Niva Bupa Health Companion plan is offered by Niva Bupa Health Insurance Company Limited.
Apart from hospitalisation and related expenses, it covers consumable items like gloves, oxygen masks, etc. If you are seeking comprehensive coverage, this plan is worth considering. Please note that the cost of health check-ups are also covered from day 1. Besides that, the plan also gives you the option to automatically increase your sum insured based on previous year's inflation. However, this plan doesn't come with a monthly premium payment option. And, as per our research, the insurer has received a higher number of claim settlement and policy purchase complaints, indicating a poor track record with respect to both purchase and claims service.
What are the benefits offered by the Niva Bupa Health Companion Plan?
- Inpatient hospitalisation coverage: The Niva Bupa Health Companion Plan offers coverage for inpatient hospitalisation. These expenses include room boarding and nursing charges, medical practitioner’s fees, cost of prescribed medicines and drugs, ICU charges and other related expenses. To be eligible for coverage, you need to be admitted to the hospital for at least 24 hours.
- Pre-hospitalisation coverage: Pre-hospitalisation charges are the medical expenses borne before hospitalisation, like tests, check-ups, consultations, lab reports, etc. The insurer will only cover these expenses if they are related to the medical condition for which you are later hospitalised, and are approved as part of inpatient hospitalisation coverage. The Niva Bupa Health Companion Plan covers pre-hospitalisation expenses incurred up to 30 days before hospitalisation up to the sum insured.
- Post-hospitalisation coverage: Post-hospitalisation coverage includes the medical costs that arise after getting discharged from the hospital. These expenses may include follow-up consultations with your doctor, medical check-ups, rehabilitation sessions, physiotherapy, and more. To be eligible for coverage, the post-hospitalisation expenses must be related to the condition you were hospitalised for and your claim must be approved under inpatient hospitalisation coverage. The Niva Bupa Health Companion Plan covers post-hospitalisation expenses incurred up to 60 days after hospitalisation up to the sum insured.
- Daycare treatment coverage: The Niva Bupa Health Companion Plan covers all daycare treatments. These are the treatments that traditionally required an extended stay at the hospital but now can be completed within 24 hours due to groundbreaking advancements in the healthcare industry. Niva Bupa Health Companion Plan imposes no limit on any daycare treatment and the expenses will be covered up to the sum insured.
- Domiciliary treatment coverage: Domiciliary treatments refer to medical treatments for illnesses or injuries that require immediate attention in a hospital but are administered at home if the patient is very ill or injured and cannot be transported safely to a hospital, or because there are no hospital beds available nearby. The Niva Bupa Health Companion Plan covers domiciliary treatment costs for all illnesses up to the sum insured.
- Organ donor coverage: The Niva Bupa Health Companion Plan also provides coverage for expenses associated with harvesting the organ from the organ donor in case of an organ transplantation where you are the organ recipient - up to the sum insured. Keep in mind that the living organ donor's hospital stay expenses as well as stem cell donation expenses are excluded (except for Bone Marrow Transplant).
- Modern treatment coverage: The field of healthcare is rapidly evolving with advancements in technology leading to the development of modern treatments. These treatments, such as radio surgeries, stem cell therapy, etc. aim to cure ailments that were previously thought to be incurable. Niva Bupa Health Companion Plan is designed to keep pace with these advancements and covers the expenses associated with modern treatments up to the sum insured except for few robotic surgeries where sub-limits are applicable.
- Non-medical expenses coverage: The Niva Bupa Health Companion Plan not only covers medical expenses but also includes coverage for non-medical expenses - if you opt for an add-on. These expenses refer to the cost of consumables, such as gloves, nebulization kits, oxygen masks, and other items necessary for treatment. The plan provides coverage for these expenses up to the sum insured - eliminating the financial burden of additional costs.
- No Claim Bonus: No-Claim Bonus is a reward given by the insurance company if no claim is made during a policy year. In the case of the Niva Bupa Health Companion Plan, if you do not make any claims during the policy year, you will be eligible for a bonus of 20% of the sum insured. Also, if you file a claim during a policy year, the accumulated bonus amount will not be reduced. The maximum bonus that can accumulate under this plan is 100% of the sum insured.
- Super No Claim Bonus: This is an advanced version of the No Claim Bonus and works exactly like it. Niva Bupa Health Companion Plan doesn’t provide the Super No Claim Bonus feature.
