Health Insurance Company Limited,
  B-1/I-2,
  Mohan Cooperative Industrial Estate Mathura Road,
  New Delhi-110044 Website : www.maxbupa.com
  
  For Health Claims (International Treatment Assistance) – as per plan availability
  Call at : Customer helpline number1860-3010-3333
  Email ID at : customercare@maxbupa.com
  For Emergency Medical Evacuation Call at: +45 7923 2403
  Email id : mergency@ihi.com
  
  

  Cashless Claims Process

  Step 1	Get admitted to any one of Niva Bupa network hospitals, currently they have 4500+ hospitals across the country…check out the hospital list at Niva Bupa (Note: Cashless Facility is only available at hospitals in the company’s cashless network)
  Step 2	Use your Niva Bupa Health Card or share your Policy number and Passport / PAN card / voter’s ID for identification purposes
  Step 3	The Network Hospital will check your identity for validation and submit the pre-authorisation request form to Niva Bupa as per the defined process / format
  Step 4	Niva Bupa will review and provide our confirmation to the Network Hospital by fax and E-mail and also send a text message and an E-mail confirming the same to you. We will respond to your request within 30 Minutes.
  Step 5	Niva Bupa will settle the claim (as per policy terms & conditions) with the hospital after completion of all formalities of documentation as per submission by the hospital.

  
  

  Reimbursement Claims Process

  Step 1	In case of hospitalization notify Niva Bupa within 48 hours of your admission in our network or non network hospital. After getting admitted settle bills directly to the hospital.
  Step 2	On discharge, please ensure you collect all relevant documents, invoices, medical reports and discharge certificate from the Hospital in originals.
  Step 3	Send these documents and the completely filled and signed claim form to us along with your valid ID proof and age proof. The claim form is available on the company website and in your policy document kit as well.
  Step 4	We review your claim request and the supporting documents provided along with the claim form. Accordingly based on policy terms & conditions, Niva Bupa will approve, query or reject the same.
  Step 5	Subject to the claim being approved, Niva Bupa will settle the claim (as per policy terms & conditions) and reimburse the approved amount to the insured.

• Coverages under Health Pulse

  PERIOD ON RISK	RATE OF PREMIUM TO BE CHARGED
  Up to 15 days	Full policy premium refundable
  Up to one-month	1/3rd of the policy premium
  Up to three months	1/2nd of the policy premium
  Up to six months	3/4th of the policy premium
  Exceeding six months	Full policy premium

• Exclusions of Niva Bupa Health Premia Health Insurance

  • Pre-existing conditions: Benefits will not be available for pre-existing conditions as per your policy plan until 24 months of continuous coverage from first policy start date.
  • 30 days initial waiting period: Treatment during the first 30 days of the plan will nt be covered,unless the treatment needed is a result of an accident.This waiting period does not apply for renewal polices.
  • Specific Waiting Periods:Few conditions like cataract,hernia,internal congenital anomaly,spinal disorder,etc. will be subject to a waiting period of 12 months.
  • The following benefits will have a waiting period of 36 months since inception of the policy and subject to continuous renewal: weight loss(bariatric) surgery| Mental disorder treatment| LASER surgery cover.
  • For HIV/AIDS cover.there will be a waiting period of 48 months since inception of the policy and subject to continuous renewal.
  • For Critical illness cover,a 90 days initial waiting period along with the pre-existing disease waiting period of 4 years and survival period exclusion of 30 days will apply for all conditions.
    (The aforementioned waiting periods shall not apply to e-consultation, health check-up, premium waiver, pharmacy and diagnostic services,personal accident cover and health coach).

  Permanent exclusions

  • Ancillary Hospital Charges
  • Hazardous Activities
  • Artificial life maintenance
  • Circumcision
  • AYUSH Treatments
  • Conflict & Disaster
  • External Congenital Anomaly
  • Convalescence & Rehabilitation
  • Cosmetic or plastic Surgery
  • Dental/oral treatment
  • Eyesight & Optical Services
  • Experimental or Unproven Treatment
  • Hormone Replacement Therapy
  • Hospitalization not justified
  • Inconsistent, Irrelevant or Incidental Diagnostic procedures
  • Non-Medical Expenses
  • Obesity and Weight Control Programs
  • Reproductive medicine & other Maternity Expenses
  • Robotic Assisted Surgery, Specialized Light Amplification by Stimulated Emission of Radiation (LASER) & Cyber Knife Treatments
  • Sexually transmitted Infections & diseases
  • Sleep disorders
  • Substance related and Addictive Disorders
  • Unlawful Activity
  • Treatment received outside India
  • Unrecognized Physician or Hospital