Niva Bupa GoActive Plan

Niva Bupa Health Insurance - Niva Bupa GoActive has been designed as a comprehensive health insurance policy that offers financial protection during medical treatments owing to illnesses and accidents. It not only covers individuals, but the family floater plan covers families as well. Niva Bupa GoActive is a cost-effective health insurance plan that can cover the policyholder, his/her spouse and up to 4 children .

Niva Bupa GoActive specializes in a wide range of benefits. It not only covers medical charges incurred during hospitalization, but a variety of other medical expenses – pre and post hospitalization, day care services, OPD charges, doctors’ consultation, etc. It offers policyholders the flexibility to choose from the various sum insured options, as per his/her preference. There are also optional covers that policyholders can choose from to enhance the effectiveness of the plan. Besides, policyholders are also eligible for direct claim settlement, cashless benefits and tax benefits.

(Note – All the information contained in this page has been obtained from the website of Niva Bupa.)

Please Note: Max Bupa Health Insurance Company Limited was renamed to Niva Bupa Health Insurance Company Limited on 5^th July 2021.

Family Floater Cover

Family Floater Plan offers a sum assured between Rs. 4 lakhs and Rs. 25 lakhs.

Features:

• The entry age for adults vary between 18 years and 65 years, while the entry age for dependent children ranges from 91 days to 21 years.
• A discount of 10% on the base premium is applicable on the first policy year and all subsequent renewal base premiums, in case the age of the eldest insured individual at the time of inception of the first policy is less than or equal to 35 years.

• Can be purchased individually or for the family. The family floater policy is available in the following varied combinations, which applicants can select from as per their preference:

• 1 Adult + 1 Child

• 1 Adult + 2 Children
• 2 Adults
• 2 Adults + 1 Child
• 2 Adults + 2 Children
• 2 Adults + 3 Children
• 2 Adults + 4 Children

Benefits offered by Niva Bupa GoActive Plan are as follows:

• In-patient hospitalization: Insured members are eligible for medical treatment on being hospitalized.

• Hospital Accommodation: Niva Bupa GoActive Plan finances accommodation, except suite or higher room category, without any capping on room rent charges. This is applicable for sum insured of Rs. 5 lakhs and above.

• Pre and post hospitalization expenses: Medical expenditures incurred due to illness or injury during pre and post hospitalization are reimbursed. The applicable period of the treatment is 90 days before getting admitted and 180 days after getting discharged from the hospital. This is subject to the insurance company accepting the in-patient care hospitalization, day care or domiciliary hospitalization claim.

• Day care treatments: Day care treatments are covered under the plan up to the sum insured.

• Home Healthcare Services: This includes a list of medical treatments that can be administered at home for illnesses and injuries. These treatments include nursing care, investigations, oral and intravenous medications, chemotherapy, dialysis, transfusions, physiotherapy and postsurgical care.

• Domiciliary Hospitalization: In case of unavailability of a bed in the hospital or on the advice of the attending medical consultant, the insured can undergo treatment at home. Under such circumstances, the insured can avail such treatments and get the incurred medical expenses reimbursed by the insurance company. However, to avail this reimbursement, the treatment should continue for at least 3 consecutive days.

• Organ Transplantation: Niva Bupa GoActive plan reimburses the medical expenses incurred during an organ donor’s in-patient treatment for the harvesting of the organ donated, provided the organ is for the use of the insured person.

• Emergency Ambulance: Ambulance expenses of up to Rs. 3,000 per hospitalization, incurred while transferring the insured to the nearest hospital, are covered.

• Refill Benefit: The insured can avail an additional sum insured equal to the base sum insured for a subsequent claim in the same year for any unrelated illness in case his/her base sum insured is exhausted.

• Second Medical Opinion: The insured is eligible for opting for second medical opinion for certain specific illnesses and planned surgeries.

• OPD Consultation: The insured will be eligible for availing OPD consultations in a network hospital on cashless or reimbursement basis.

• Other Benefits: Niva Bupa GoActive Plan also reimburses expenditures incurred for certain medical services like Behavioral Assistance Program, pharmacy and diagnostic services, etc.

• Coverage on Pre-existing Diseases: Pre-existing diseases are covered after a waiting period of 36 months since the inception of the Niva Bupa GoActive policy and continuous renewal.

Optional Benefits:

• I-PROTECT: Under this optional benefit, the policyholder will be eligible for a 10% increase on the base sum insured on each policy year in case of renewal or until the insured opts out of this benefit.

• Health Coach: This optional cover allows the policyholder to avail personalized health coaching services to ensure best of health and fitness. He/she will be eligible to avail a premium discount of a maximum of up to 20% of the base premium at the time of renewal. PERSONAL ACCIDENT COVERAGE: This offers coverage against accidental death, permanent total and partial disability.

• DEDUCTIBLE: Deductible option of Rs. 25,000, Rs. 50,000, Rs. 1 lakh, Rs. 2 lakhs, Rs. 3 lakhs, Rs. 5 lakhs and Rs. 10 lakhs.

ZONAL COVERAGE

You can opt for one of the following two zones.

• Zone 1: All India coverage

• Zone 2: This includes all India coverage with co-payment facility applicable for Mumbai, Delhi NCR, Kolkata and Gujarat. On selection of Zone 2, 20% co-payment will be applicable on in-patient treatment in the mentioned cities. This facility is not applicable on OPD consultation, emergency ambulance, health check-up and diagnostic tests, second medical opinion, Behavioral Assistance Program and Personal Accident Cover.

