What is the meaning of Health Insurance?

When thinking about buying the best health insurance in India, it is crucial to understand what it truly means. A medical insurance plan is a financial instrument designed to mitigate the risk of medical expenses by providing coverage for various healthcare services. At its core, the best health insurance in India aims to safeguard individuals and families against the financial burden of unexpected medical costs resulting from illnesses, injuries, or preventive care. Primarily, best health insurance plans operate on the principle of risk pooling. Policyholders pay regular premiums into a collective fund managed by the insurance provider. In return, the insurer agrees to cover a portion or all of the policyholder's eligible medical expenses, depending on the terms and conditions outlined in the insurance policy. The scope of coverage offered by best health insurance plans can vary widely, ranging from basic plans covering essential healthcare services to comprehensive policies encompassing a broader range of benefits, including hospitalisation, prescription drugs, preventive care, and specialist consultations. However, it's essential to recognise that best health insurance in India is not a one-size-fits-all solution, and the adequacy of coverage can vary depending on factors such as the specific terms of the policy, the insurer's network of healthcare providers, and any limitations or exclusions outlined in the policy documents. By providing coverage for a range of medical services, the best health insurance plans in India help ensure access to necessary care while mitigating the financial burden on policyholders

What is a Mediclaim Insurance Policy?

Here are convenient ways to purchase this policy: A Mediclaim policy, commonly known as health insurance in India, is a type of insurance coverage that provides financial protection against medical expenses incurred due to illness, injury, or hospitalisation. It functions as a safety net, ensuring individuals and families can access quality healthcare without excessive out-of-pocket costs. At its core, the best Mediclaim insurance in India works by reimbursing the policyholder for eligible medical expenses or by directly settling bills with healthcare providers, depending on the terms of the policy. These expenses typically include hospitalisation, surgery, diagnostic tests, medications, and sometimes even pre and post-hospitalisation expenses. The coverage and extent of benefits vary across different policies and insurance providers.

What does Niva Bupa Health Insurance cover?

Niva Bupa medical insurance plan offers comprehensive coverage across various healthcare needs. Here's a breakdown of what it typically covers: Inpatient Hospitalisation: Niva Bupa medical insurance plan covers expenses incurred during inpatient hospitalisation, which include room charges, doctor's fees, medical tests, surgeries, and medication expenses. This ensures that you receive adequate financial support during a hospital stay for illnesses or injuries requiring extensive medical care. Pre and Post-Hospitalisation Care: The best health insurance plan extends coverage to pre and post-hospitalisation care expenses. This includes diagnostic tests, consultations, medications, and other medical services received before admission to the hospital and after discharge. By covering these aspects, Niva Bupa medical insurance plans ensure continuity of care, helping you manage your health effectively throughout the treatment process. Ambulance Charges: In case of medical emergencies or the need for non-emergency transportation to a medical facility, Niva Bupa medical insurance plans cover ambulance charges and the cost of air ambulances as well. Whether it's transporting you to the hospital in a critical situation or for scheduled medical appointments, having ambulance charges covered ensures timely access to medical care without worrying about the associated costs.

Are pre-existing conditions covered under Health Insurance?

Best health insurance in India covers pre-existing conditions, albeit with certain conditions and limitations. Insurers usually define pre-existing conditions as illnesses or medical conditions the policyholder had before purchasing the insurance policy. However, there's often a waiting period before coverage kicks in for pre-existing conditions. During this time, policyholders may be unable to claim expenses related to these conditions. The duration of this waiting period varies depending on the insurer and the specific policy but can range from one to four years. Additionally, insurers might have clauses specifying that coverage for pre-existing conditions will only be provided after continuous policy renewal without any breaks. Moreover, policyholders must disclose any pre-existing conditions accurately when purchasing the policy. Failure to disclose such conditions can lead to claim rejection or even policy cancellation later. While the best health insurance in India does cover pre-existing conditions, understanding the waiting periods, disclosure requirements, and policy terms is crucial to ensure adequate coverage and avoid any disputes during claim settlements. Additionally, individuals with pre-existing conditions may find it beneficial to explore policies with comprehensive coverage or consider top-up plans to supplement their existing medical insurance plans coverage.

Can I customise my Niva Bupa Health Insurance plan?

