Niva Bupa Health Insurance Company Ltd. (Niva Bupa) is a joint venture between Max India Limited and the UK-based healthcare services expert, Bupa.
The Heartbeat Policy offers to provide a comprehensive medical coverage for individual as well as extended family covering up to 14 members. In their Family First Plan, an individual sum insured is offered for each member, and a floating sum insured to any family member.
Please Note: Max Bupa Health Insurance Company Limited was renamed to Niva Bupa Health Insurance Company Limited on 5th July 2021.
The benefits offered by Niva Bupa Heartbeat Policy make it a much preferred choice for families looking for a health insurance policy: Comprehensive Cover: The comprehensive features and benefits offered by Niva Bupa Heartbeat Policy ensure a wide coverage and low waiting periods.
For children : 91 days
Adults :
Minimum : 18 years
Maximum : No Age Bar
Maximum Members : 6
Maximum Adults : 4
Maximum Children : 2
2 - 100 lakhs
For longer policy term
family discount
1, 2 years
40 yrs/10 Lacs
For children : 91 days
Adults :
Minimum : 18 years
Maximum : No Age Bar
Maximum Members : 6
Maximum Adults : 2
Maximum Children : 4
2 - 100 lakhs
For longer policy term
family discount
1, 2 years
40 yrs/10 Lacs
Due to scientific advancement, some procedures/treatments do not require you to be hospitalized for a minimum of 24 hours to raise a claim. This plan covers such procedures.
This benefit covers medical costs up to the sum insured for an organ donor's treatment for the harvesting of the donated organ.
The insurance company will compensate you for the medical expenses related to your hospitalization 30 days before the hospitalization.
The insurance company will pay you for the medical expenses related to your hospitalization 60 days post hospitalization.
Only the Platinum plan includes the OPD expenses between Rs.10,000 to Rs.40,000 depending on the sum insured.
This policy does not offer any daily hospital cash.
Offers complimentary health check-up that covers some listed tests, ranging from annual to once in two years depending on the plan variant.
You can avail treatment at home up up to a limit ranging between Rs.10,000 to Rs.2.5 lakh, depending on the plan variant you have opted for.
This plan offers to cover for expenses related to non-allopathic treatment for Platinum plan members only.
This plan provides ambulance cover at actuals in the network hospital up to the sum insured.
This plan does not provide coverage for eye treatment expenses.
This policy includes the costs towards Maternity ranging between Rs.20,000 up to Rs.1 lakh.
This policy does not cover any dental treatments.
Description
This policy does not provide additional cover for critical illness.
For any reason, should you decide not to proceed with the policy, you can return the same and request for a refund within 15 days from the date of receipt of the policy document.
This plan offers 10% discount on last paid premium or increase of 10% of sum insured up to a maximum of 50%. This benefit replaces the no-claim benefit offered in some other plans.
The Platinum plan offers coverage for treatment worldwide (except for USA and Canada) in the range of Rs.1.5 lakh to Rs.10 lakh for a family floater and individual coverage and Rs.5 lakh for family first coverage.
All the expenses related to the care of newborn baby are covered up to the sum insured.
The plan has defined limits for room rents and is equal to:
This plan has the option of 10% to 20% co-pay for individuals below 65 years of age. However, it is mandatory for anyone above the age of 65 years. This co-pay reduces by 5% at each renewal making it zero at the 4th renewal.
A 90 days cooling off period for all claims except any arising out of accidental injuries.
The policy covers some specific diseases/treatments only after 24 months. These include Cataract, Hysterectomy, Myomectomy for Fibroids, and so forth.
You can claim for any pre-existing conditions after 48 months from the policy start date in case of Silver plan and 24 months for Gold and Platinum plans.
Cashless Claims
This is applicable when a Niva Bupa Heartbeat policyholder/insured member is admitted at a network hospital of the insurer.
Show any proof of identity along with your Niva Bupa Health Card, or your Policy number such as Passport / PAN card / Voter’s ID
The network hospital will verify your identity and submit the pre-authorisation request form to the insurance company
The insurer then reviews and takes a decision on whether to approve or reject the cashless claim by fax and/or email. The insurer also sends a text or a message on your registered mobile number and an email to you as a confirmation of your claim. The insurer responds to a claim request decision to the hospital within 30 minutes.
Niva Bupa then pays the claim amount that you are eligible for to the network hospital directly, as per policy terms and conditions, after all formalities have been completed.
Reimbursement Claims
This is applicable when a Niva Bupa Heartbeat policyholder has not been hospitalized at any of the network hospitals of the insurance company.
In case of hospitalization at a non-network hospital, you have to pay the hospital directly and then file a reimbursement claim.
Make sure that you carefully collect all receipts, bills, doctors’ prescriptions, medical reports and discharge certificate from the hospital in originals
Fill up the claims form with accurate details and send it to the insurance company, along with the above mentioned documents and your valid Proof of Identity and Proof of Age
The insurer then reviews and takes a decision on whether to approve or reject the reimbursement claim. It may also decide to raise a query or reject the same, as per policy terms and conditions
The insurer reimburses you the approved amount in your bank account.
The Plan will not cover any liabilities towards the treatments of following conditions-
The detailed list of what the policy does not cover is available in the policy wording.
If you have a large family to cover under a single policy, Niva Bupa's Heartbeat Family First plan is one to consider. With wide benefits on offer, the plan includes relevant medical expenses towards diagnostic procedures and newborn baby. At any point, if you wish to seek the medical treatment abroad, then you can consider Platinum plan.
**Reviews and ratings are based only on Benefits and Conditions. Things like Claim Settlement Ratio, Hospital Network have not been covered under product ratings. These are covered under Company ratings.Niva Bupa Heartbeat Policy can be bought through the official website of the insurance company.
There is a 15-day free look period applicable on Niva Bupa Heartbeat Policy.
Definition
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