Niva Bupa GoActive Health Insurance Plan UIN MAXHLIP21173V022021

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Niva Bupa GoActive Health Plan Summary

Niva Bupa which was formerly known as Max Bupa has an all rounder health insurance plan named GoActive, that covers your medical expenses. GoActive plan is a comprehensive plan that covers a wide range of illness treatment charges and also provides cashless OPD and diagnostic services. It provides cover to individuals as well as your entire family.

Plan name	Niva Bupa GoActive Health Plan
Policy type	Health Plan
UIN	MAXHLIP21173V022021

Key Features of Niva Bupa GoActive Health Plan

Pre & post hospitalization expenses

The GoActive Plan not only covers your in-patient hospitalization but also covers all the expenses that occurred 60 days before being hospitalized and 180 days after discharge from the hospital.

In-Patient Hospitalization

The insured person under the GoActive Health plan gets cashless facility at all the network hospitals of Niva Bupa. They can avail this facility by just presenting the health card at the time of admission at the hospital. To avail the cashless facility, the insured should be hospitalized for at least 24 hours.
If hospitalized in any of the non-network hospitals, then the policyholder can opt for reimbursement claim. For that, necessary documents are to be submitted within a stipulated time.

Diagnostic test check-up

Check-up costs up to Rs. 2,500 per year are covered under the plan. The cost may vary depending on the amount of sum insured. Every insured person with the GoActive health insurance plan can opt for this benefit. The insured person can avail this benefit in any of the Niva Bupa Network hospitals. The table below shows the value of the Diagnostic test that can be availed for different cover amounts chosen.

Cover Amount	Diagnostic Test
4 lakhs	NA
5 lakhs	Rs. 1,000
7.5 lakhs	Rs. 1,500
10 lakhs
15 lakhs
25 lakhs	Rs. 2,500

Refill benefit
In case, during the year you have exhausted the base sum insured and also the increased sum insured under the I-protect feature partially or completely, then you are entitled to receive a refill benefit up to the base sum insured. This feature can be used for subsequent claims which are not related to the treatment of the same illness as for the previous claims.
Example:
Say Mr. Shinde, age 45, buys a Niva Bupa GoActive health insurance plan with a base sum insured of Rs. 10 Lakhs. In the first year, he claims for Rs. 8 lakhs for a surgery.
After the first claim the company will re-fill the amount of maximum up to 100% of base sum insured i.e. Rs.10 lakhs. In the same year, Mr. Shinde gets hospitalized for any other illness and the bill amount is Rs. 4 Lakhs. So, Rs. 2 lakhs from the base sum insured will be used and Rs. 2 Lakhs from the Re-filled amount will be used to make the payment.

Note: Re-filled amount can’t be carried forward to the subsequent policy year.

Organ transplant
If the policyholder has to go through an organ transplant, then under this policy, all the medical expenses for the organ donor’s in-patient treatment along with the policyholder is covered.

Room rent capping
Depending on the amount of sum insured, the room rent capping varies. Room rent capping is basically a limit on expenses of the type of room chosen at the time of hospitalization.
In Niva Bupa GoActive health plan, the room rent capping are as below:

Cover Amount	Room Rent
4 lakhs	Upto 1% of sum insured
5 lakhs	No restrictions on availing any type of room
7.5 lakhs
10 lakhs
15 lakhs
25 lakhs

So if you have a plan with a 4 lakhs cover, the daily Room Rent will be capped at Rs. 4,000. However, if you have a plan with a cover amount greater than 4 lakhs, there is no limit on the type of room you choose.

ICU Room Rent Capping
Being hospitalized, the policyholder might be kept under observation ward or special care war. In such a situation, the expenses occurring will still be covered under the Niva Bupa GoActive Health Plan.
The expenses covered vary on the basis of sum insured:

Cover Amount	ICU Care
4 lakhs	Upto 2% of base sum insured
5 lakhs	Covered upto base sum insured
7.5 lakhs
10 lakhs
15 lakhs
25 lakhs

So if you have a plan with a 4 lakhs cover, the daily ICU Room Rent will be capped at Rs. 8,000. However, if you have a plan with a cover amount greater than 4 lakhs, there is no limit on the type of room you choose.

Early age Advantage
A discount of 10% on the premium is offered under the GoActive plan on the first base premium and also on all subsequent renewal of the base premium if the policyholder's age is less than or equal to 35 years.

Hassle free renewal process
You can renew the Niva Bupa GoActive Health Plan without much documentation. Simply by entering the policy details you can renew your existing GoActive Health Plan and utilize the various benefits.

Want to cover your family? Compare to find which is the best health insurance policy that covers your medical expenses.