Yes, Niva Bupa medical insurance plans often offer customisation options to suit individual needs and preferences. These customisation features can vary depending on your chosen plan and the insurer's offerings. Typically, customisation options include: Selecting different coverage levels.Adding optional riders or benefits. Adjusting deductibles or co-payments. Tailoring the policy duration and sum insured to align with your requirements and budget. For instance, you may have the flexibility to choose between various coverage tiers such as basic, standard, or comprehensive, allowing you to prioritise coverage for specific medical services or conditions. Additionally, Niva Bupa may offer a range of optional riders, such as maternity coverage, critical illness coverage, or outpatient benefits, which you can add to enhance your policy's scope. Moreover, you might have the option to adjust deductibles or co-payments, which can affect your premium costs. Higher deductibles or co-payments typically result in lower premiums, while lower out-of-pocket expenses may come with higher premiums. Niva Bupa medical insurance may also provide the option to customise the policy duration and sum insured based on your financial needs and risk tolerance. Customising your Niva Bupa’s best health insurance plan allows you to tailor coverage to your specific healthcare needs and budget constraints, ensuring you have the protection you need while optimising costs. It's advisable to thoroughly review and understand all customisation options available to make informed decisions that best meet your requirements.

Is there a network of healthcare providers associated with Niva Bupa Health Insurance?

Yes, Niva Bupa medical insurance typically maintains a network of healthcare providers, including hospitals, clinics, and healthcare professionals, to offer policyholders access to quality medical services. This network, often called the preferred provider network, consists of facilities and practitioners with whom Niva Bupa has established partnerships or agreements. When policyholders seek medical treatment within this network, they can benefit from cashless claim settlement, meaning the insurer directly settles the medical bills with the healthcare provider, subject to policy terms and conditions The advantage of having a network of healthcare providers associated with Niva Bupa medical insurance is the convenience and cost-effectiveness it offers to policyholders. Policyholders can often enjoy discounted rates for medical procedures and consultations by availing services within the network. Additionally, the cashless facility eliminates the need for policyholders to pay upfront for covered services and seek reimbursement, streamlining the claims process and reducing financial burden during emergencies. Furthermore, Niva Bupa's network of healthcare providers is usually extensive, encompassing various medical specialities and facilities across various locations. This ensures that policyholders have access to healthcare services wherever they may be, whether locally or while travelling within India. However, policyholders need to familiarise themselves with the specific network providers available under their policy and understand any coverage limitations or requirements, such as pre-authorisation procedures, to maximise the benefits of their best health insurance coverage.

Are there any exclusions to Niva Bupa Health Insurance coverage?

Niva Bupa’s best Health Insurance policies typically come with certain exclusions, specific conditions, treatments, or circumstances for which coverage is not provided. While the exact list of exclusions can vary depending on the policy type and insurer, some common exclusions typically found in the best health insurance policies include pre-existing conditions (at least for a certain initial waiting period), cosmetic procedures, alternative or experimental treatments not recognised by standard medical practice, self-inflicted injuries, injuries sustained during participation in hazardous activities or sports, and expenses related to non-medical services like administrative charges. Additionally, certain lifestyle-related conditions such as obesity, smoking-related illnesses, and substance abuse disorders may be excluded from coverage or may require additional premium or specific riders for coverage. Moreover, expenses incurred for treatments received outside the network of healthcare providers associated with Niva Bupa Health Insurance may not be covered, except in emergency treatment cases It's essential for policyholders to thoroughly review the policy documents and understand the exclusions mentioned therein to avoid any surprises during claim settlements. While exclusions are common in medical insurance policies, Niva Bupa typically provides transparent information about them upfront, allowing policyholders to make informed decisions about their coverage. Policyholders can also seek clarification from the insurer or their insurance advisor regarding any uncertainties about coverage or exclusions.

Does Niva Bupa Health Insurance cover outpatient expenses?

Niva Bupa Health Insurance typically offers coverage for outpatient expenses as part of its comprehensive best health insurance plans. However, the extent of coverage may vary depending on the specific policy and any additional riders or benefits chosen. Outpatient expenses generally include consultations with healthcare professionals, diagnostic tests, medications, and minor medical procedures conducted outside a hospital, such as in clinics or outpatient departments. Policyholders may be able to enhance their coverage for outpatient expenses by selecting specific add-on riders or benefits tailored to outpatient care. These may include coverage for routine health check-ups, vaccinations, preventive screenings, specialist consultations, and prescription medications. However, it's important to review the policy terms and conditions carefully to understand the scope of outpatient coverage, any limits or sub-limits applicable, and any exclusions that may apply While outpatient coverage adds value by providing financial support for day-to-day medical expenses and preventive care, policyholders should know that certain expenses, such as cosmetic treatments or elective procedures, may not be covered under outpatient benefits. Additionally, reimbursement for outpatient expenses may require submission of original bills and receipts, subject to the policy's claim procedures and documentation requirements.

