Niva Bupa Health Premier (Gold)

Niva Bupa Health Premier (Gold) is one of those health insurance plans that brings both security and peace of mind. Offered by Niva Bupa Health Insurance Company Limited, it’s designed to keep medical expenses from becoming a financial headache. Life throws surprises, and not all of them are pleasant, especially when it comes to health. That’s where this plan steps in, making sure hospital bills don’t drain savings. It comes with a range of coverage options, so everything can be tailored to fit personal healthcare needs. No undue stress, just the knowledge that medical attention will always be close at hand.

This plan arrives loaded with an extensive list of benefits and features, as well as some discounted offers. It pays for child delivery, mental health care, weight loss treatments, and the like. On top of that, it even offers international coverage with built-in travel insurance, making trips smoother and stress-free.  

It does, however, have certain drawbacks. It’s on the pricier side compared to other plans in the market, and there’s no option to pay premiums in monthly instalments. Hospital room selection is also limited, which could be a dealbreaker for some. 

Plus, based on our research, the insurer has received a higher-than-usual number of complaints related to both policy purchases and claim settlements. This raises concerns about their overall service quality when it comes to both buying the policy and getting claims processed.

What are the benefits offered by the Niva Bupa Health Premier (Gold) Plan?

• Inpatient hospitalisation coverage: Inpatient cover comes into effect when a patient is admitted to the hospital for over 24 hours. It covers necessary costs such as room fee, nursing care, consultation with a doctor, prescription drugs, ICU charges, and other required medical expenses. The goal is simple. It covers the financial burden so recovery remains the only thing to focus on, without the stress of piling bills. The Niva Bupa Health Premier (Gold) Plan covers all expenses related to inpatient hospitalization. There are no limits on ICU charges, and you are free to choose any hospital room except a suite or higher. This means you can focus on your recovery with the comfort and care you prefer, without worrying about restrictions. 
• Pre-hospitalisation coverage: Before hospital admission, there are often several medical expenses to handle, known as pre-hospitalization costs. These usually include doctor consultations, lab tests, checkups, and medical reports. After discharge, any post-hospitalization expenses will be covered only if they are directly related to the treated condition and your inpatient hospitalization claim is approved. With the Niva Bupa Health Premier (Gold) Plan, pre-hospitalization expenses are covered up to the sum insured, giving you one less thing to worry about. Physiotherapy expenses incurred before hospitalization will also be covered. Also, expenses for alternative treatments before hospitalization will be covered, except for allopathy.
• Post-hospitalisation coverage: Post-hospitalization coverage is essential for a smooth recovery after discharge. It takes care of follow-up doctor visits, ongoing treatment, and necessary medications. To be covered, these expenses must be directly related to your hospital treatment and fall within the limits of your inpatient hospitalization plan.  The Niva Bupa Health Premier (Gold) Plan provides extensive coverage for post-hospitalization expenses for up to 180 days after discharge, up to the sum insured. Post-hospitalization physiotherapy expenses will be covered. Additionally, costs for alternative treatments after hospitalization will be included, except for allopathy.
• Daycare treatment coverage: Daycare treatments include medical procedures or surgeries that used to keep patients in the hospital for days, but can now be done within 24 hours, all thanks to medical advancements. The Niva Bupa Health Premier (Gold) Plan covers 536 daycare treatment procedures with no financial limit. 
• Domiciliary treatment coverage: Domiciliary treatments involve urgent medical care given at home rather than in a hospital. This is usually needed when a patient is too unwell to be moved safely (as per a doctor) or when hospital beds are unavailable nearby. The Niva Bupa Health Premier (Gold) Plan covers all expenses for domiciliary treatments up to the sum insured. 
• Organ donor coverage: The Niva Bupa Health Premier (Gold) Plan takes care of organ donor expenses too. It covers the donor's inpatient costs for the transplant procedure up to the sum insured, offering much-needed financial relief during such critical moments. Stem cell donation is not covered under the Organ Donor Cover, except in the case of a Bone Marrow Transplant. Also, note that the Organ Donor Cover does not include coverage for the donor’s pre- and post-hospitalization expenses.
