Niva Bupa Senior First (Platinum)

The Niva Bupa Senior First (Platinum) plan is a comprehensive health insurance policy provided by Niva Bupa Health Insurance Company Limited. 

Health insurance provides financial security from the unpredictability of costly medical costs that could hit anyone. With the security provided, you will get all the required medical attention without the stress of hefty bills. The Niva Bupa's Senior First (Platinum) Plan is tailored towards elderly citizens to be comprehensive and secure. Loaded with various distinct features and advantages, this product is quite popular to take care of healthcare cost concerns in old age. 

Explicitly designed for senior citizens, this plan goes past taking care of hospitalization costs. It also includes coverage for consumable items like gloves, oxygen masks, and more ensuring comprehensive support. From day one, the plan provides coverage for health check-ups, offering added peace of mind. Furthermore, it includes an option to automatically increase the sum insured to keep pace with inflation, ensuring your coverage develops with rising medical care costs.

On the downside, this plan does not allow for a monthly premium payment option. On top of that, our research revealed that the insurer received more than the average number of complaints concerning claim settlements and policy purchases. This implies a less-than-perfect record for purchase as well as for claims service.

What are the benefits offered by the Niva Bupa Senior First (Platinum)?

• Inpatient hospitalisation coverage: Typically, inpatient hospitalization coverage kicks in when the patient has to stay at the hospital for more than 24 hours. In that case, the plan pays for the various costs such as your hospital room, nursing care, consultations, prescribed medications, ICU charges, and other medically required costs. The Niva Bupa Senior First (Platinum) plan provides coverage for the expenses related to inpatient hospitalisation. There is no limit for ICU charges through inpatient coverage and the room rent limit is single private room.
• Pre-hospitalisation coverage: Pre-hospitalization costs are various medical expenses you may incur before you are admitted into the hospital. They include, among others, consultation charges, lab tests, tests and medical reports.  It's worth noting that your insurance will only foot the bill for these expenses if they are directly related to the medical condition that necessitates your admission and if your claim is approved as part of your inpatient hospitalisation expenses. With the Niva Bupa Senior First (Platinum) plan, you can be confident that your pre-hospitalisation expenditures will be covered for a period of 60 days, up to the sum insured.
• Post-hospitalisation coverage: Post-hospitalization coverage is important to support the recovery of the patient after discharge from the hospital. It allows regular follow-ups with care and medicines, as well as frequent medical consultations. To be covered, expenses must be directly related to your hospital stay and supported by your inpatient hospitalisation coverage. With the Niva Bupa Senior First (Platinum) plan, you get comprehensive coverage for post-hospitalisation expenses up to the sum insured for 180 days after your hospitalisation.
• Daycare treatment coverage: Daycare treatment is the medical procedures or surgeries that otherwise take more than 24 hours of hospital stay. But today such medical treatments are completed within a stay of 24 hours with the help of medical technology.  The Niva Bupa Senior First (Platinum) plan covers all daycare treatment procedures up to the sum insured. However, daycare treatment is covered only if the admission lasts for more than 2 hours.
• Domiciliary treatment coverage: In domiciliary treatments, urgent medical care is provided at home rather than in a hospital. This is typically necessary when there are no beds available in the nearby hospitals or if a patient is too sick or injured to be moved to the hospital safely. With the Niva Bupa Senior First (Platinum) plan, all expenses pertaining to domiciliary treatments are covered up to the sum insured. 
• Organ donor coverage: The Niva Bupa Senior First (Platinum) plan also covers organ donor expenses. It covers the inpatient expenses of the donor related to organ transplantation, up to the sum insured. 
• Modern treatment coverage: Modern treatments bring together remarkable medical advancements that have made previously untreatable conditions now manageable. These facilities offer a broad range of choices that are customised to each patient's needs, such as robotic surgeries, radio surgeries, and stem cell therapies. The Niva Bupa Senior First (Platinum) plan is carefully crafted to keep up with these developments and covers the expenses associated with these modern treatments with no financial limits. However, robotic total radical prostatectomy, robotic cardiac surgery, robotic partial nephrectomy, and robotic surgery for malignancies has a maximum cap of Rs. 1 Lakh.
• Non-medical expenses coverage: Non-medical expenses such as vaccinations, gloves, nebulisation kits, oxygen masks, medical footwear, urine bags, hospital gowns and more are covered under consumables cover. The Niva Bupa Senior First (Platinum) plan provides peace of mind by covering these non-medical costs up to the sum insured. It's crucial to remember that this benefit is available as an add-on option. 
• No Claim Bonus: The No Claim Bonus is a benefit offered by the insurance company as a reward for not making any claims during the policy period. Under Niva Bupa Senior First (Platinum), No Claim Bonus goes up to 100% of the sum insured and attracts a 10% annual bonus for claim-free years with no reduction in bonus after a claim. 
• Super No Claim Bonus: The Super No Claim Bonus is an upgraded version of the standard No Claim Bonus, working in much the same way but offering additional benefits. However, the Niva Bupa Senior First (Platinum) Plan does not have any provisions for the super no-claim bonus. 
• Restoration benefit: The restoration benefit is a unique feature that replenishes your sum insured if it is exhausted during the policy year due to unforeseen circumstances. The Niva Bupa Senior First (Platinum) Plan offers an unlimited refill benefit, allowing customers to restore their coverage multiple times in a policy year. This benefit kicks in from the first paid claim and is triggered when the Sum Insured and No Claim Bonus are partially exhausted. It applies to both related and unrelated illnesses, ensuring comprehensive coverage. 