Which Health Insurance is the best?

Determining the best health insurance policy depends on various factors such as individual needs, budget, coverage options, and customer service. However, Niva Bupa, known for its comprehensive coverage, innovative benefits, and reliable customer support, emerges as a strong contender in health insurance. With a wide range of plans tailored to diverse requirements, Niva Bupa offers features like cashless hospitalisation, an extensive network of healthcare providers, and add-on benefits. Their reputation for prompt claim settlements and transparent policies also adds to their appeal. While the definition of 'best' may vary from person to person, Niva Bupa merits consideration for those seeking quality health insurance coverage.

What is Mediclaim Health insurance?

Mediclaim health insurance, also known as medical insurance, is a policy that provides coverage for medical expenses incurred by the insured individual or their family in case of illness, injury, or hospitalisation. This insurance typically covers expenses related to hospitalisation, surgery, diagnostic tests, and sometimes outpatient treatments, offering financial protection against unexpected healthcare costs. Policyholders often pay a premium annually and may have deductibles or copayments. With the rising costs of medical care, the best Mediclaim policy is crucial in ensuring access to quality healthcare without the burden of hefty expenses, offering peace of mind and financial security to individuals and their families.

Which is the No. 1 Health Insurance in India?

Identifying the definitive 'No. 1' health insurance provider in India can be subjective, depending on individual preferences, needs, and experiences. However, among India's leading health insurance companies, Niva Bupa consistently stands out for its comprehensive coverage, innovative solutions, and customer-centric approach. With diverse plans catering to various demographics and requirements, Niva Bupa offers features like cashless hospitalisation, an expansive network of healthcare providers, and additional benefits such as wellness programmes and critical illness coverage. Their commitment to prompt claim settlements and transparent policies further enhances their reputation in the industry. While choosing the best health insurance policy provider is a personal decision, considering Niva Bupa for your health insurance needs could be prudent.

Why Do You Need Health Insurance?

Health insurance is not just a luxury but a necessity today. It serves as a financial safety net and protects you and your family in times of medical emergencies. Moreover, health insurance offers preventive care and promotes a healthier lifestyle. Many policies include free or discounted health check-ups, vaccinations, and screenings, helping you detect and prevent potential health issues before they become serious. So take your first step towards a secured future and buy the best health insurance plans for individuals & families to avail cashless treatments, free health checks, critical illness cover, tax benefits up to ₹54,600 and quick claim settlements.

How can I buy this policy?

Here are convenient ways to purchase this policy: Online: Buy Health Insurance Online in India at an affordable price. Niva Bupa health insurance covers medical expenses, including treatments, surgeries & hospitalisation. Get instant policy generation, along with your policy kit and card, by purchasing the plan online. This applies to cases without further underwriting or medical checkup. Telephone: For more information on Niva Bupa's Health Plans, speak to our knowledgeable sales team or your local advisor. Call us at 1800 3010 3333 between 9 am and 6 pm IST (Monday to Saturday) or tap on 'Click to arrange a call' to buy the policy over the phone or schedule an appointment.

How to calculate health insurance premium?

Calculating health insurance premiums is a straightforward process that allows you to determine the cost of your coverage. To get started, you can use online premium calculators provided by insurance companies or third-party websites. Simply enter details such as your age, family size, location, and desired sum assured. These calculators will estimate the premium amount based on these factors. Additionally, you can compare premiums offered by different insurers to find the best deal. Remember, while the premium amount is important, it's equally crucial to consider the extent of coverage, exclusions, and special features provided by the policy. By calculating your health insurance premium beforehand, you can make an informed decision and ensure the affordability of your coverage.

How to renew your health insurance policy?

Renew health insurance in India, medical insurance plans with Niva Bupa that covers ✓Tax Benefits. Check your health insurance premium quotes now & get the best health insurance policy online! Renewing your health insurance policy is a breeze, ensuring uninterrupted coverage for your well-being. Here are a simple steps to follow: Mark your Calendar: Keep track of your policy's expiration date and set a reminder to initiate the renewal process in advance. Review your Policy: Take the opportunity to review your existing policy and assess if it still meets your healthcare needs. Consider factors like coverage, premium, deductibles, and any changes in your health circumstances. Contact your Insurer: Reach out to your insurance provider either through their website, customer service hotline, or mobile app. They will guide you through the renewal process and provide any necessary forms or documents. Provide Updated Information: Update your personal details, such as address, contact number, or any changes in your health condition. This ensures accurate documentation and streamlined communication. Pay the Premium:Make the payment for the premium either through online platforms, bank transfers or as per the instructions provided by your insurer. Online payment methods offer convenience and speed. Obtain Renewal Confirmation: Once the payment is processed, you will receive a confirmation of your policy renewal. Keep this document safe for future reference.

