Product Name – Health Premia
Product header - Your health deserves nothing less
Product USP - (Platinum Variant) –
- Comprehensive coverage up to 3 Crore
- Maternity (worldwide)∞ and newborn baby cover^
- Modern Treatments coverage
- International coverage for specified illness and medical emergencies∞
- International coverage for specified illness and medical emergencies∞
- Annual health check-up of your choice from day 1
- Refill benefit for any illness in a policy year
- Loyalty Additions of 10% in sum insured per year
Product Coverage and Limits
(Individual and Floater)
Plans | Silver | Gold | Platinum | ||||||||
Base Sum Insured (in Rs) | 5 Lakhs | 7.5 Lakhs | 10 Lakhs | 15 Lakhs | 20 Lakhs | 30 Lakhs | 50 Lakhs | 100 Lakhs | 200 Lakhs | 300 Lakhs | |
Benefits | |||||||||||
Inpatient care | Covered up to Sum Insured | ||||||||||
Room rent | Covered up to Sum Insured (except for Suite or above room category) | Covered up to Sum Insured | |||||||||
Pre-Hospitalization Medical Expenses (90 days) | Covered up to Sum Insured | ||||||||||
Post-Hospitalization Medical Expenses (180 days) | Covered up to Sum Insured | ||||||||||
Day Care Treatment Covered up to Sum Insured | Covered up to Sum Insured | ||||||||||
Domiciliary Hospitalization | Covered up to Sum Insured | ||||||||||
Alternative Treatment | Covered up to Sum Insured | ||||||||||
Living Organ Donor Transplant | Covered up to Sum Insured | ||||||||||
Emergency Ambulance | Network Hospital: Covered up to Sum Insured; Non-network Hospital: Covered up to Rs. 2,000 per event | ||||||||||
e-consultation | Unlimited tele / online consultations | ||||||||||
Maternity Benefit (covered for up to 2 pregnancies or terminations) (1) | Covered up to Rs 40,000 | Covered up to Rs 60,000 | Covered up to Rs 70,000 | Covered up to Rs 75,000 | Covered up to Rs 80,000 | Covered up to Rs 1,00,000 | Covered up to Rs 1,00,000 | Covered up to Rs 200,000 (worldwide excluding USA & Canada) |
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New Born Baby (covered uptill the end of Policy Year) (1) | Covered up to Sum Insured | ||||||||||
Vaccination of the new born baby | Covered until new born baby completes one year | ||||||||||
Health Check-up (from Day 1) for silver and gold variants - Cashless only for platinum - both cashless and reimbursement | Annual, Tests covered up to worth Rs 1,250 per Insured Person | Annual, Tests covered up to worth Rs 1,875 per Insured Person | Annual, Tests covered up to worth Rs 2,500 per Insured Person | Annual, Tests covered up to worth Rs 2,500 per Insured Person | Annual, Tests covered up to worth Rs 2,500 per Insured Person | Annual, Tests covered up to worth Rs 5,000 per Insured Person | Annual, tests covered up to worth Rs 7,500 per Insured Person | Annual, tests covered up to worth Rs 10,000 per Insured Person | Annual, tests covered up to worth Rs 10,000 per Insured Person | Annual, tests covered up to worth Rs 10,000 per Insured Person | |
Re-fill benefit | Reinstate up to base Sum Insured. Applicable for same & different illness as well | ||||||||||
Premium Waiver | One time premium waiver if the Policyholder dies or suffers from specified illness | ||||||||||
Pharmacy and diagnostic services | Available through our empanelled service provider | ||||||||||
Loyalty Additions | Increase of 10% of expiring Base Sum Insured in a Policy Year; maximum up to 100% of Base Sum Insured | ||||||||||
HIV / AIDS | covered up to Rs 50,000 | ||||||||||
Emergency assistance services (only within India) | covered up to Sum Insured | ||||||||||
Medical consultation referral | covered up to Sum Insured | ||||||||||
Emergency medical evacuation (air ambulance) | covered up to Sum Insured | ||||||||||
Medical repatriation | covered up to Sum Insured | ||||||||||
Compassionate visit | covered up to Sum Insured | ||||||||||
Care and/or transportation of minor children | covered up to Sum Insured | ||||||||||
Return of mortal remains | covered up to Sum Insured | ||||||||||
