| Plan Details | Gold Plan | Platinum Plan | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Base Sum Insured (in Rs) | 5 lacs, 7.5 lacs, 10 lacs, 15 lacs, 20 lacs, 30 lacs, 50 lacs | 15 lacs, 20 lacs, 50 lacs, 1 Cr (100 lacs) | |||||||||
| Inpatient care | Covered up to Sum Insured | Covered up to Sum Insured | |||||||||
| Room rent | Covered up to Sum Insured (except for Suite or above room category) | Covered up to Sum Insured | |||||||||
| Pre-Hospitalization Medical Expenses (60 days) | Covered up to Sum Insured | Covered up to Sum Insured | |||||||||
| Post-Hospitalization Medical Expenses (90 days) | Covered up to Sum Insured | Covered up to Sum Insured | |||||||||
| Alternative Treatment | Covered up to Sum Insured | Covered up to Sum Insured | |||||||||
| Day Care Treatment | Covered up to Sum Insured | Covered up to Sum Insured | |||||||||
| Domiciliary Hospitalization | Covered up to Sum Insured | Covered up to Sum Insured | |||||||||
| Maternity Benefit (4)(Covered Upto) | Rs 40,000, Rs 60,000, Rs 70,000, Rs 75,000, Rs 80,000, Rs 1,00,000, Rs 1,00,000 | Rs 120,000, Rs 160,000, Rs 200,000, Rs 200,000 | |||||||||
| New Born Baby (covered uptill the end of Policy Year) (4) | Covered up to Sum Insured | Covered up to Sum Insured | |||||||||
| Vaccination of the new born baby | Covered until new born baby completes one year, vaccinations as per defined list | ||||||||||
| Living Organ Donor Transplant | Covered up to Sum Insured | Covered up to Sum Insured | |||||||||
| Emergency Ambulance | Network Hospital : Covered up to Sum Insured Non-network Hospital : Covered up to Rs 2,000 per event |
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| Re-fill benefit | Reinstate up to base Sum Insured. Applicable for same & different illness as well | ||||||||||
| Pharmacy and diagnostic services | Available through empanelled service provider | ||||||||||
| HIV / AIDS | Covered up to Rs 50,000 | Covered up to Rs 50,000 | |||||||||
| Emergency assistance services (only within India) | Covered up to Sum Insured | Covered up to Sum Insured | |||||||||
| Mental disorder treatment | Covered up to Sum Insured (sub-limit of Rs 50,000 applicable on few conditions) | ||||||||||
| Loyalty Additions | Increase of 10% of expiring Base Sum Insured in a Policy Year; maximum up to 100% of Base Sum Insured | ||||||||||
| Health Check-up (per Insured Person) (3) | Annual, Tests covered up to worth Rs 1,250 | Annual, Tests covered up to worth Rs 1,875 | Annual, Tests covered up to worth Rs 2,500 | Annual, Tests covered up to worth Rs 2,500 | Annual, Tests covered up to worth Rs 2,500 | Annual, Tests covered up to worth Rs 2,500 | Annual, Tests covered up to worth Rs 2,500 | Annual, tests covered up to worth Rs 3750 | Annual, tests covered up to worth Rs 5,000 | Annual, tests covered up to worth Rs 5,000 | Annual, tests covered up to worth Rs 5,000 |
| OPD Treatment and Diagnostic Services | Not Applicable | Covered up to Rs 15,000 | Covered up to Rs 20,000 | Covered up to Rs 35,000 | Covered up to Rs 50,000 | ||||||
| Child Care Benefits (Vaccinations for children up to 12 years including one consultation for nutrition and growth during the visit for vaccination) | Not Applicable | Covered up to Sum Insured (As per defined list) | |||||||||
| Emergency Medical Evacuation | Not Applicable | Covered up to Sum Insured ( for worldwide excluding USA, Canada & India) | |||||||||
| Emergency Hospitalization | Not Applicable | Covered up to Sum Insured ( for worldwide excluding USA, Canada & India) | |||||||||
| Specified Illness Cover (5) | Not Applicable | Covered up to Sum Insured ( for worldwide excluding USA, Canada & India) | |||||||||
| Second Medical Opinion | Not Applicable | Covered, One opinion per Insured Person per Specified Illness / planned Surgery / Surgical Procedure | |||||||||
| Modern Treatments | Covered up to Sum Insured (sub-limit applicable on few conditions) | ||||||||||
| Optional Benefits | |||||||||||
| Hospital Cash (8) | Rs 3,000/day | Rs 6,000/day | |||||||||
| Personal Accident cover (for insured aged 18 years & above on individual basis) | Personal Accident cover will be equal to 5 times of base Sum Insured; subject to maximum of 50 lacs | ||||||||||
| Critical illness cover (for insured 18 years & above on individual basis) | Critical illness cover will be equal to base Sum Insured; subject to maximum of 10 lacs | ||||||||||
| e-consultation | Unlimited tele / online consultations | ||||||||||
| Premium Waiver | One time premium waiver if the Policyholder (who is also an Insured Person) dies or suffers from specified illness | ||||||||||
| Enhanced Geographical Scope for International coverage | Not Applicable | USA & Canada included for ‘Emergency Medical Evacuation', 'Emergency Hospitalization' & 'Specified illness cover' | |||||||||
| Claim cost sharing options | |||||||||||
| Co-payment | a. If you select Zone 2, then 20% co-payment will apply for treatment in Mumbai (including Navi Mumbai & Thane), Delhi NCR, Kolkata & Gujarat State b. Options of 10% and 20% co-payment |
Options of 10% and 20% co-payment | |||||||||
| (1) Niva Bupa processes pre- authorization within 30 minutes for all active policies, subject to receiving all documents and information(s) upto Niva Bupa’s satisfaction. The above commitment does not include pre-authorization settlement at the time of discharge or system outage. (2) Refer Loyalty Additions in product benefit table for details. (3) If the Policy is Renewed with Us without a break or if the Policy continues to be in force for the 2nd Policy Year in the 2 year Policy Period (if applicable). (4) subject to a continuous coverage of 24 months of that Insured Person since the inception of the first Policy which offers Maternity benefit with Us. New Born child cover is provided only where maternity claim is payable. (5) Covered for 9 specific illnesses for treatment abroad as per plan. (6) for specific illnesses & planned surgeries. (7) Tax benefits are subject to changes in tax law. Please consult your tax advisor for more details. (8) Hospital Cash - Minimum 48 hrs of continuous hospitalisation required. Maximum coverage offered for 30 days/policy year/insured person. Payment made from day one subject to hospitalization claim being admissible. |
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