Niva Bupa Health Assurance Plan

Niva Bupa Health Assurance Policy offers a personal accidental plan that helps you during medical contingencies like sudden, accidental death and disability. This policy provides the much-needed financial support that your family needs without shelling out your years of savings.

The Health Assurance policy provides high flexibility to customers to choose this plan for themselves or their entire family, with an option to select all or any of the three covers. The customers also have the option to choose their own sum insured for the guaranteed cash payment ranging from Rs. 3 lakh to Rs. 2 crore in case of critical illness cover, Rs. 5 lakh to Rs. 25 lakh for personal accident cover, and Rs. 1,000 to Rs. 4,000 per day as daily cash benefit under hospital cash. This plan proves to be a major support in accidental and irreparable crisis times.

Key features and benefits

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  Accidental death cover

  Accidental death is covered under this plan. In the case of accidental death of any insured person, 100% of the sum assured is payable under the Niva Bupa Health Assurance Plan.

• 

  Permanent total disability cover

  In case the insured individual sustains a serious accidental bodily injury during the policy term, which directly or independently causes permanent total disability within 12 months from the date of that accident, the insurer will pay 125% of the sum insured.

• 

  Permanent partial disability cover

  If the insured individual sustains permanent partial disability due to an accident, the insurer will pay up to 100% of the sum insured.

• 

  Children's education benefit

  Children's education benefit is an optional cover that is payable towards the cost of the education of your dependent children in case of death or permanent disability due to an accident.

• 

  Funeral expenses covered

  The policy also covers funeral expenses of up to Rs. 5,000 of all the persons insured under the Niva Bupa Health Assurance Plan.

• 

  Accidental hospitalisation coverage*

  *The accident hospitalisation benefit shall be available only for hospitalisation in India if the insured person is hospitalised solely and directly due to an injury sustained from an accident during the policy period.

• 

  Worldwide coverage

  The Niva Bupa Health Assurance Plan covers all the accidental expenses for the insured in any part of the world.

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  Customisable cover

  The insured has the flexibility to choose from the three plan options available under the health assurance policy.

• 

  CritiCare cover

  • If the insured suffers a critical illness during the policy period and while the policy is in force, they will be paid the sum insured provided that:
  
  • Critical illness first occurs or manifests itself during the policy period
  
  • The signs and symptoms of such critical illness commence after 90 days from the date of commencement of the policy, i.e. the benefit would not be payable if the signs or symptoms occurred during the first 90 days or earlier from the date of commencement of coverage, as specified in the Schedule of Insurance Certificate
  
  • The insured person survives for a minimum period of at least 30 days from the date of diagnosis of such critical illness for the claim to be admissible
  
  •The top 20 critical illnesses are covered under CritiCare are as follows:
   

  1. Cancer of specified severity	2. Multiple sclerosis with persisting symptoms
  3. Myocardial infarction	4. Aplastic anaemia
  5. Open chest CABG	6. Bacterial meningitis
  7. Open heart replacement or repair of heart valves	8. Loss of speech
  9. Coma of specified severity	10. End-stage liver disease
  11. Kidney failure requiring regular dialysis	12. Deafness
  13. Stroke resulting in permanent symptoms	14. End-stage lung disease
  15. Major organ/ bone marrow transplant	16. Fulminant viral hepatitis
  17. Permanent paralysis of limbs	18. Third-degree burns
  19. Motor neuron disease with permanent symptoms	20. Muscular dystrophy

Health insurance helps you be stress-free while dealing with medical contingencies due to sickness and accidental injuries. The plans are available starting from Rs. 576, with maximum coverage of Rs. 25 lakh.