Mental disorder treatment | Covered up to Sum Insured (sub-limit of Rs 50,000 applicable on few conditions) | Covered up to Sum Insured (sub-limit of Rs 1,00,000 applicable on few conditions | |||||||||
LASER surgery cover | Not available | Covered up to Rs 50,000 | Covered up to Rs 1,00,000 | ||||||||
Second Medical Opinion | Not available | Not available | Covered worldwide, One opinion per Insured Person per Specified Illness / planned Surgery | ||||||||
Child Care Benefits | Not available | Not available | Covered worldwide, One opinion per Insured Person per Specified Illness / planned Surgery | ||||||||
Specified Illness Cover (2) (outside India for worldwide excluding USA & Canada) | Not available | Not available | Covered up to Sum Insured | ||||||||
OPD cover | Not available | Not available | covered up to Rs 50,000 per policy | ||||||||
Modern Treatments | Covered up to Sum Insured with sub-limit of Rs. 1Lac on few robotic surgeries | ||||||||||
International coverage (outside India for worldwide excluding USA & Canada) | Not available | Condition: One single trip (max 15 days) per Insured Person; | Covered worldwide, One opinion per Insured Person per Specified Illness / planned Surgery | ||||||||
International coverage (outside India for worldwide excluding USA & Canada) | Not available | International Sum Insured: up to Rs. 30 Lacs per Insured Person | International Sum Insured: up to Rs. 1 Cr per Insured Person | ||||||||
Emergency Hospitalization | Not available | Covered up to International Sum Insured | |||||||||
Emergency Medical Evacuation | Not available | Covered up to International Sum Insured | |||||||||
OPD cover | Not available | Covered up to International Sum Insured with a co-payment of 20% | |||||||||
Compassionate visit | Not available | Covered up to International Sum Insured | |||||||||
Loss of Passport | Not available | Covered up to Rs 20,000 | |||||||||
Care and/or transportation of minor children | Not available | Covered up to International Sum Insured | |||||||||
Loss of checked-in baggage | Not available | Covered up to Rs 10,000 | |||||||||
Return of mortal remains | Not available | Covered up to International Sum Insured | |||||||||
Trip Cancellation & Interruption | Not available | Rs 25,000 | |||||||||
Trip Delay | Not available | Rs 10,000 | |||||||||
Delay of Checked-in Baggage | Not available | Rs 5,000 | |||||||||
Medical Referral | Not available | Covered up to International Sum Insured | |||||||||
Medical repatriation | Not available | Covered up to International Sum Insured | |||||||||
Optional Benefits | |||||||||||
Personal Accident cover (for insured aged 18 years & above on individual basis) | 25 lacs | 50 lacs | 1 cr | ||||||||
Critical illness cover (for insured 18 years & above on individual basis) | 5 lacs / 10 lacs | 10 lacs / 15 lacs / 25 lacs | 25 lacs / 50 lacs / 1 Cr | ||||||||
Enhanced Loyalty Addition | Increase of 20% of expiring Base Sum Insured in a Policy Year; maximum up to 200% of Base Sum Insured | ||||||||||
International coverage extension (outside the geographical boundaries of India for worldwide excluding USA & Canada) | Not available | 1. Double Sum Insured for 'international coverage' benefit 2. Additional single trips available from 1 day to 30 days |
Double Sum Insured for 'international coverage' benefit | ||||||||
Hospital Cash | Rs 1,500/day | Rs 3,000/day | Rs 6,000/day | ||||||||
Enhanced Geographical Scope for International coverage | Not available | USA & Canada included for Maternity Benefit under platinum plan, Specified Illness under platinum plan and International coverage | |||||||||
Health Coach | Personalized health coaching for insured aged 18 years & above for any 90 days per Policy Year |
subject to a continuous coverage of 24 months of that Insured Person since the inception of the first Policy which offers Maternity benefit with Us.
The symptoms of the Specified Illness first occur or manifest itself during the Policy Period and after completion of the 90 day from the inception of 1st Policy with Us.