• Modern treatment coverage: Modern treatments have transformed healthcare, making it possible to tackle conditions that once had no cure. From stem cell therapies to radiosurgery and robotic procedures, these advanced options are tailored to meet each patient’s unique needs. The Niva Bupa Health Premier (Gold) Plan is designed to stay in step with medical advancements, covering the costs of modern treatments without any financial cap. However, limitations exist for a few robotic surgeries. Under the Modern Treatment Cover, robotic surgeries have a coverage limit of Rs. 1 lakh, except for robotic total radical prostatectomy, robotic cardiac surgeries, robotic partial nephrectomy, and robotic surgeries for malignancies, which are fully covered. 
• Non-medical expenses coverage: Coverage for non-medical expenses takes care of essential items like gloves, oxygen masks, nebulization kits, hospital gowns, medical footwear, urine bags, and even vaccinations. This ensures that these extra costs do not add to your financial stress during treatment. However, with the Niva Bupa Health Premier (Gold) Plan, non-medical expenses are not covered. 
• No Claim Bonus: A No Claim Bonus is the insurer's way of rewarding you for staying claim-free throughout the policy term, giving you added benefits for maintaining a healthy, uninterrupted coverage period. Under the Niva Bupa Health Premier (Gold) Plan, the No Claim Bonus allows you to accumulate benefits over time, with a maximum bonus of up to 100%. If you make a claim, there will be no reduction in the accumulated bonus from the previous year. Each year without a claim adds a 10% bonus to your coverage, rewarding you for maintaining a claim-free record. However, No Claim Bonus does not apply to e-Consultation, Health Check-ups, Premium Waivers, Pharmacy and Diagnostic Services, Emergency Assistance, Second Medical Opinion, Child Care Benefits, International Coverage, or any optional benefits chosen under the policy.
• Super No Claim Bonus: The Super No Claim Bonus takes the regular No Claim Bonus up a notch, providing all the same benefits but with even greater rewards. The Niva Bupa Health Premier (Gold) Plan provides provisions for the super no-claim bonus. With the Super No Claim Bonus, the maximum bonus you can accumulate goes up to 200%. Even if a claim is made in the previous year, there is no reduction in the accumulated bonus. Each year without a claim adds a 20% bonus, making it a highly rewarding feature for those who maintain a claim-free record.
• Restoration benefit: Restoration benefit acts as a safety net, refilling your sum insured if it gets completely exhausted during the policy year due to unexpected medical expenses. With the Niva Bupa Health Premier (Gold) Plan, the refill benefit allows a one-time restoration of your sum insured within a policy year. It kicks in for subsequent claims when the sum insured, along with any accumulated No Claim Bonus or Super No Claim Bonus, is partially used up. Whether the medical condition is related to a previous illness or entirely different, the reinstatement of coverage ensures continued financial support when needed. 

Please note that the terms and conditions mentioned for the benefits above are applicable to a sum insured of Rs. 10 lakhs. 

Niva Bupa Health Premier (Gold): Financial Limits

• Room rent limit: The room rent limit determines the highest amount your insurance will cover for hospital room charges. As long as you stay within this limit, there are no extra costs. But if you go for a higher-priced room, a proportionate deduction will apply, and you'll need to cover the difference. With the Niva Bupa Health Premier (Gold) Plan, you can select any room without any restrictions except a suite or above. 
• ICU rent limit: The ICU rent limit defines the maximum coverage for your intensive care unit stay at the hospital. With the Niva Bupa Health Premier (Gold) Plan, there are no restrictions on ICU rent, meaning the full cost of your ICU stay is covered up to the sum insured.
• Copayment: A copayment, or copay, is the share of the approved claim amount that you must pay out of pocket. After covering this portion, the insurer takes care of the remaining expenses. The Niva Bupa Health Premier (Gold) Plan does not provide any provisions for copayment.
• Deductible: A deductible is the amount you need to pay out of pocket for medical expenses before your insurance starts covering the remaining costs. However, deductibles are not available under the Niva Bupa Health Premier (Gold) Plan.   
• Limits on surgeries/treatments: When going through your health insurance policy, it's crucial to be aware of the coverage limits for surgeries and treatments. These limits define the maximum amount your insurer will pay for specific medical procedures. While some plans impose fixed caps on certain treatments, others offer greater flexibility in coverage. With the Niva Bupa Health Premier (Gold) Plan, joint replacement surgeries and cataract treatment are covered up to the sum insured.