OPD Consultations
A policyholder can avail up to 10 OPD consultations and all the expenses incurred will be covered. The benefit will be covered as cashless or as means of reimbursement. The OPD consultations may vary based on the cover amount you have opted. The number of person covered under each cover amount is different, so have look at the below table to understand more about it:

Cover Amount	Consultation for (1A, 1A+1C, 1A+2C)	Consultation for 2A and more
4 lakhs	3	5
5 lakhs	4	6
7.5 lakhs	4	8
10 lakhs	6	10
15 lakhs	6	10
25 lakhs	6	10

Domiciliary hospitalization
Domiciliary hospitalization is medical treatment of illnesses, which is a normal situation that is done at a hospital. In a situation where the illness or disease can be treated by giving home treatment and as advised by the Doctor, then it will be treated as Domiciliary hospitalization.
The expenses incurred during domiciliary hospitalization in the policy period will be covered under this plan. However, this can be only claimed for reimbursement in case where the treatment was done for 3 consecutive days.

Emergency ambulance
In case if the medical condition of the policyholder calls for immediate requirement of ambulance services, then reasonable and customary charges will be covered. The coverage amount a policyholder can avail for emergency ambulance is upto Rs. 3,000 in a Niva Bupa GoActive Health Plan.

Tax Benefit
You can save tax under section 80 D of the Income Tax Act if you buy a Niva Bupa GoActive health insurance plan.

Direct claim settlement
Purchasing the GoActive health insurance policy from Niva Bupa leaves you unquestioned about the claim settlement. There is no involvement of any third party during the claim settlement process, thus making it easy for the policyholder.

I-Protect (optional)
The GoActive Niva Bupa Health Plan offers a very unique feature of the I-Protect plan. It is an optional plan where the policyholder gets an increase of 10% of the base sum insured for every renewal. This benefit is valid until the policyholder renews the policy or wishes to opt out from this feature by sending a request. You can avail this feature by paying an additional premium.

Health coach (optional)
Worried about how to be healthy with changing lifestyle? Now you can opt for a health coach with a GoActive health insurance plan. A personalized health coaching service will be allocated to the policyholder to keep a track on their fitness.

Based on the health score, you will be eligible for a premium discount of up to 20% on the base premium at the time of renewal of policy. The policyholder can opt for this feature by paying an additional premium.

Deductible(optional)
The policyholder has the option to choose various deductibles under the Niva Bupa GoActive Health plan. Deductible is the amount that the policyholder has to pay before the insurer pays for the claim amount. On opting the deductibles, the health insurance company pays for the claim only if it exceeds the deductible amount. You can opt for deductibles in the range of Rs. 25,000 / 50,000 / 1 lakh / 2 lakhs / 3 lakhs / 5 lakhs / 10 lakhs.

Personal Accidental Cover (optional)
You can now even have a personal accidental cover when you purchase Niva Bupa GoActive Health plan. It is an additional feature that can be availed by paying an extra premium. The cover varies on the basis of the sum insured chosen:

Sum Insured Amount	PA Cover Amount
4 lakhs	Rs. 25 lakhs
5 lakhs	Rs. 25 lakhs / 50 lakhs
7.5 lakhs
10 lakhs
15 lakhs
25 lakhs

To know more about the personal accidental plan from Niva Bupa, click here.

Eligibility Criteria in Niva Bupa GoActive Health Plan

Any individual can purchase the GoActive health insurance plan of Niva Bupa. As it is a comprehensive plan, healthcare expenses of every individual as well as his family members are covered. However, there are a few criteria in the GoActive health insurance plan.

Parameters	Minimum	Maximum
Entry Age	18 years for adults 91 days	65 years for adults 21 years for dependant child
Cover amount	4 / 5 / 7.5 / 10 / 15 / 25 lakhs
Members	Individual Adult or 2 Adults	2 Adults and 4 Child

Exclusion in Niva Bupa GoActive Health Plan

Expenses related to the surgical treatment of obesity
Expenses related to any admission, primarily for enforced bed rest and not for receiving treatment.
Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment are excluded

Claim Process in Niva Bupa GoActive Health Plan

The policyholder or his relatives can follow the below mentioned procedure to claim for the hospitalization expenses. One can avail the cashless claim benefits at network hospitals or apply for a reimbursement claim.

Know about Cashless Claim Process:

When you choose to be hospitalized at network hospitals, you can go cashless.
You will be given a health card, which is required to be presented at the time of admission in hospitals. Also, the personal identification number such as passport, pan card or voter’s id.
Post this, the hospital will send a pre-authorization request to Niva Bupa
Next Niva Bupa will confirm the details and offer confirmation on the claim made for hospitalization.
The claim will be settled directly with the hospital after all the process is completed.

