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Niva Bupa Senior Citizen Health Insurance Plan UIN MAXHLIP21575V012021

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Niva Bupa Senior Citizen Health Insurance Plan Summary

Niva Bupa,earlier known as Max Bupa is one of the well known insurance companies that provides exclusive health insurance plans. The health insurance plans offered by Niva Bupa are all at affordable premiums and cover every aspect of healthcare. It is important for senior citizens to have a health insurance plan as their healthcare needs can be substantial in nature. Niva Bupa Health Insurance offers an exclusive plan for Senior Citizens that provides numerous benefits. 

Niva Bupa Health Insurance has a wide network of 4,500+ hospitals for cashless treatments along with over 2,000+ doctors for cashless OPD treatments as well. It also provides various facilities such as home pick-up service for diagnostic samples & also for delivery of medicines.

Plan Type Niva Bupa Senior Citizen Health Insurance Plan
Policy Type Health Insurance Plan
UIN MAXHLIP21575V012021

Key Features of Niva Bupa Senior Citizen Health Insurance Policy

  • ReAssure benefit: The insured person can make multiple claims throughout the year for the treatment of any illnesses. The sum insured will be Reinstated after every claim up to the limit of the base sum insured. This feature is available in the Platinum variant.
  • For example:
    • Mr. Singh has a NIva Bupa Senior Citizen health insurance policy with a base sum insured of Rs. 10 lakhs. Say due to certain reasons, he gets admitted and makes his first claim of Rs. 8 lakhs. Post the claim, the balance of the base sum insured is of Rs. 2 lakhs. 
    • Now, in the same year Mr. Singh makes another claim of Rs. 13 lakhs. In such a situation, the total claim of Rs. 12 lakhs (2 lakh from the base sum insured and 10 lakhs from the ReAssure benefit) is paid. The balance of 1 lakh will have to be borne by Mr. Singh.  
    • Suppose, in the same year Mr. Singh makes a third claim of Rs. 5 lakhs. In such a scenario, the base sum insured had exhausted completely but was triggered up to the limit of base sum insured i.e. Rs. 10 lakhs. So, the third claim will be completely covered under the policy.
  • Direct Claim Settlement: In case of hospitalization, the insured person or their relatives can claim directly with the health insurer. There won't be any involvement of a third party authority for claim settlement thus maintaining the transparency.
  • No Claim Bonus: Under the Niva Bupa Senior Citizen Health Insurance plan, with every claim free year, an increase in 10% of the sum insured is awarded as a no claim bonus. This is maximum up to 100% of the base sum insured amount. 
  • No Room-rent capping: There are zero sub-limits on room rent in Niva Bupa Senior Citizen health insurance.
  • In-patient care: Get cashless coverage for hospitalization expenses at network hospitals. To make a claim of Niva Bupa Senior Citizen health insurance plan, the insured has to be admitted for a minimum of 24 hours.
  • Organ transplant: In this, the medical expenses related to an organ donor's inpatient treatment is also covered along with the insured person who is undergoing the surgery.
  • Day care treatment: Here, day care treatments are covered for senior citizens. Day care treatments refers to medical treatment and/or surgical procedure which is usually undertaken under general anesthesia in a hospital/ day care center in less than 24 hours. 
  • Hospital accommodation: There is no room rent capping for any of the variants you choose. Be it a shared room under the Gold plan or a single private room under the Platinum plan of Niva Bupa Senior Citizen Health Insurance Plan.
  • Domiciliary Hospitalization: On account of lack of availability of beds at hospital, if the insured person takes treatment at his/her home on doctors advice, then the expenses related to the treatment will be covered.
  • Pre & Post hospitalization cover: Niva Bupa Senior Citizen health insurance plan covers the pre as well as post hospitalization expenses of the insured person. With 60 days of pre hospitalization and 180 days of post discharge expenses related to the admittance at hospital is covered. 
  • Waiting period for pre-existing diseases: In the Senior Citizen plan, the insured person with specified pre-existing diseases will have to wait for a period of 2 year. Post completion of the waiting period, they can apply for claims under the Senior Citizen Plan.
  • Co-payment clause: There is always a co-payment clause that comes in every senior citizen plan. Co-payment means that the cost is shared by the insurer and the insurance company. Under the Niva Bupa Senior Citizen health insurance plan, the insurer can choose the proportion of co-payment they would agree to contribute along with the insurance company. The insured can choose the co-payment as 40%/30%/20% and the premium charged may vary accordingly. 