- Restoration Benefit: The Restoration Benefit is a feature which restores your sum insured once it has been depleted within a policy year. Under the Niva Bupa Health Companion Plan, the refill benefit is applicable for both related and unrelated illnesses. This feature will activate only when the sum insured and the No Claim Bonus are partially exhausted. This refill is applicable for subsequent claims once in a policy year.
Please note that the limits and terms mentioned in the above benefits and features are applicable for a sum insured of Rs. 10 lakhs.
Niva Bupa Health Companion: Financial Limits
- Room rent limit: The maximum amount that your insurance company will cover for the room you are hospitalised in is known as the room rent limit. If you select a room that falls within your plan's room rent limit, you will not incur any additional expenses. However, if you opt for a room with a higher rent than your eligibility, you will be subject to a proportionate deduction. This implies that you will be responsible for paying a proportionate share of the entire bill, rather than just the difference in the room rent. The Niva Bupa allows you to choose any room type - without imposing any restrictions.
- ICU rent limit: It is the maximum amount that your health insurance policy will cover for your stay in the intensive care unit (ICU) of a hospital. There is no ICU rent limit under Niva Bupa Health Companion plan.
- Co-payment: A co-payment or copay is a portion of the approved claim amount that you are responsible for paying out of your pocket. After you pay the copay, the insurance company will cover the remaining amount. There is no co-payment limit in the Niva Bupa Health Companion Plan.
- Deductible: A deductible is a certain amount that you have to pay from your end before your health insurance coverage starts to pay for your medical expenses. Niva Bupa Health Companion Plan offers you with a range of deductible limits to choose from - Rs 1 lakh, Rs 2 lakhs, Rs 3 lakhs, Rs 4 lakhs, Rs 5 lakhs and Rs 10 lakhs.
- Limits on surgeries/treatments: It refers to the maximum amount that the health insurance policy will cover for specific medical procedures or treatments. While some policies may have specific limits on the amount that they will cover for certain procedures, others may not. The Niva Bupa Health Companion plan has no limit on surgeries and treatments like cataract treatment or joint replacement surgery. This means it’ll cover the associated expenses up to the sum insured.
Please note that the terms and limits mentioned in the above benefits and features are applicable for a sum insured of Rs. 10 lakhs.
Niva Bupa Health Companion: Waiting Periods & Exclusions
After you purchase a health insurance policy, some illnesses and diseases may not be covered for a certain period. This timeframe is known as the waiting period. Once this period gets over, you will be able to claim for these conditions.
- Initial waiting period: There is an initial waiting period of 30 days for all medical conditions except for accidents. This indicates that you will not be able to claim hospitalisation charges for the initial 30 days, except for accidents.
- Waiting period for pre-existing diseases: A pre-existing disease is any medical condition or illness that you have had in the 48 months before applying for the health insurance policy. Niva Bupa Health Companion plan has a waiting period of 36 months for pre-existing diseases. During this period, the policy will not cover any treatments you undergo related to your pre-existing diseases.
- Waiting period for specific diseases: Insurance companies have a specific list of medical conditions or illnesses, other than your pre-existing conditions, for which they impose waiting periods regardless of whether you have had those diseases in the past or not. This waiting period is solely determined by the insurer and is not based on your current health status. The Niva Bupa Health Companion Plan has a waiting period of 24 months for specific diseases.
Exclusions are medical situations that will not be covered under your health insurance policy, including -
- Standard permanent exclusions: The IRDAI has defined a set of 'standard permanent exclusions'' that must be followed by all insurance companies in India. These include -
- Investigation and evaluation: Hospital admission for diagnostics or evaluation purposes only.
- Rest, rehabilitation and respite care: Admission to a facility for bed rest where no active treatment is provided.
- Obesity/weight control: Treatment or surgery for controlling the weight or obesity.
- Gender reassignment: Treatments crafted to change the body’s characteristics to those of the opposite sex.
- Plastic/Cosmetic surgery: Treatments to modify appearances and body characteristics.
- Profession in hazardous or adventure sports: Treatments for accidents that occurred while participating as a professional in any adventurous sports like rafting, scuba diving, horse racing, etc.
- Breach of law: Expenses for the treatment of a person who has caused a breach of law with criminal intent.
- Excluded providers: Treatments from a medical practitioner or hospital that is not included by the insurance company.