Please keep in mind that these financial limits are based on a 30-year-old individual selecting a sum insured of Rs. 10 lakhs. 

Niva Bupa Health Premier (Gold): Waiting Periods & Exclusions

👉Waiting period

A waiting period is the time frame after buying a policy during which coverage for specific illnesses and medical conditions is not available. Claims for these conditions can only be made once this period is over. The duration of the waiting period may differ depending on the insurance provider. The several kinds of waiting periods are listed below:

• Initial waiting period: For the first 30 days after purchasing the policy, coverage for medical conditions is on hold, except in the case of accidents. This means any hospitalization during this period won't be eligible for a claim unless it's due to an accidental injury. 
• Waiting period for pre-existing conditions: A pre-existing medical condition refers to any health problem or illness you’ve been diagnosed with or treated for in the 36 months leading up to buying your health insurance policy. The pre-existing disease waiting period is 24 months for the Niva Bupa Health Premier (Gold) Plan.
• Waiting period for specific diseases: In addition to pre-existing conditions, insurers have a set list of medical conditions that come with their own waiting periods, no matter your health history. These waiting periods are decided by the insurer and remain the same regardless of your current medical status. There is a waiting period of 12 months for specific diseases (and 1 month for cancer) under the Niva Bupa Health Premier (Gold) Plan.

👉Exclusions

Exclusions are certain medical diseases or situations that are not covered by a health insurance policy. Here are a few instances of these exclusions:

• Standard Permanent Exclusions: Every insurance company must adhere to the ‘standard permanent exclusions’ set by IRDAI. These exclusions include: 

1. Investigation and evaluation: Hospital admissions meant only for observation or evaluation, without any active treatment.
2. Rest, rehabilitation, and respite care: Services focused solely on rehabilitation, rest, or respite care, rather than medical treatment or surgical intervention. 
3. Obesity/weight control: Any treatments, medications, or surgeries aimed at weight loss or obesity control.
4. Gender reassignment: Medical procedures related to gender reassignment or altering one’s gender identity.
5. Plastic/Cosmetic surgery: Surgeries or treatments performed purely for cosmetic enhancement or altering physical features for appearance-related reasons.
6. Profession in adventure or hazardous sports: Medical expenses for injuries sustained while professionally engaging in extreme sports like mountaineering, scuba diving, or river rafting. 
7. Breach of law: Medical expenses associated with treating a person who has committed or is intending to commit a crime.
8. Excluded providers: Medical expenses incurred at hospitals or by practitioners not recognized under the policy.
9. Narcotics: Treatment for substance abuse disorders or addiction, including those involving drugs, alcohol, or other controlled substances. 
10. Treatments in establishments arranged for domestic purposes: Medical expenses for treatments received in nursing homes or other establishments primarily meant for domestic care rather than medical purposes. 
11. Dietary Supplements: Costs for over-the-counter vitamins, minerals, and dietary supplements that are not prescribed by a doctor.
12. Refractive error: Expenses for vision correction procedures for refractive errors up to 7.5 diopters.
13. Unproven treatments: Any medical procedures, surgeries, or treatments lacking scientific validation or proven effectiveness.
14. Expenses related to sterility, birth control, and infertility: Costs related to sterilization, contraceptive procedures, artificial insemination, and advanced reproductive techniques like IVF, ICSI, GIFT, ZIFT, and gestational surrogacy.
15. Maternity expenses: Hospitalization costs for childbirth, including pre- and post-natal care, along with delivery expenses