To purchase the policy, follow these steps:

• To apply for the product, click on 'Apply Now' and fill in the necessary details
• Make the fee payment online using your preferred mode of payment
• Fill in your name and mobile number
• Complete the process by clicking 'Buy Now'. You can also request a callback

The following mandatory documents will be needed to purchase the policy:

• Photograph of the applicant
• Age proof, such as birth certificate, Voter's ID, PAN card, passport, etc.
• Identity proof, such as passport, Aadhaar card, PAN card, Voter's ID, etc.
• Income proof, such as Form 16, salary slips, employment certificate, etc.
• Address proof, such as telephone bill, electricity bill, passport, bank statement, Voter's ID, etc.
• Medical test that the insurer requires you to undergo

Life is uncertain, and so are medical emergencies and accidents. Use the guide below to complete your claim processing in a few simple steps.

With the Niva Bupa Health Assurance Plan, you can benefit from cashless treatment at one of 5000+ network hospitals by following the process below:

• Get admitted to any one of the Niva Bupa network hospitals.
• Use your Niva Bupa Health Card or share your policy number with the concerned team at a hospital along with your Passport/PAN card/Voter's ID as identification proof.
• Now, the network hospital will validate your identity and submit the pre-authorisation request to the insurer.
• After validation, the insurer will review and provide their confirmation to the network hospital by fax and e-mail. The insurer ensures you are also notified of the same through text message and e-mail. The insurer will respond to your request within 30 minutes of filing the claim request.
• The only activity left to do now is the final settlement of your claim (per policy terms and conditions) with the hospital after completing all the necessary formalities.

Reimbursement claim:

• If you get hospitalised, notify the insurer within 48 hours of admission to a network or non-network hospital. After getting admitted, pay the amount directly to the hospital you are in.
• After you are discharged from the hospital, make sure you have all the relevant documents, invoices, medical reports, and the discharge certificate. The insurer would need the originals of all the mentioned documents to process your reimbursement.
• Send all the documents to the insurer along with the filled and signed claim form. Send your valid ID proof and age proof as well.
• After receiving your documents, the insurer will review your claim request and accordingly give their approval, raise a query, or reject the same (per policy terms and conditions).
• Finally, the insurer will settle the claim (per policy terms and conditions) and reimburse the approved amount.

Documents required for reimbursing claims

Collect the relevant documents mentioned below in original from the hospital and submit them to the insurer within 15 days of discharge from the hospital.

• Original investigation reports
• Final hospital discharge summary, FIR or post-mortem report (if any)
• Pharmacy bills along with the prescription
• Cancelled cheque or NEFT details for payment
• Original bills, receipts, and discharge report
• Indoor case papers and duly filled claim form
• Original hospital bills and a valid photo ID proof
• Treating doctor's report
• Original consultation notes
• Nature of operation performed and surgeon's bill and receipt
• Test reports along with attending doctor's or surgeon's report

1. Engaging in or taking part in professional sports or any hazardous pursuits
2. Any disability arising out of pre-existing conditions if not accepted and endorsed by Niva Bupa.
3. Participation in criminal activity or a breach of law with criminal intent
4. Ailments requiring treatment due to use or abuse of any substance, drug or alcohol, and treatment for de-addiction
5. War, the act of a foreign enemy, revolution, etc.
6. Intentional self-injury.

Initial Waiting Period

• Criticare: Benefits will not become payable if the signs or symptoms of any of the listed critical illnesses commence within 90 days from the date of commencement of CritiCare coverage of the first policy.
• HospiCash: Benefits will not become payable if the signs or symptoms and/or treatment fall within 30 days from the date of commencement of HospiCash coverage except for accidents.
• Pre-existing diseases: For CritiCare and HospiCash, benefits will not be available for pre-existing diseases until 48 months of continuous coverage have elapsed since the inception of the policy.

Refer to the policy brochure to know further exclusions in detail.

BFL helpline number:  08698010101

Niva Bupa helpline number: 1860-500-1000

E-mail:  wecare@bajajfinserv.in

Mailing address: Ground Floor, Bajaj Finserv Corporate Office, Off Pune-Ahmednagar Road, Viman Nagar, Pune – 411014.

*For claim related issues, please refer to your policy document or Certificate of Insurance (COI).