How to renew your health insurance policy?

When purchasing health insurance, you must gather a few essential documents to ensure a smooth and hassle-free process. Here's a concise list of documents you may require: Identification Proof Address Proof Age Proof Income Proof Medical Reports Passport-size Photographs

What documents do you require to buy health insurance?

When purchasing health insurance, you must gather a few essential documents to ensure a smooth and hassle-free process. Here's a concise list of documents you may require: Identification Proof Address Proof Age Proof Income Proof Medical Reports Passport-size Photographs

What are the eligibility criteria for health insurance?

You should buy health insurance plans from top medical insurance companies, but before that, you should be aware of the eligibility criteria. It can vary depending on the insurance provider and the specific policy you are interested in. However, there are some common factors to consider. Typically, individuals who are above a certain age (often 18 or 21 years) and below a certain age (usually 65 or 70 years) are eligible for health insurance coverage. Citizenship or residency status is another important factor, as most policies are available for citizens and residents of the country where the insurance is being purchased. Additionally, some insurers may have specific eligibility requirements based on pre-existing medical conditions or other risk factors. It's crucial to review the terms and conditions of different health insurance policies to determine the specific eligibility criteria for the coverage you are considering.

What are the benefits of comparing health insurance plans online?

Comparing health insurance plans online offers a convenient way to find the right coverage for your needs and budget. With clear and straightforward information, you can easily compare different policies and their features. You can compare up to three Niva Bupa plans simultaneously and determine which one suits you best. You can even obtain an estimated premium quote by providing a few basic details, like your name and age. This empowers you to make informed health decisions based on your own research rather than relying solely on an agent's recommendations.

Do health insurance plans cover Ayurveda and other alternative treatments?

Health insurance providers understand the growing demand for holistic treatments and have responded by including coverage for traditional and alternative therapies like Ayurveda, Unani, Sidha, and Homeopathy (AYUSH). Niva Bupa Health Insurance, along with other leading providers, offers comprehensive health plans such as Health Companion, Health Premia, ReAssure, and more, which cover these treatments. It's important to note that the coverage kicks in after 24 hours of hospitalisation, and the treatment must be obtained at a government hospital or an accredited institute approved by organisations like the Quality Council of India, the National Accreditation Board of Health (NABH), Central Council of Indian Medicine (CCIM), or Central Council of Homeopathy (CCH). Embrace the benefits of holistic healing with health insurance plans that support your well-being

Which medical insurance plan is best for you?

Choosing the best medical insurance plan for you depends on your individual needs and preferences. Consider factors such as coverage, premium costs, a network of hospitals, add-on benefits, and claim settlement records. It's important to assess your healthcare requirements, including pre-existing conditions, family size, and anticipated medical expenses. Research and compare different plans from reputable insurers like Niva Bupa Health Insurance to find the one that aligns with your specific needs. Remember, the best plan is the one that offers comprehensive coverage, fits within your budget, and provides peace of mind during uncertain times. So prioritise your health and make an informed decision to secure the best medical insurance plan for yourself.

Save Tax in India with Health Insurance Plans

Health insurance plans provide financial protection for your medical expenses and tax benefits in India. Under Section 80D, you can avail of tax deductions on the premium paid for health insurance policies. By investing in a health insurance plan, you not only safeguard your health but also reduce your taxable income. Here's how it works: If you pay the premium for yourself, your spouse, children, and parents, you can file a deduction of up to ₹25,000. For senior citizens, the deduction limit increases to ₹50,000. If you are under 60 and also pay the premium for your parents above 60, the combined deduction limit goes up to ₹75,000. Additionally, if you and your parents are senior citizens, the maximum deduction can be as high as ₹1,00,000. So, not only does health insurance provide essential coverage and financial security, but it also offers a valuable opportunity to save on taxes. Consult with a financial advisor or explore health insurance plans from trusted providers like Niva Bupa Health Insurance to maximise your tax savings while ensuring comprehensive health coverage for you and your loved ones.

