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Individual Health Insurance Plans
Niva Bupa Senior First Policy
While retirement age is called the golden days of life, it is also the age of medical vulnerability as people are usually exposed to various types of health risks. But to ease your problem, Niva Bupa Health Insurance has come up with their Senior First plan that not only helps you to stay fit and healthy but also provides different unique benefits such as Reassure benefit, annual aggregate deductible, direct claim settlement facility without any third party, and many more. Let us know more about this plan.
Minimum – 61 years
Maximum – 75 years
|Plan type||Individual and Family Floater|
|Plan variants||Gold and Platinum|
|Base sum insured|
Gola plan – Rs. 5 lakhs and Rs. 10 lakhs
Platinum plan – Rs. 5 lakhs, Rs. 10 lakhs, Rs. 15 lakhs, Rs. 20 lakhs, and Rs. 25 lakhs
|Family combination||1 adult or 2 adults (self and spouse). 2 adults policy can be taken on an individual basis or floater basis sum insured.|
General – 30 days
Pre-existing diseases – 24 months
Specified illnesses and procedures – 24 months
Coverage Details of Niva Bupa Senior First Plan
As this plan is specially designed for senior citizens, the benefits are also made keeping in mind their requirements. To know more details about the plan, keep an eye on the following table.
|In-patient care, day care treatment, pre and post-hospitalization treatment, alternative (AYUSH) treatments, domiciliary hospitalization (treatment at home), organ donor expenses||Covered up to the sum insured|
Gold plan – Shared room
Platinum plan – Single private room
|Pre-hospitalization coverage||Up to 60 days|
|Post-hospitalization coverage||Up to 180 days|
|Modern treatments||Covered up to the sum insured but that comes with a sub-limit of Rs. 1 lakh per claim on a few robotic surgeries.|
|Emergency road ambulance cover||Up to Rs. 2000 per hospitalization|
|Emergency air ambulance cover||Up to Rs. 2,50,000 per hospitalization|
|No Claim Bonus (NCB)|
Gold plan – Not applicable
Platinum plan – Increase of 10% of expiring base sum insured in a policy year only if it is a claim-free year that is subject to a maximum limit of 100%. In the case of a claim, there will be no reduction in the No Claim Bonus.
Gold plan – Not applicable
Platinum plan – Unlimited up to the base sum insured. Applicable for both same and different illnesses.
(It is done annually and starts from day 1. It is applicable for pre-listed tests only.)
Gold plan – Not applicable
Platinum plan – The limit is up to Rs. 500 for every Rs. 1 lakh base sum insured.
For individual policy – Rs. 5000 per insured
For family floater policy – Rs. 10,000 per insured
|Co-payment||50% (10% additional co-payment will be applicable if the treatment is taken in a higher room category than the eligible room category.|
|Other discounts||For staying healthy, you can get up to a 20% discount at the time of renewal.|
|Annual Aggregate deductible (This is an aggregate amount in a year that is incurred by the insured person during the hospitalization, which is not paid by the insurer)||Rs. 1 lakh, Rs. 2 lakhs, Rs. 3 lakhs, Rs. 4 lakhs, and Rs. 5 lakhs|
|Modification in co-payment|
0%, 20%, 30%, or 40%.
Alternatively, you can choose a deductible amounting to 1/5th of your base sum insured.
Exclusions of Niva Bupa Senior First Policy
Without knowing the exclusion of an insurance policy, you should not buy that product as this ignorance may land you in a difficult situation, in the future. So, to have a comprehensive idea of this plan, here are exclusions for which the insurer does not compensate.
- Expenses related to the investigation, evaluation, or any kind of diagnostic tests that are not related to the present medical condition are excluded from the policy benefits.
- If the patient is enforced to have bed rest and does not receive any medical treatments, that will also fall under the category of exclusion.
- The costs of dietary supplements and substances without a prescription, including but not limited to vitamins, minerals, organic substances, etc. are permanently excluded from the policy.
- If you receive any treatment that is unrecognized, unauthorized, or illegal, the company does not take responsibility for that.
- If your treating doctor, medical practitioner, or surgeon does not have a legal license and is not registered, you will not get any compensation for the incurred expenses.
- Any treatment arising out of the consumption of drugs, alcohol, or any kind of intoxicating substance will be excluded from the policy.
- Expenses arising out of the treatments of sterility, infertility, and maternity costs will not be compensated by the insurer.
- If you take part in any kind of hazardous activities, or adventurous games such as skiing, para-gliding, mountaineering, etc., and you receive any injury arising out of it, the policy will not cover those expenses.
- Plastic surgery, any procedure for gender treatments, and cosmetic surgery fall under the category of exclusion.
- The following health conditions or procedures are not covered by the Senior First plan – Circumcision, External Congenital Anomaly, sexually transmitted Infections & diseases (other than HIV / AIDS), sleep disorders, and dental or oral treatments.
- Self-inflicted injury, suicide, or suicide attempts are excluded as well.
Niva Bupa Senior First Policy Premium
Calculating the premium for your policy and evaluating that is an important part of choosing a suitable plan for yourself. Therefore, for your better understanding of the plan, here is an example.
Suppose, Mr. Bose a 66-years-old, Mumbai based senior citizen has bought Niva Bupa Senior First Plan for himself and his wife. Let us find out, how much premium he has to pay for different sum insured options for the chosen data.
|Type of policy||Number of people covered||Age of the insured persons||Plan variant||Base sum insured||The payable premium for 1 year||Premium break-up|
|Family Floater||2 adults|
Mr. Bose -66 years
Mrs. Bose – 64 years
|Platinum Plan||Rs. 10 lakhs||Rs. 45,356|
Actual premium – Rs. 45,356
Base premium – Rs. 38,437
GST (18%) – Rs. 6919
|Rs. 15 lakhs||Rs. 54,968|
Actual premium – Rs. 54,968
Base premium – Rs. 46,583
GST (18%) – Rs. 8385
|Rs. 20 lakhs||Rs. 63,521|
Actual premium – Rs. 63,521
Base premium – Rs. 53,831
GST (18%) – Rs. 9690
Frequently Asked Questions
Niva Bupa Senior First Plan covers the following modern treatments:
- Uterine Artery Embolization and HIFU (High intensity focused ultrasound)
- Immunotherapy – Monoclonal Antibody to be given as an injection
- The vaporization of the prostate (Green laser treatment or holmium laser treatment)
- Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for hematological conditions
- Balloon Sinuplasty
- Oral chemotherapy
- Robotic surgeries
- Stereotactic radio surgeries
- Deep brain stimulation
- Intra vitreal injections
- Bronchial thermoplasty
- IONM – Intra Operative Neuro Monitoring
No, once the co-payment option is chosen at the time of purchasing the policy, later on, it cannot be changed.
No, under this policy, the deductibles will not apply to health check-up benefits.
Niva Bupa Health Insurance offers Covid-19 covers for all of its indemnity plans.
No, charges related to a hospital stay not expressly mentioned as being covered, including RMO charges, surcharges, and service charges levied by the hospital, will not be covered by the policy.
No, in case of migration or change of insurance policy, your NCB of the previous policy will not be carried forward to the next or new policy.
If you want to enjoy the benefit of domiciliary hospitalization, you need to fulfill the following criteria.
- At the time of a medical emergency, either room was not available in the hospital or the patient was not in the condition to reach the hospital, and it has to be given in writing by the treating doctor.
- The patient has to receive a minimum of 3 consecutive days of treatment.
No, for the Senior First plan, a pre-policy medical check-up is not mandatory.