Niva Bupa ReAssure plan is a health insurance policy provided by Niva Bupa Health Insurance Company Limited.
With a variety of unique features and benefits, this plan is a great choice if you need a health insurance plan that matches your specific needs. One of the unique features offered by this plan is a Health Check-Up. It covers diagnostic medical tests and preventive tests on a cashless basis. The plan also covers hospitalisation costs for diabetes and hypertension from day 1. The only downside is that there's no monthly premium payment option under this plan. As per our research, the insurer has received a higher number of complaints related to claim settlement and policy purchase - indicating a poor track record when it comes to both claim and policy purchase processes.
What are the benefits offered by the Niva Bupa ReAssure Plan?
- Inpatient hospitalisation coverage: Niva Bupa ReAssure plan covers inpatient hospitalisation charges, which include room boarding and nursing services, medical practitioner’s fees, prescribed medications and drugs, ICU charges, and other related costs. To be eligible for coverage, you must be admitted to the hospital for at least 24 hours.
- Pre-hospitalisation coverage: The Niva Bupa ReAssure plan covers pre-hospitalisation expenses which are costs incurred before hospitalisation, like tests, check-ups, consultations, lab reports, etc. To be eligible for the claim, these expenses must be associated with the medical condition for which you are admitted to the hospital later, and your claim for them must be approved as part of your inpatient hospitalisation coverage. The NIva Bupa ReAssure plan covers pre-hospitalisation expenses for 60 days before hospitalisation up to the sum insured.
- Post-hospitalisation coverage: With the Niva Bupa ReAssure plan, you are covered for post-hospitalization costs. These are medical expenses that you may incur after being discharged from the hospital, like follow-up consultations with your doctor, medical check-ups, rehabilitation sessions, physiotherapy, and more. To qualify for coverage, the post-hospitalisation expenses must be related to the illness for which you were hospitalised before and your claim must be approved under inpatient hospitalisation. These expenses are covered for 180 days after hospitalisation up to the sum insured.
- Daycare treatment coverage: Daycare treatments are medical treatments or surgeries that used to require a long hospital stay, but now can be completed within 24 hours because of technological advancements. The Niva Bupa ReAssure plan provides coverage for all daycare treatments up to the sum insured - only if you are hospitalised for more than 2 hours.
- Domiciliary treatment coverage: Domiciliary treatments are the treatments for illnesses or injuries which need immediate care in a hospital but can be treated at home, if the patient is very ill or injured and cannot be brought safely to a hospital, or there are no beds available in the vicinity. The Niva Bupa ReAssure plan covers such treatment costs up to the sum insured.
- Organ donor coverage: With the Niva Bupa ReAssure plan, you also get coverage for organ donor expenses associated with in-patient hospitalisation, up to the sum insured - where you are the organ recipient. Please note that stem cell donation is excluded (except for bone marrow transplant) under this coverage.
- Modern treatment coverage: The healthcare industry is rapidly growing with technological advancements, leading to the development of modern treatments that once seemed impossible. Such treatments, like radio surgeries, stem cell therapy, etc., aim to cure illnesses that were previously thought to be incurable. The Niva Bupa ReAssure plan has been designed to keep up with these advancements and covers the cost associated with modern treatments up to the sum insured except for some robotics surgeries where sub-limits are applicable. There is a limit of Rs. 1 Lakh for robotic surgeries except robotic total radical prostatectomy, robotic cardiac surgeries, robotic partial nephrectomy, robotic surgeries for malignancies.
- Non-medical expenses coverage: Apart from covering medical expenses, the Niva Bupa ReAssure plan also covers non-medical expenses. These expenses refer to the cost of consumables needed during treatments like gloves, nebulization kits, oxygen masks, and other items. The policy provides coverage for these expenses up to the sum insured, helping you avoid any additional expenses. This coverage is available as an add-on.
- No Claim Bonus: If you do not make any claims during the policy period, the Niva Bupa ReAssure plan provides a No-Claim Bonus of 50% of the sum insured. The maximum bonus that can be accumulated under this plan is 100% of the sum insured. But if you make a claim, the accrued bonus will reduce in the same way it increased. This policy comes with an add-on that ensures the No Claim Bonus remains unaffected by claims as long as the claim amount does not exceed Rs. 50,000.