Why buy health insurance online?

Experience the Simplicity and Convenience of Buying Health Insurance Online with Niva Bupa: Stay Safe, Shop from Home: There's no need to step out in the current pandemic. Instead, purchase your health insurance policy online, ensuring your safety and convenience. Empower Yourself: Say goodbye to agents! Instead, explore a wide range of plans on the Niva Bupa website, equipped with detailed policy information and brochures. Then, take your time to compare and choose the perfect plan that meets your specific needs. Calculate Premium with Ease: Take control of your premiums. Utilise the online calculator to customise your preferences and instantly calculate the premium amount and coverage details. Save Time and Effort: Skip the lengthy paperwork and endless phone calls. By purchasing health insurance online, you can save time and effort, allowing you to focus or concentrate on what matters most. Secure and Transparent: Rest assured with a secure and transparent online process. The terms and conditions are clearly presented during the purchase, and the entire transaction, including payment, is conducted in a safe and protected environment.

How to buy health insurance online?

You can buy health policies online with Niva Bupa. Compare medical policies and get access to benefits like cashless hospitalisation, medical expense cover & more. Here's how you can embark on your health coverage journey with just a few clicks: Research and Compare: Explore various health insurance providers and their plans. Compare their benefits, coverage, and premiums to find the best fit for your needs. Visit Provider Websites: Head to the official websites of insurance providers offering the plans you are interested in. Customise Your Plan: Use online tools to personalise your health insurance plan based on your requirements. For example, adjust coverage limits, add riders, and calculate premiums to align with your budget. Provide Information: Fill in your details and answer any necessary health-related questions during the online application process. Review and Confirm: Carefully review the plan details, terms and conditions, and coverage limits. Make sure everything aligns with your expectations before proceeding. Secure Payment: Complete the payment securely using the available online payment options provided by the insurance provider. Get Policy Documents: Once the payment is processed, your health insurance policy documents will be generated. They will be emailed to you or available for download on the website.

Can I buy a Health Insurance Plan for my whole family?

Yes, You have the flexibility to choose between a family plan or individual health insurance plans for each family member. A Family Health Insurance Plan allows you to cover yourself, your spouse, dependent children, parents, in-laws, and even other relatives, as defined by the insurance company. By opting for a family plan, you simplify the process with a single premium payment for comprehensive coverage for your entire family. Furthermore, you can also enjoy tax benefits under section 80D for the premium paid. Make the most of your health insurance options and secure the well-being of your loved ones.

Is a Health Insurance Policy the Same as a Family Floater?

No, a health insurance plan can be tailored for individuals, families, or even groups such as employees. However, a family floater policy is specifically designed to provide coverage for all members included in the policy under a single plan. With a family floater policy, any member of the family can make claims up to the sum assured value individually or collectively. While regular health insurance plans consider the age of the applicant, in a family floater, the premium is based on the age of the oldest member. Additionally, the premium increases as the number of members in the family floater plan increases. This allows families to have comprehensive coverage while simplifying the insurance process.

What is the waiting period for critical illnesses under a Health Insurance Plan?

Traditional health insurance plans typically offer coverage for critical illnesses after a waiting period of 90 days from the start of the policy. Additionally, the concept of a survival period is important for critical illnesses. This means that the insured individual must survive for a specific number of days, known as the survival period, before receiving the sum assured.

Can I add a rider to a Health Insurance Plan?

Yes, while standard health insurance plans may not encompass all the coverage you desire, you can enhance your health insurance by opting for additional riders. These riders allow you to tailor your health coverage according to your specific needs. Some popular riders to consider include room rent waiver, critical illness cover, AYUSH cover, hospital cash cover, maternity cover, personal accident cover, and NBHI's Safeguard, among others. These riders provide an extra layer of protection and ensure comprehensive health insurance coverage.

Does the Health Insurance Plan offer maternity benefits?

Yes, some health insurance plans do offer maternity benefits. It is important that these benefits may be subject to sub-limits specified by the insurer in the plan. Typically, they cover normal and caesarean deliveries and prenatal and postnatal hospitalisation. However, specific waiting periods may range from 9 months to 4 years for these benefits to become active. Alternatively, you can enhance your maternity coverage by choosing for a maternity add-on cover or rider. By paying an additional premium, you can unlock comprehensive maternity-related benefits such as coverage for delivery and labour expenses, pregnancy complications, infertility treatment, lawful termination of pregnancy, newborn baby cover, and more. This ensures that you have a coverage specifically customised to your maternity needs.