Know about Reimbursement Claim Process:

In case you are admitted to a hospital, it is mandatory to inform the Niva Bupa helpline within 48 hours.
You will be required to clear the hospitalization bill on your own
Post that, all the medical bills, reports, documentation, discharge summary is to be duly collected from the hospital.
Then, all these documents are to be submitted along with claim form filled and proof of identity and age proof to Niva Bupa for scrutinizing
Following the review of the claim, the policyholder will be authorized to either receive the reimbursement claim amount or would be denied, depending upon the plan’s terms and conditions.

FAQ’s

How can I buy the Niva Bupa GoActive Health plan?

You can visit MyInsuranceClub.com and our trained and certified insurance experts will guide you through the purchase of the Niva Bupa GoActive health insurance plan.

Is medical check up mandatory before buying Niva Bupa GoActive Health plan?

A medical checkup might be necessary when you purchase a new health insurance policy, depending on the age criteria and the base sum insured you choose.

However, if the policy gets rejected by the actuaries, then the medical test cost shall be deducted and the balance amount of the first premium paid will be transferred back to the individual.

My Wife and child are residing in Delhi. Will they still be covered under the Niva Bupa GoActive Health plan?

Definitely Yes! You can cover your family residing in India under one GoActive policy. You can use your health insurance policy anywhere in India. For cashless hospitalization, you need to check with the network hospitals list. You can even avail the reimbursement facility if at all you get treated somewhere else.

What is the waiting period for pre-existing illnesses in Niva Bupa GoActive Health plan?

If you are having a pre-existing disease such as Diabetes, Blood pressure, it will still be covered after a waiting period. Pre-existing illnesses are covered after 36 months of a continuous renewal of the GoActive plan.

What is the claim process in the Niva Bupa GoActive Health plan?

1.Get in touch with the insurance helpdesk of any network hospital of the insurance company, preferably at least 72 hours before treatment

2.Present your Niva Bupa health card or Policy Number along with any of these documents as proof of your identity - Passport, Voter ID, PAN Card, Driver's License

3.Claim form, duly filled and signed by the policyholder

4.Receipts and bills of medical tests, hospitalization, doctors’ consultation fees, etc. as proofs of hospitalization and medical expenses

Following these, the company will assign a relationship manager to simplify the claim settlement process.

What are the documents required at the time of claim settlement in Niva Bupa GoActive Health plan?

One needs to present the following documents at the time of submitting the claim:

Proof of Identity: Aadhar card, PAN, Voter ID, Driving License, Passport.
Proof of Address: Aadhaar, Passport, Driving License, Voter ID, electricity bill, telephone bill, water bill, gas bill, Ration Card, bank statement, copy of insurance policy are all acceptable documents.
Proof of Age: Aadhaar, School Leaving Certificate, Passport, Driving License.

How to renew a GoActive Health Insurance Policy?

The renewal process of the GoActive plan is quite simplified:

Visit the official website of Niva Bupa and enter the 14 digit policy number
Enter your date of birth
Select ‘Submit’ button and choose the payable annual premium as per the plan
Select the ‘Pay’ button to make the premium payment.
You will receive an email of the policy transaction and also the policy documents on the registered email id.

Does Niva Bupa GoActive Health insurance policies cover diagnostic charges like X- ray, MRI or ultrasound?

Yes, the GoActive health insurance plan from Niva Bupa covers all diagnostic tests like X-Rays, MRIs, Blood test and a few more. Also, it is mandatory that the tests are to be done maximum 60 days prior to being hospitalized or 180 days post hospitalization for the amount to be claimed.

From where can I download the claims form?

In order to download the claim form, you can simply visit the official website of Niva Bupa and click on ‘claims’. Then you can select the claim form in the drop down option and then on the service form and choose the plan for which you want to download the claim form.

How many times can I make a claim under the Niva Bupa GoActive Health plan?

One can file any number of claims over a year with the Niva Bupa GoActive health insurance plan. However, the claim has a limit up to the sum insured amount, exceeding which the policyholder will have to bear the expenses from his/her pocket.

Covering your medical expenses is the need of the hour. Niva Bupa provides numerous benefits in their health insurance plans. Through this review, we intend you to make an informed decision and cover your family with adequate health cover. Our trained and certified experts will be happy to guide you through the best plans.

Niva Bupa GoActive Health Insurance Plan UIN MAXHLIP21173V022021

Know about Cashless Claim Process:

Know about Reimbursement Claim Process:

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