    Say for example; Mr. Patel, aged 66 years has a Niva Bupa Senior Citizen health insurance plan. He agrees for a cost sharing of 30% under the co-payment clause. So, if on admittance at hospital his final bill amount comes to around Rs. 5 lakhs. Due to co-payment clause, Mr. Patel will have to pay 30% of Rs. 5 lakhs i.e. Rs. 1.5 lakhs from his pocket.

Variants in Niva Bupa Senior Citizen Health Insurance Policy

One can avail any of the Niva Bupa Senior Citizen plan variants based on their personal requirement. Each plan is self-sufficient with more or less similar features. Have a look at both the variants offered under Niva Bupa Senior Citizen Health Insurance Plan:
Variants Gold Platinum
Base sum insured 5 lakhs/10 Lakhs 5/10/15/20/25 Lakhs
Room Category Shared room Single Private Room
Ambulance coverage Road ambulance: up to Rs. 2,000 per hospitalization

Air ambulance: up to Rs. 2,50,000 per hospitalization
ReAssure Feature NA Can reinstate the base sum insured value unlimited times
Health Check-up NA Up to Rs. 500 for every 1 Lakh. 
In an Individual plan, the maximum cost covered is up to Rs. 5,000.
In a Family Floater plan, maximum cost covered is up to Rs.10,000.
Co-Payment Clause Co-payment clause is mandatory under Senior Citizen plan
Modern Treatments Covered up to Sum Insured with a sub-limit of Rs. 1 Lac for every claim on a few robotic surgeries. 
AYUSH Treatments Covered up to Sum Insured
Pre-issuance medical test Not Mandatory

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Eligibility Criteria in Niva Bupa Senior Citizen Health Insurance Plan

In order to avail the Niva Bupa Senior Citizen Health Insurance Plans, there are a few criteria that need to be looked upon. These criteria have a key role when it comes to purchasing a Senior Citizen Health Insurance plan.
Categories Eligibility
Minimum entry age 61 years
Maximum age for entry 75 years
Person’s covered Individual and family floater (2 adults)
Co-payment category Depending on the cost sharing option chosen

Exclusion in Niva Bupa Senior Citizen Health Insurance Plan

Niva Bupa Health Insurance plans for senior citizens come with certain exclusions. In case if the insured person is hospitalized and applies for the below mentioned criterias, the claim would not be considered for approval. The exclusions are:
  • Sleep disorders
  • OPD treatment
  • Dental treatment
  • Treatment for alcoholism or drug abuse
  • Unproven treatments
  • External congenital anomaly
  • Artificial life maintenance

Claim Process in Niva Bupa Senior Citizen 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:
1.When you choose to be hospitalized at network hospitals, you can go cashless.
2.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.
3.Post this, the hospital will send a pre-authorization request to Niva Bupa
4.Next Niva Bupa will confirm the details and offer confirmation on the claim made for hospitalization.
5.The claim will be settled directly with the hospital after all the process is completed.
Know about Reimbursement Claim Process:
1.In case you are admitted to a hospital, it is mandatory to inform the Niva Bupa helpline within 48 hours. 
2.You will be required to clear the hospitalization bill on your own
3.Post that, all the medical bills, reports, documentation, discharge summary is to be duly collected from the hospital.
4.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 
5Following 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.

Is COVID-19 covered under the Niva Bupa Senior Citizen Health Insurance plan?
The expenses incurred during the treatment for Covid-19 ailment is covered upto the base sum insured. 

Who can take the Niva Bupa Senior Citizen Health plan?
Any individual or family floater who has attained a minimum age of 61 years and maximum of 75 years can purchase the Senior Citizen Health Plan.

Can I avail tax benefit on purchasing the Niva Bupa Senior Citizen Health Plan?
Yes, one can avail tax benefit under sec 80 D of Income Tax Act.

What are the documents required to make a claim in Niva Bupa Senior Citizen Health plan?
In order to make a successful claim, the policyholder has to present the following documents:
  • ID proof
  • Doctor’s letter of hospitalization
  • Medical bills
  • Reports of lab test 

Is it necessary to undergo a health checkup while purchasing the Niva Bupa Senior Citizen Health Plan?
With more risk associated, a medical examination is mandatory in the Niva Bupa Senior Citizen Health plan.

Reading through the Niva Bupa Senior Citizen Health Insurance review, we hope you will be able to make an informed decision. In case you need a better understanding of the plan, you can visit, our trained experts will guide you through all the details.
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