- Super No Claim Bonus: This is an upgraded version of the No Claim Bonus and works exactly like it. But the Niva Bupa ReAssure plan doesn’t offer the Super No Claim Bonus feature.
- Restoration Benefit: Niva Bupa ReAssure plan provides a restoration benefit which reinstates the sum insured in case it gets exhausted during a policy year. This refill is applicable to both related and unrelated diseases for subsequent claims and kicks in with the partial exhaustion of both the sum insured and the No Claim Bonus. And the best part is that the refill can be applied unlimited times in a policy year.
Please note that the limits and conditions mentioned above apply to Rs. 10 lakhs sum insured.
Niva Bupa ReAssure Plan: Financial Limits
- Room rent limit: The maximum amount that your insurance company covers for the room in which you are hospitalised is known as the room rent limit. If you choose a room that comes under your plan's room rent limit, you won’t have to pay anything extra from your end. But if you choose a room that exceeds the limit, you will be responsible for paying the proportionate share of the hospital bill, rather than just the difference in the room rent. Under the Niva Bupa ReAssure plan, you can choose any type of room that ensures your comfort - there is no restriction.
- ICU rent limit: ICU rent limit is the amount covered by the insurance policy for your stay in the Intensive Care Unit (ICU) of a hospital. There is no limit on the ICU rent under the Niva Bupa ReAssure plan, which means that the plan covers the entire cost without any limit.
- Copayment: A copayment or copay is a portion of the approved claim amount that you need to pay from your end before the insurance company pays the rest. The Niva Bupa ReAssure plan doesn’t have a copayment limit.
- Deductible: A deductible is a certain amount that you must pay from your end before your health insurance coverage kicks in to pay for your medical expenses. There is no deductible in the Niva Bupa ReAssure plan.
- Limits on surgeries/treatments: These limits refer to the maximum amount that a health insurance policy provides for certain medical procedures or treatments. These limits may vary based on the insurer and the policy you choose. The Niva Bupa ReAssure does not impose any limits for critical surgeries and treatments such as cataract treatment or joint replacement surgery. This means that the policy will cover the expenses of these treatments up to the sum insured.
Please note that the financial limits are taken for a 30-year-old individual, opting for a sum insured of Rs. 10 lakhs.
Niva Bupa ReAssure Plan: Waiting Periods & Exclusions
After you purchase a health insurance policy, some illnesses and diseases may not be covered for a certain period of time. This timeframe is known as the waiting period. Once this period ends, you can claim for such conditions. Here are some of the types of waiting periods -
- Initial waiting period: An initial waiting period of 30 days applies for all medical conditions except accidents. This means that you will not be able to make a claim for any hospitalisation, except for accidents, for the initial 30 days of policy purchase.
- Waiting period for pre-existing diseases: A pre-existing disease is a medical condition that you have had in the past 48 months before applying for the health insurance policy. Under the Niva Bupa ReAssure plan, there is a waiting period of 36 months for pre-existing diseases, which means that expenses related to pre-existing diseases will not be covered by the policy during this period.
- Waiting period for specific diseases: Apart from pre-existing conditions, insurers will have a list of specific medical conditions or illnesses that are subject to a waiting period irrespective of whether you have had those diseases before or not. The duration of this waiting period is decided by the insurer and is not based on your current health status. Under the Niva Bupa ReAssure plan, specific diseases are subject to a waiting period of 24 months.
Exclusions are medical situations that will not be covered under your health insurance policy at any cost. These include -
- Standard permanent exclusions: The IRDAI has defined a set of 'standard permanent exclusions', which are required to be followed by all insurance companies. Some of these include -
- Investigation and evaluation: Hospital admission for diagnostics or evaluation purposes only.
- Rest, rehabilitation and respite care: Expenses related to admission to a facility for bed rest where no active treatment is catered.
- Obesity/weight control: Treatment of weight or obesity control-related diseases.
- Gender reassignment: Treatment aimed at achieving changes in the body’s characteristics to match as that of the opposite sex.
- Plastic/cosmetic surgery: Expenses related to the treatment for the modification of appearances and body characteristics.
- Profession in hazardous or adventure sports: Treatment of injuries incurred while participating as a professional in adventurous sports, such as rafting, scuba diving, etc.