• Tax Benefit: Policyholders are eligible for tax benefits as specified by Section 80D of the Income Tax Act, 1961, on the purchase of Niva Bupa GoActive Plan.

• Assured Policy Renewal for Life: The plan offers the benefit of lifelong renewability.

• Direct Claim Settlement: All claims are processed directly by the insurer’s customer service team, ensuring quick and hassle-free claim settlement process.

• Cashless Benefit: Niva Bupa has an extensive list of 4,200 network hospitals across the country. Policyholders can avail cashless facilities on medical expenses incurred in these network hospitals.

• Waiting Period: The initial waiting period for availing any treatment except due to accidents is 30 days. For certain illnesses, as specified in the policy document the waiting period is 24 months.

• Free Look Period: Niva Bupa GoActive Plan includes a Free Look Period of 15 days from the date of issuance of the policy. This gives policyholders the convenience to read through the terms and conditions of the plan more thoroughly and decide whether the policy benefits are aligned with his/her health insurance objectives. In case it doesn’t meet his/her goals, he/she can return the policy and get the return of premium paid till then, except certain charges.

Below is the list of health conditions that are insured by Niva Bupa GoActive Plan:

• Ancillary hospital charges
• Hazardous activities
• Artificial life maintenance
• Behavioral, Neurodevelopmental and Neurodegenerative Disorders
• Circumcision
• AYUSH treatments, except inpatient treatments taken under Ayurveda, Unani, Sidha and Homeopathy
• Conflict & disaster
• External congenital anomaly
• Convalescence & rehabilitation
• Cosmetic and reconstructive surgery
• Dental/oral treatment
• Eyesight & optical services
• Experimental or unproven treatment
• HIV, AIDS, and related complex
• Hospitalisation not justified
• Inconsistent, irrelevant or incidental diagnostic procedures
• Mental and psychiatric conditions
• Non-medical expenses
• Obesity and weight control programs
• Off- label drug or treatment
• Puberty and menopause related disorders
• Reproductive medicine & other maternity expenses
• Robotic assisted surgery, light amplification by stimulated emission of radiation (LASER) & light-based treatment
• Sexually transmitted infections & diseases
• Sleep disorders
• Substance related and addictive disorders:
• Unlawful activity
• Treatment received outside India
• Unrecognized physician or hospital
• Generally, excluded expenses - Any costs or expenses specified in the list of expenses generally excluded at Annexure II of the Policy Document

Compare & Buy Health Insurance Plans

Get upto 60% discount

Compare Plans

Following are the documents that you will be required to submit at the time of purchasing Niva Bupa GoActive Plan:

• Proof of Identity (PoI): Aadhaar, PAN, Voter ID, Driving License, Passport, etc. are accepted documents

• Proof of Address (PoA): Aadhaar, Passport, Driving License, Voter ID, electricity bill, telephone bill, water bill, gas bill, Ration Card, bank statement, copy of insurance policy, etc. are acceptable documents

• Proof of Age – Aadhaar, School Leaving Certificate, etc. are valid proofs

Easy Renewal Process for Niva Bupa GoActive

Niva Bupa GoActive Plan can be renewed by following these steps:

• Visit the official website of the insurance company and enter your 14-digit policy number

• Enter the date of birth

• Select the ‘Submit’ button and then choose your payable annual premium

• Select the ‘Pay’ button to make the premium payment

• You will receive a policy transaction number and also a new policy kit will be emailed to you within 48 hrs

What is Claim Procedure for Niva Bupa GoActive?

The claim process for Niva Bupa GoActive is as follows:

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

• 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 Licence

• Also submit a pre-authorization form

• The insurance company conveys its decision to the concerned network hospital within 4 hours

• The insurance company may decide to assign a relationship manager to simplify the hospitalization process.

Documents Required To Claim under Niva Bupa GoActive

Below are the documents that you will be required to submit at the time of initiating the claims process:

• Claim form, duly filled and signed by the policyholder

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

• Prescription of doctor advising the admission

• Detailed report from the attending physician about past medical and surgical history of the patient

Conclusion

Niva Bupa GoActive is a comprehensive health insurance plan that covers individuals and families against planned and unexpected medical expenses arising due to illnesses and accidents. It offers coverage to the policyholder, his/her spouse and up to 4 children. It offers policyholders the convenience to choose from a wide range of sum insured levels, as per their unique insurance objectives. It not only covers hospitalization, but also other medical expenses – pre and post hospitalization, day care services, OPD Consultations, etc.

Reviews of Niva Bupa GoActive

“Cashless benefit that the insurance company offers against Niva Bupa GoActive Plan helped me to get admitted at one of their network hospitals without the usual hassles. All I had to do was present my policy health card at the time of getting admitted.” – Anita Shah

“I was impressed with the Direct Claim Settlement process of Niva Bupa. The quick service from the customer care in settling my claim ensured that I got the sum assured without having to be actively involved in following up with the insurer.” – Mahesh Deshpande

“I have been a customer of Niva Bupa for more than 15 years now. The lifetime renewability option has prevented the inconvenience of having to look for other insurers.” – Namita Gupta