Family First
Plans | Silver | Gold | Platinum |
Base Individual Sum Insured (in Rs & per Insured Person) | 1Lacs, 2Lacs, 3Lacs, 4Lacs & 5Lacs | 5Lacs, 6 Lacs, 7 Lacs, 8 Lacs, 9 Lacs & 10Lacs | 10 Lacs, 11 Lacs, 12 Lacs, 13 Lacs, 14 Lacs & 15 Lacs |
Floater Sum Insured (in Rs) | Number of Insured Persons (value to be considered as 10 for more than 6 members) * Base Individual Sum Insured * Multiplier factor (1.5 for 2 member policy & 1 for others) | ||
Benefits | |||
Inpatient care | Covered up to Sum Insured | ||
Room rent | Option 1: Rs 3,000 per day or Shared Room; whichever is lower Option 2: Rs 5,000 per day or Single Private Room; whichever is lower | Covered up to Sum Insured (except for Suite or above room category) | Covered up to Sum Insured |
Pre-Hospitalization Medical Expenses (90 days) | Covered up to Sum Insured | ||
Post-Hospitalization Medical Expenses (180 days) | Covered up to Sum Insured | ||
Day Care Treatment | Covered up to Sum Insured | ||
Domiciliary Hospitalization | Covered up to Sum Insured | ||
Alternative Treatment | Covered up to Sum Insured | ||
Living Organ Donor Transplant | Covered up to Sum Insured | ||
Emergency Ambulance | Network Hospital: Covered up to Sum Insured; Non-network Hospital: Covered up to Rs. 2,000 per event | ||
e-consultation | Unlimited tele / online consultations | ||
Maternity Benefit (covered for up to 2 pregnancies or terminations) (1) | Covered up to Rs 35,000 | Covered up to Rs 50,000 | Covered up to Rs 1,00,000 (worldwide excluding USA & Canada) |
New Born Baby (covered uptill the end of Policy Year) (1) | Covered up to Sum Insured | ||
Vaccination of the new born baby | Covered until new born baby completes one year | ||
Health Check-up (from Day 1) for silver and gold variants - Cashless only for platinum - both cashless and reimbursement | Once in two years, tests as per annexure | Annual, Tests covered up to worth Rs 2,500 per Insured Person | Annual, tests covered up to worth Rs 5000 per Insured Person |
Premium Waiver | One time premium waiver if the Policyholder dies or suffers from specified illness | ||
Pharmacy and diagnostic services | Available through our empanelled service provider | ||
Loyalty Additions | Increase of 10% of expiring Base Sum Insured in a Policy Year; maximum up to 100% of Base Sum Insured | ||
HIV / AIDS | Covered up to Rs 50,000 | ||
Emergency assistance services (only within India) | Covered up to Sum Insured | ||
- Medical consultation referral | Covered up to Sum Insured | ||
- Emergency medical evacuation (air ambulance) | Covered up to Sum Insured | ||
- Medical repatriation | Covered up to Sum Insured | ||
- Compassionate visit | Covered up to Sum Insured | ||
- Care and/or transportation of minor children | Covered up to Sum Insured | ||
- Return of mortal remains | Covered up to Sum Insured | ||
Mental disorder treatment | Covered up to Sum Insured (sub-limit of Rs 50,000 applicable on few conditions) | Covered up to Sum Insured (sub-limit of Rs 1,00,000 applicable on few conditions) | |
LASER surgery cover | Not available | Covered up to Rs 50,000 | Covered up to Rs 1,00,000 |
Second Medical Opinion | Not available | Not available | covered worldwide, One opinion per Insured Person per Specified Illness / planned Surgery |
Child Care Benefits | Not available | Not available | Covered up to Sum Insured |
Specified Illness Cover (2) (outside India for worldwide excluding USA & Canada) | Not available | Not available | Covered up to Sum Insured |
OPD cover | Not available | Not available | covered up to Rs 35,000 per policy |
Modern Treatments | Covered up to Sum Insured with sub-limit of Rs. 1Lac on few robotic surgeries | ||
International coverage (outside India for worldwide excluding USA & Canada) | Not available | Condition: One single trip (max 15 days) per Insured Person; International Sum Insured: up to Rs. 30 Lacs per Insured Person |
Condition: annual multi trip (Max 45 days coverage in a single trip) International Sum Insured: up to Rs. 1 Cr per Insured Person |
Emergency Hospitalization | Not available | Covered up to International Sum Insured | |
Emergency Medical Evacuation | Not available | Covered up to International Sum Insured | |
OPD cover | Not available | Covered up to International Sum Insured with a co-payment of 20% | |
Compassionate visit | Not available | Covered up to International Sum Insured | |
Loss of Passport | Not available | Covered up to Rs 20,000 | |
Care and/or transportation of minor children | Not available | Covered up to International Sum Insured | |
Loss of checked-in baggage | Not available | Covered up to Rs 10,000 | |
Return of mortal remains | Not available | Covered up to International Sum Insured | |
Loss of checked-in baggage | Not available | Covered up to Rs 10,000 | |
Return of mortal remains | Not available | Covered up to International Sum Insured | |
Trip Cancellation & Interruption | Not available | Rs 25,000 | |
Trip Delay | Not available | Rs 10,000 | |
Delay of Checked-in Baggage | Not available | Rs 5,000 | |
Medical Referral | Not available | Covered up to International Sum Insured | |
Medical repatriation | Not available | Covered up to International Sum Insured | |
Optional Benefits | |||
Personal Accident cover (for insured aged 18 years & above on individual basis) | 25 lacs | 50 lacs | 1 Cr |
Critical illness cover (for insured 18 years & above on individual basis) | 5 lacs / 10 lacs | 10 lacs / 15 lacs / 25 lacs | 25 lacs / 50 lacs / 1 Cr |
Enhanced Loyalty Addition | Increase of 20% of expiring Base Sum Insured in a Policy Year; maximum up to 200% of Base Sum Insured | ||
International coverage extension (outside the geographical boundaries of India for worldwide excluding USA & Canada) | Not available | Double Sum Insured for 'international coverage' benefit Additional single trips available from 1 day to 30 days |
Double Sum Insured for 'international coverage' benefit |
Hospital Cash | Rs 1,500/day | Rs 3,000/day | Rs 6,000/day |
Enhanced Geographical Scope for International coverage | Not available | USA & Canada included for Maternity Benefit under platinum plan, Specified Illness under platinum plan and International coverage | |
Health Coach | Personalized health coaching for insured aged 18 years & above for any 90 days per Policy Year |
- subject to a continuous coverage of 24 months of that Insured Person since the inception of the first Policy which offers Maternity benefit with Us.