- Breach of law: Expenses incurred in the treatment of a person who has caused a breach of law with criminal intent.
- Excluded providers: Expenses incurred for the treatment received from a medical practitioner or hospital excluded by your health insurance policy.
- Narcotics: Treatment for alcohol addiction, usage of drugs, etc.
- Treatments in establishments arranged for domestic purposes: Expenses related to treatment offered in health spas, nursing homes, or similar establishments which partially or entirely serve domestic purposes.
- Dietary supplements, substances purchased without prescription: Supplements like vitamins minerals, etc that are bought without a doctor’s prescription.
- Refractive error: Fixing refractive errors up to 7.5 diopters to enhance eyesight.
- Unproven treatments: Expenses associated with treatments that do not prove to be effective.
- Expenses related to birth control, sterility or infertility: Expenses related to contraception, sterilisation, artificial insemination, IVF, ZIFT, GIFT, ICSI, the use of surrogate mothers for gestational purposes, etc.
- Maternity Expenses: Expenses incurred in the treatments related to childbirth, pre/postnatal care, etc.
- Additional permanent exclusions: Apart from these standard permanent exclusions, insurance companies may apply additional exclusions for specific situations or medical conditions. In case you have certain diseases or medical conditions that are too risky to cover according to the insurance companies, they may permanently exclude them from your policy. However, it is worth noting that insurance companies are restricted to a list of diseases by the Insurance Regulatory and Development Authority of India (IRDAI) for which they can apply a permanent exclusion. They are not authorised to exclude any illness or disease that is not mentioned in the list.
- Non-standard exclusions (Specific exclusions): These are specific exclusions apart from the standard permanent exclusions listed by IRDAI. These exclusions may vary across insurers and depend on the terms and conditions of the policy. Here is a list of specific exclusions under the Niva Bupa ReAssure plan -
- Circumcision, unless necessary for treating a disease or injury
- Injury or illness caused due to direct or indirect involvement in terrorism, nuclear emissions, war, civil war, etc.
- Expenses incurred in screening, consulting or treatment related to external birth defects.
- Dental treatment except for treatment required because of an accident.
- Hormone replacement therapy
- Multifocal lenses and other medical equipment later used at home like walkers, crutches, etc.
- Screening, prevention and treatment of sexually related infections or diseases other than HIV/AIDS.
- Treatment for sleep disorders.
- Conditions that are not clinically significant or are related to anxiety, bereavement, relationship or academic problems, acculturation difficulties or work pressure.
- Treatments related to intentionally self-inflicted injury or attempted suicide by any means.
- Use of a ventilator for a patient in a vegetative state (brain dead) with no room for 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 within 30 days. This means they are committed to providing prompt claim settlements for their customers.
- Claim-related complaints: As per our research, Niva Bupa Insurance Company has received higher complaints compared to other insurance companies, accounting for 0.49%.
- Claims incurred ratio: The claims incurred ratio is a measure of an insurance company's financial performance. It shows the total value of claims incurred by the company as compared to the total amount of premiums they collected in a financial 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 within a financial year. Niva Bupa Health Insurance Company’s claim settlement ratio is 85.18%.
- Network hospitals: Niva Bupa Insurance Company has a vast network with over 10,000+ hospitals. The large number of network hospitals offered by the company means that you can avail cashless treatments anywhere, anytime.
How is the customer service of Niva Bupa Health Insurance Company Limited?
- Policy purchase-related complaints: Our research indicates that Niva Bupa Health Insurance Company has received a higher number of complaints regarding their post-sales service as compared to other insurers, accounting to 0.01%.
- Response on Toll-Free: When compared to other insurance companies, our research found that Niva Bupa Health Insurance Company's response on toll-free is average.
- Response on Twitter: Niva Bupa Health Insurance Company’s response rate on Twitter is also average as per our research.
About Niva Bupa Health Insurance Company Limited
Niva Bupa Health Insurance Company, previously known as Max Bupa Health Insurance Company Limited, is a health insurance company in India. It is a joint venture between Fettle Tone LLP and Bupa Singapore Holdings Private Limited. It offers a wide range of products including individual health plans, family floaters, top-up policies, and more. It was established in 2008 and is headquartered in New Delhi, India. The company's CEO and MD is Mr. Ashish Mehrotra.