• In-patient Care (Hospitalisation)

We cover cost of medical treatment when you or your insured family members are hospitalised for treatment.

• Hospital Accommodation

We cover cost of all types of hospital accommodation (except suite or above room category) without any capping on room rent charges.

• Pre & Post Hospitalisation Medical Expenses

We shall reimburse pre & post hospitalisation medical expenses incurred due to illness/injury. The period of the treatment which we will cover should be 30 days before you get admitted to a hospital and 60 days after you get discharged from the Hospital. This is subject to Niva Bupa accepting the Inpatient Care hospitalisation claim.

• All day care treatments covered

We cover all day care treatments, not a select few. However, such a procedure should not be in the outpatient department of a hospital.

• Refill Benefit

In case you have exhausted your Base Sum Insured and No Claim Bonus partially or completely, under this benefit, you are entitled for an additional sum insured equal to the base sum insured for a subsequent claim in the same year, provided it is for an unrelated illness. (This feature is not available under family first)

• Alternative treatments

Avail In-patient treatment under AYUSH (Ayurveda, Unani, Siddha and Homeopathy) up to the base sum insured.

• Renewal Benefit

You would be entitled to both the benefits as renewal benefit:

1. No Claim Bonus : Increase in Sum Insured @20% of Base Sum Insured subject to the maximum of 100% of Base Sum Insured for each claim free year with no penalization in case of claim
2. Health Check up: Avail Heath Check up for yourself and your family once in two years (for variant 1) or annually (for variant 2, 3 & family first) so that you live a healthier and happier life.

• 2 year Policy Tenure Option

When you take a policy for two years, you get 12.5% discount on the second year premium.

• Emergency Ambulance

We also cover the ambulance expenses to transfer the insured following an emergency to the nearest hospital. These expenses are paid up to Rs 3,000 only if we have accepted the In-patient claim.

• Living Organ Donor Transplant

Medical Expenses for an organ donor’s In-patient treatment for the harvesting of the organ donated is also covered provided the organ is for the use of the Insured Person.

• Domiciliary Treatment

In case a bed in the hospital is unavailable or on advice of the attending medical practitioner, treatment is administered at home; we pay for medical treatment taken at home, which would otherwise have required hospitalisation. Such treatment should continue for at least 3 consecutive days and confirmation from treating Medical Practitioner / Insured that Insured Person could not be transferred to the Hospital or Hospital bed was unavailable, as the case may be.

• Vaccination in case of Animal Bite

We will cover Medical Expenses of OPD Treatment for vaccinations or immunizations for treatment post an Animal Bite. This benefit is available only on reimbursement basis.

(up to Rs 2,500 for variant 1; up to Rs 5,000 for variant 2 & family first; up to Rs 7,500 for variant 3)

• Hospital Cash (Optional)

A lumpsum payment for each 24 hours of hospitalisation in addition to the in-patient treatment benefits is made. To avail this benefit minimum 48 hours of hospitalisation required. This benefit is over and above the sum insured. The benefit is payable for up to 30 days of hospitalisation. No payment shall be made under this, in case of Domiciliary Hospitalization.

(Rs 1,000/Day for variant 1; Rs 2,000/Day for variant 2; Rs 4,000/Day for variant 3; Rs 1,000/Day or Rs 2,000/Day for Family First)

• Tax Benefit

You will save tax under Section 80D of the Income Tax Act when you buy a Niva Bupa health insurance policy. Tax benefits are subject to changes in the tax laws, please consult your tax advisor for more details.

• Assured Policy Renewal for Life

Once insured with us, you will always remain our customers subject to continued payment of premium. We assure you renewability for life with no extra loadings based on your claim history.

• Direct Claim Settlement

We believe you should focus on the treatment of your loved ones rather than running after claim settlement. Therefore, all claims are processed directly by our own customer services team.

• Cashless Facility

You can access cashless facility at your nearest network hospital.

• Free Look Period

We endeavor for transparency and complete satisfaction and therefore, our policies are transparent and easy to understand. If you are not satisfied, we provide a 15 day free look period within which you can cancel your plan stating the reason.

• Information at your fingertips

As a Niva Bupa Policyholder you can access your details on our website (www.nivabupa.com) containing your claims history, your favourite health information, your health profile, including records of tests you may have taken while enrolling with us.

1. We will not cover treatment during the first 30 days of the policy, unless the treatment needed is a result of an Accident occurring during the policy period. This waiting period does not apply for renewal Policy.
2. Benefits will not be available for Pre-existing Diseases until 48 months of continuous coverage from first policy start date for Variant 1 and 36 months of continuous coverage from first policy start date for Variant 2, Variant 3 and Family First.
3. Some conditions will be subject to a waiting period of 24 months and will be covered in the third policy year only.

• Health Companion can be issued to an individual customer, a family (family floater) and/or extended family (family first).
• We cover families across life stages – from new born (at least 90 days) to senior citizens of any age. There is no maximum age for enrollment.
• The maximum entry age of any dependent as a child in the policy is less than 21 years on the date of commencement of the initial cover under the Policy.

Contact details of Niva Bupa Health Insurance Company Limited

Registered office:- C-98, First Floor, Lajpat Nagar, Part 1, New Delhi-110024

Website: www.nivabupa.com

Fax: 011-30902010; Customer Helpline No.: 1860 500 8888

• Ancillary Hospital Charges
• Hazardous Activities
• Artificial life maintenance
• Behavioral, Neurodevelopmental and Neurodegenerative Disorders
• Circumcision
• Complementary & Alternative Medicine
• Conflict & Disaster
• External Congenital Anomaly
• Convalescence & Rehabilitation
• Cosmetic and Reconstructive Surgery
• Dental/oral treatment
• Eyesight & Optical Services
• Experimental/Investigational or Unproven Treatment
• HIV, AIDS, and related complex
• Hospitalization not justified
• Inconsistent, Irrelevant or Incidental Diagnostic procedures
• Mental and Psychiatric Conditions
• Non-Medical Expenses
• OPD treatment
• Obesity and Weight Control Programs
• Off- label drug or treatment
• Puberty and Menopause related Disorders
• Reproductive medicine & other Maternity Expenses: Any assessment or treatment method
• Robotic Assisted Surgery, Light Amplification by Stimulated Emission of Radiation (LASER) & Light based Treatment
• Sexually transmitted Infections & diseases
• Sleep disorders
• Substance related and Addictive Disorders
• Unlawful Activity
• Treatment received outside India
• Unrecognized Physician or Hospital
• Any costs or expenses specified in the list of expenses generally excluded at Annexure II of policy wording
• For complete list of exclusions, please refer policy terms and conditions.