Please remember that the limitations and conditions mentioned in the benefits above apply to a sum insured of Rs. 10 lakhs.

Niva Bupa Senior First (Platinum): Financial Limits

• Room rent limit: The room rent limit specifies the maximum amount your insurance provider will cover for your hospital room expenses. If you choose a room within this limit, you won't incur any additional charges. However, selecting a room that exceeds this limit will result in a proportionate deduction from all related treatment costs.  With the Niva Bupa Senior First (Platinum) plan, you can select a single private room.
• ICU rent limit: The ICU rent limit is the maximum amount your plan will cover for your stay in the intensive care unit at the hospital. Since there is no cap on ICU rent under the Niva Bupa Senior First (Platinum) plan, the entire cost of your ICU stay up to the sum insured is covered.
• Copayment: A copayment, or copay, is the portion of the approved claim amount that you are responsible for paying out of pocket. The insurer will cover the remaining expenses after your payment is made. The Niva Bupa Senior First (Platinum) plan provides provisions for co-payment as 0%/20%/30%/40%/50%, which is available as an add-on. However, an additional 10% co-payment will apply if the treatment is taken in a room category higher than the one eligible under the policy.
• Deductible: Your deductible is the sum of money you must pay for medical services before your insurance begins to cover the remaining expenses. The Niva Bupa Senior First (Platinum) plan does not provide any provisions for deductibles under the plan.   
• Limits on surgeries/treatments: While assessing your health insurance policy, understanding the limits around surgeries and treatments is significant. These limitations define the maximum coverage your policy provides for specific medical procedures or treatments. While some plans set strict limits on coverage for certain procedures, others may offer more flexibility, allowing for broader coverage options. Knowing these details helps ensure you’re prepared for any medical needs and can keep away from unforeseen out-of-pocket expenses. With the Niva Bupa Senior First (Platinum) plan, joint replacement surgeries and cataract treatment are covered up to the sum insured.

Please note that the above financial limits are taken for a 30-year-old individual in Zone 1 opting for a sum insured of Rs. 10 Lakhs.

Niva Bupa Senior First (Platinum): Waiting Periods & Exclusions

👉Waiting period

A waiting period is a set amount of time after receiving your policy during which certain diseases and medical problems are not immediately covered. Only when the waiting period has ended can claims be filed for these particular conditions. Additionally, different insurance companies have varying waiting period rates. The various kinds of waiting periods are as follows -

• Initial waiting period: There is a 30-day waiting period for all medical illnesses except accidents. You will not be able to file a claim for any hospital stays during this time, except for accidents. 
• Waiting period for pre-existing conditions: A pre-existing medical condition refers to any ailment or health issue you experienced in the 36 months before you acquired health insurance. The waiting period for pre-existing conditions under the Niva Bupa Senior First (Platinum) plan is 24 months. During this waiting time, you are not eligible to claim any expenses related to your pre-existing conditions. 
• Waiting period for specific diseases: Regardless of your medical history, insurers also keep a rundown of specific illnesses or medical conditions with waiting periods in addition to pre-existing disorders. The insurer determines these waiting periods; your present health status has no bearing on them. There is also a waiting period of 24 months for specific diseases under the Niva Bupa Senior First (Platinum) plan.

👉Exclusions

In health insurance policies, exclusions refer to particular medical disorders or circumstances that are not covered. The following are a few examples of exclusions -

• Standard Permanent Exclusions: The "standard permanent exclusions" set forth by IRDAI must be followed by all insurance companies. Among them are -