- Narcotics: Treatments of individuals addicted to alcohol, drugs, etc.
- Treatments in establishments arranged for domestic purposes: Expenses of treatment undergone in health spas, nursing homes, or similar establishments arranged entirely or partially for domestic purposes.
- Dietary supplements, substances purchased without prescription: Supplements such vitamins, minerals, etc. bought without prescription by a medical practitioner.
- Refractive error: Treatments related to correcting refractive errors of up to 7.5 diopters to enhance your eyesight.
- Unproven treatments: Treatments, surgeries or medical procedures that do not prove to be effective.
- Expenses related to birth control, sterility infertility: Contraception, sterilisation, artificial insemination, advanced reproductive technologies like IVF, ZIFT, GIFT, ICSI, the use of a surrogate mother for gestational purposes, etc.
- Maternity Expenses: Expenses related to childbirth, pre/post-natal costs, etc.
- Additional permanent exclusions: Along with these standard permanent exclusions, insurance companies may have their own additional exclusions for particular situations or medical conditions. If you have certain diseases or severe medical conditions that insurance companies consider too risky to cover, they may exclude those diseases permanently from your policy. However, it is important to understand that insurance companies are restricted to a list of diseases mentioned by IRDAI for which they can apply a permanent exclusion. They cannot permanently exclude any illness or disease that is not mentioned in the list.
- Non-standard exclusions (Specific exclusions): These are the specific exclusions that go beyond the standard permanent exclusions listed by IRDAI. These exclusions may vary between the insurance companies and may also depend on the policy’s terms and conditions. Here is a list of some of the specific exclusions under the Niva Bupa Health Companion plan-
- Circumcision unless it is crucial to treat a disease or an injury
- Injury or illness that occurs directly or indirectly due to involvement in terrorism, nuclear emissions, war, civil war, etc.
- Expenses for screening, counselling, or treatments related to external birth defects.
- Dental treatment except if required due to an accident
- Medical and ambulatory devices like BP monitors, sugar monitors, crutches, wheelchairs, etc. that are used at home
- Treatments related to intentional self inflicted injury or attempted suicide by any means
- Use of ventilator for a patient in the vegetative state (brain dead) without any chances of recovery
What to expect in terms of claims experience if you buy from Niva Bupa Health Insurance Company Limited?
- Speed of claims: Niva Bupa Health Insurance Company has settled 99.95% of claims in less than 30 days. This makes Niva Bupa Health Insurance Company Limited a great choice for those looking for a fast and reliable claims experience.
- Claim-related complaints: According to our research, we found that Niva Bupa Health Insurance Company has received a higher number of complaints related to claims(0.49%) in comparison to other insurance companies.
- Claims incurred ratio: The claims incurred ratio is a measure of an insurance company's financial performance. It represents the total amount of claims incurred by the insurer compared to the total amount of premiums they collected in a given fiscal year. The claims incurred ratio of Niva Bupa Health Insurance Company is 65.44%.
- Claim settlement ratio: The claim settlement ratio refers to the percentage of claims that an insurer has settled as compared to the total number of claims received by them in a financial year. Niva Bupa Health Insurance Company’s claim settlement ratio is 85.18%.
- Network hospitals: Niva Bupa Health Insurance Company has over 10,000+ hospitals in their network. This means you can access a wide range of healthcare providers in different locations and enjoy the benefits of cashless treatments.
How is the customer service of Niva Bupa Health Insurance Company Limited?
- Policy purchase-related complaints: Niva Bupa Health Insurance Company has received a higher number of complaints related to their after-sales service as compared to other insurers, accounting to 0.01%.
- Response on Toll-Free: Our research team found that Niva Bupa Health Insurance Company’s response over the toll-free is average as compared to other insurance companies.
- Response on Twitter: Niva Bupa Health Insurance Company’s response rate on Twitter is average.
About Niva Bupa Health Insurance Company Limited
Niva Bupa Health Insurance Company Limited, previously known as Max Bupa Health Insurance Company Limited, is a health insurance provider that offers various health insurance products including individual health plans, family floaters, top-up policies, and more. It was established in 2008 and is headquartered in New Delhi, India. It is a joint venture between Fettle Tone LLP and Bupa Singapore Holdings Private Limited. The company's CEO and MD is Mr. Ashish Mehrotra.