- The symptoms of the Specified Illness first occur or manifest itself during the Policy Period and after completion of the 90 day from the inception of 1st Policy with Us.
For detailed coverage information, please refer to the policy terms and conditions document.
Product Design and Eligibility
- Policy Type – ‘Health Premia’ product can be issued to an individual customer or to a family with up to 4 children (referred to as a ‘family floater’ policy) or extended family (referred to as a ‘family first’ policy).
- Entry Age - The range of entry ages for Adults under the policy is from 18 years (last birthday) to 65 years (last birthday). The range of entry ages for dependent children is from 91 days to 30 years under a family floater policy.
Relationships allowed – The Family First may be available in any of the below relationships with the Proposer - - Relationships allowed
- Legally married spouse as long as he or she continues to be married to You;
- Son;
- Daughter-in-law as long as Your son continues to be married to Your Daughter-in-law;
- Daughter; Son-in-Law as long as Your daughter continues to be married to Your Son-in-law;
- Father;
- Mother; Father-in-law as long as Your spouse continues to be married to You;
- Mother-in-law as long as Your spouse continues to be married to You.;Grandfather;
- Grandmother;
- Grandson;
- Granddaughter;
- Brother;
- Sister;
- Sister-in-law;
- Brother-in-law;
- Nephew;
- Niece
- Lifetime Renewability - There is no maximum cover ceasing age on renewals.
Discounts Offered -
Term discount: The default policy term for all plans is one year. Two year and three-year policy term options are also available under the product. You get 7.5% discount on the premium for second policy year + 15% discount on the premium for third policy year (If Opted for)
For detailed Product Design, Eligibility and Discount information, please refer to the Prospectus document.
Product Exclusions
- Investigation & Evaluation
- Rest Cure, rehabilitation and respite care
- Obesity/ Weight Control
- Cosmetic or plastic Surgery
- Hazardous or Adventure sports
- Breach of law
- Excluded Providers
- Treatment for, alcoholism, drug or substance abuse or any addictive condition and consequences thereof
- Treatments received in heath hydros, nature cure clinics, spas or similar establishments or private beds registered as a nursing home attached to such establishments or where admission is arranged wholly or partly for domestic reasons
- Refractive Error
- Unproven Treatments
- Sterility and Infertility
- Maternity Expenses
- Conflict & Disaster
- External Congenital Anomaly
- Dental treatment
- Unrecognized Physician or Hospital
- Artificial life maintenance for the Insured Person who has been declared brain dead or in vegetative state
For detailed exclusions list information, please refer to the policy terms and conditions document.
Disclaimer: Insurance is a subject matter of solicitation. Niva Bupa Health Insurance Company Limited (formerly known as Max Bupa Health Insurance Company Limited) (IRDAI Registration No. 145). ‘Bupa’ and ‘HEARTBEAT’ logo are registered trademarks of their respective owners and are being used by Niva Bupa Health Insurance Company Limited under license. C-98, First Floor, Lajpat Nagar, Part 1, New Delhi-110024. ∞By default, coverage is not available for USA & Canada. However, coverage can be extended to USA & Canada on payment of additional premium. ^Maternity and newborn baby cover not available under individual plan. (1) subject to a continuous coverage of 24 months of that Insured Person since the inception of the first Policy which offers Maternity benefit with Us. (2) The symptoms of the Specified Illness first occur or manifest itself during the Policy Period and after completion of the 90 day from the inception of 1st Policy with Us. For more details on risk factors, terms and conditions please read sales brochure carefully before concluding a sale. CIN: U66000DL2008PLC182918. Website: www.nivabupa.com. Fax: + 91 11 41743397. Customer Helpline No.: 1860-500-8888. Product Name: Health Premia. Product UIN: MAXHLIP21176V022021.