• Additional permanent exclusions: Insurance companies can impose extra exclusions for certain health conditions or situations, beyond the standard permanent exclusions. If an insurer determines that a particular illness or severe medical condition carries too much risk, they may decide to exclude it from your policy permanently. Health insurers must adhere to the guidelines set by the Insurance Regulatory and Development Authority of India (IRDAI), which specifies the medical conditions eligible for permanent exclusions. They are not allowed to impose permanent exclusions on any illnesses that are not included in this approved list.  
• Non-standard exclusions (Specific exclusions): Non-standard exclusions go beyond the permanent exclusions set by IRDAI and vary from one insurer to another. These additional restrictions are based on the specific terms and conditions of each policy, making it important to review them carefully before choosing a plan. Here are the most important specific exclusions listed under the Niva Bupa Health Premier (Gold) Plan -

1. Circumcision costs are not covered unless required to treat a medical condition or injury.
2. Expenses related to the diagnosis, counseling, or treatment of external birth defects are excluded.
3. The cost of undergoing Hormone Replacement Therapy (HRT) is not covered unless medically necessary.
4. Multifocal lenses, crutches, walkers, splints, and other assistive devices used at home are not included in coverage.
5. Expenses for screening, prevention, and treatment of sexually transmitted infections or diseases, except for HIV/AIDS, are not covered.
6. Costs associated with diagnosing or treating sleep-related disorders are excluded.
7. The use of a ventilator for a patient in a brain-dead state with no possibility of recovery is not covered.
8. Alternative treatments other than Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy are not included in the policy coverage.

What to expect in terms of claims experience if you buy from Niva Bupa Health Insurance Company Limited?

• Speed of claims settlement: Niva Bupa Health Insurance Company Limited has settled 99.97% of its claims within 30 days, ensuring a timely and efficient claim payment process. 
• Claim-related complaints: Our research shows that Niva Bupa Health Insurance Company Limited has a claims complaint rate of 0.39%, which is relatively higher than many other insurers.  
• Claims incurred ratio: The claims incurred ratio reflects an insurer's financial stability by indicating the percentage of claims settled in relation to the total premiums collected within a given year. Niva Bupa Health Insurance Company Limited has a claims incurred ratio of 59.02%. 
• Claim settlement ratio: Niva Bupa Health Insurance Company Limited has a claim settlement ratio of 89.95%, indicating the percentage of claims successfully processed out of the total received during a given financial year.
• Network hospitals: Niva Bupa Health Insurance Company Limited provides access to an extensive network of 10,000+ hospitals. With this extensive network, customers can access cashless treatment without any financial stress. 

How is the customer service of Niva Bupa Health Insurance Company Limited?

• Policy purchase-related complaints: Our research shows that Niva Bupa Health Insurance Company Limited has received 0.02% of complaints regarding its after-sales service.
• Response on Toll-Free: In comparison to other insurers, our study indicates that Niva Bupa Health Insurance Company Limited's toll-free number response time is average.    
• Response on Twitter(X): Our investigation indicates that, in comparison to other companies, Niva Bupa Health Insurance Company Limited has a slow reaction time on Twitter(X). 

About Niva Bupa Health Insurance Company Limited

Niva Bupa Health Insurance Company Limited, formerly Max Bupa Health Insurance Company Limited, is a dedicated health insurance provider formed through a joint venture between Fettle Tone LLP and Bupa Singapore Holdings Pte. Limited. Established in 2008 and headquartered in New Delhi, India, the company offers a diverse range of health insurance solutions, including individual plans, family floaters, and top-up policies, designed to meet varying customer needs. The company has a turnover of Rs 5216.72 Crores and is led by Mr. Ashish Mehrotra, who serves as its CEO and MD.