1. Evaluation and investigation: Hospitalisation for observation or proper monitoring.
2. Rest, rehabilitation, and respite care: Medical treatments that don't include any active treatment or surgeries. 
3. Obesity/weight control: Surgery or treatment for obesity or weight control.
4. Gender reassignment: Medical treatments and procedures to transition to the opposite sex and change gender identity.
5. Plastic/Cosmetic surgery: Treatment or surgery designed to enhance or alter physical appearance.
6. Profession in adventure or hazardous sports: Expenditures of medical treatment because of participating professionally in adventurous activities like river rafting, mountaineering, scuba diving, and other risky sports. 
7. Breach of law: Cost of treatment for offenders who have committed or attempted a criminal act.
8. Excluded providers: Costs for treatment received from medical professionals or hospitals not covered by the insurance company.
9. Narcotics: Treatment for addiction to substances like alcohol, drugs, and other substance abuse disorders.
10. Treatments in establishments arranged for domestic purposes: Expenses related to treatment in nursing homes or other healthcare facilities intended for non-medical, domestic care.
11. Dietary supplements are substances purchased without subscription:  Products like vitamins and minerals that are purchased over-the-counter without a prescription from a healthcare provider.
12. Refractive error: Costs associated with correcting refractive issues up to 7.5 diopters to improve vision.
13. Unproven treatments: It refers to unproven or ineffective medical procedures, surgeries, or treatments.
14. Expenses related to sterility, birth control, and infertility: Costs related to contraception, sterilization, artificial insemination, and advanced reproductive treatments like IVF, GIFT, ZIFT, ICSI, and gestational surrogacy.  
15. Maternity expenses: Costs for pre- and post-natal care, along with hospitalization expenses related to childbirth.

• Additional permanent exclusions: Standard permanent exclusions aside, the insurance companies can further exclude some medical conditions or circumstances from your policy. Sometimes, certain illnesses or serious medical conditions may be permanently excluded from your policy when the insurer considers them too risky to cover. It's crucial to understand that health insurers are restricted to a defined list of illnesses, as mandated by the Insurance Regulatory and Development Authority of India (IRDAI), for which they can apply permanent exclusions. Insurers cannot impose permanent exclusions for any other diseases or conditions beyond this specified list. This ensures that customers are protected from unexpected exclusions, as insurers must adhere strictly to these guidelines.
• Non-standard exclusions (Specific exclusions): Non-standard exclusions describe additional exclusions that apply beyond the usual permanent exclusions as defined by the IRDAI. These exclusions differ from one insurance company to another and are based on the individual terms and conditions of the policy. As such, it's important for customers to carefully review the terms of their insurance plan to understand any additional exclusions that may apply to their coverage. Here are the most important specific exclusions listed under the Niva Bupa Senior First (Platinum) plan -

1. Circumcision is not covered unless it is medically necessary to treat a disease or injury.
2. Treatment for injuries or illnesses caused directly or indirectly by terrorism, nuclear or radiological emissions, war-like situations, or rebellion is excluded.
3. Expenses related to screening, consultation, or treatment for external birth defects are not covered.
4. Dental treatments are excluded unless they are required due to an accident.
5. Hormone replacement therapy is not included under the policy coverage.
6. Costs for multifocal lenses, ambulatory devices such as walkers, crutches, splints, and other home-use medical equipment are not covered.
7. Screening, prevention, and treatment for sexually transmitted infections or diseases are excluded, except for HIV/AIDS.
8. Treatment for sleep-related disorders is not covered.
9. Medical expenses related to intentional self-inflicted injuries or attempted suicide are excluded.
10. It does not include the use of a ventilator for a patient who is in a vegetative state (brain dead) and has no possibility of recovery.

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

• Speed of claims settlement: 99.95% of claims have been resolved by Niva Bupa Health Insurance Company Limited in less than 30 days, guaranteeing a quick and easy claim settlement process. 
• Claim-related complaints: Our analysis indicates that Niva Bupa Health Insurance Company Limited has a 0.49% complaint rate, which is higher than that of other insurers. 
• Claims incurred ratio: One indicator of an insurer's financial performance is the claims incurred ratio. It shows how many claims were paid out overall compared to the amount of premiums collected within a specific fiscal year. The claims incurred ratio for Niva Bupa Health Insurance Company Limited is 65.44%. 
• Claim settlement ratio: The claim settlement ratio for Niva Bupa Health Insurance Company Limited is 85.18%. The ratio of total claims received to claims settled by the company for a specific fiscal year is displayed in this figure. 
• Network hospitals: Access to more than 10,000 hospitals is made possible by Niva Bupa Health Insurance Company Limited. Customers can receive cashless treatment without worrying about upfront payments, thanks to this wide network. 

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

• Policy purchase-related complaints: In comparison to other insurance firms, Niva Bupa Health Insurance Company Limited has a 0.01% complaint rate about their after-sales service, according to our research. 
• Response on Toll-Free: According to our research, when compared to other insurers, Niva Bupa Health Insurance Company Limited's toll-free number response time is average. 
• Response on Twitter: Our analysis indicates that Niva Bupa Health Insurance Company Limited responds to tweets slower than comparable companies. 

About Niva Bupa Health Insurance Company Limited

Niva Bupa Health Insurance Company Limited, previously known as Max Bupa Health Insurance Company Limited, is a joint venture between Bupa Singapore Holdings Pte. Limited and Fettle Tone LLP. Established in 2008 and headquartered in New Delhi, India, it is a dedicated health insurance provider offering a wide range of products, including individual plans, family floaters, and top-up policies, designed to meet diverse customer needs. The company is led by Mr. Ashish Mehrotra, who serves as its CEO and Managing Director.