Can I change my existing policy to Niva Bupa Health Insurance Policy?

Yes, it is indeed possible to change or transfer your current health insurance plans in India to Niva Bupa through the process of health insurance portability. However, to be eligible for this transfer or portability, it is crucial to maintain your previous policy without any gaps in coverage. Owing to the introduction of health insurance portability by IRDAI, policyholders now have the flexibility to switch health insurance providers without losing the accumulated benefits from their previous health insurance policy. Furthermore, the best health insurance plans will waive the waiting period already fulfilled under the last policy. By porting or transferring your health insurance to Niva Bupa, you gain access to its exceptional features and services and retain your existing benefits. This permits for a seamless transition while enjoying the advantages provided by Niva Bupa Health Insurance.

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Sub-Limit in Health Insurance

A sub-limit in health insurance is a pre-set cap on specific medical expenses, often expressed as a percentage of the total sum insured. While these limits can help insurers manage costs, opting for a policy without sub-limits ensures you can file claims up to the full sum insured, offering more comprehensive coverage for your healthcare needs.

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Trusted by over 1.5 crore+ happy customers, Niva Bupa (formerly known as Max Bupa Health Insurance) provides a wide range of health insurance plans to suit every need

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Get to know the steps involved in the claim Process, Whether it is a planned or emergency hospitalisation. Filling a claim is made easy by choosing any of the following ways:

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Niva Bupa App

Hospital Admission:

Get admitted to a Niva Bupa network hospital.

Identification:

Present your Niva Bupa Health Card or policy number along with valid ID (Passport/PAN card/Voter’s ID) to the hospital staff.

Pre-authorisation:

The hospital will verify your details and submit a pre-authorisation request to Niva Bupa.

Niva Bupa Confirmation:

After verification, Niva Bupa will confirm coverage to the hospital via fax and email, and notify you by text and email, typically within 30 minutes of the request.

Final Settlement:

Upon completion of treatment and necessary formalities, the hospital will settle the claim with Niva Bupa according to your policy terms.

What is a Sub-Limit in a Health Insurance Plan?

Sub limit in health insurance is pre-determined limits on specific medical expenses that are typically a percentage of the sum insured. You should purchase a health insurance policy with no sub-limits to file a claim up to the sum insured.

Health insurance sub-limits are monetary caps your insurance company imposes on your medical insurance claim for certain coverage. Sub limit in health insurance is typically stated as a percentage of the policy's aggregate coverage limit.

Types of Sub limit in Health Insurance

There are many types of sub-limits in health insurance. Some of them are:

Sub-limit on Room Rent

Under the room rent sublimit alternative, your medical insurance company covers the hospital room rent per day, but only up to a specific limit. If you choose a room with a daily rent that exceeds your sub-limit, you must pay the additional charges. This type of sub-limit also applies to the type of hospital room. For instance, due to their low expense rate, the insurer's plans may only cover the general or twin-sharing rooms. Therefore, you may have to pay an additional fee if you require a private room.

Sub-limit on Specific Treatments

The insurance company places a coverage limit on the treatment cost of certain diseases under specific treatment sub-limits. Therefore, even if your sum insured is high, due to the sub-limit clause on specific medical procedures, you will not be able to claim your entire hospitalisation expenses. For example, assume your health insurance policy includes a sub-limit of 50% of the sum insured for cancer treatment. In this case, even if your total sum insured is Rs 10 lakh, the sub-limit clause prevents you from claiming more than Rs 5 lakh for cancer treatment. Therefore, before you purchase a health policy with a treatment sub-limit, you should review the list of diseases/ailments covered.

Sub-limit on post-Hospitalisation

There are some illnesses for which patients do not need to stay in the hospital but must receive treatment at home. In such cases as surgeries, prolonged illnesses, or hospitalisation, the insurance company offers to cover only a certain amount of post-hospitalisation charges. The policyholder will be responsible for the difference if the expenses exceed the agreed-upon amount.

Importance of Sub Limit in Health Insurance Policy

Health insurance sub-limits are critical when purchasing medical insurance. A health insurance policy with no sub-limits may be more expensive. This occurs due to a sub-limit reducing the insurance company's liability. The purpose of sub-limits is to control costs and reduce unjustified medical bills.

Assume you have a large sum insured and, as a policyholder, you want to get the most out of your policy by opting for better facilities. If you are told that you must pay a small percentage of the medical bills once you reach a certain threshold, you will be more cautious about the hospital room you choose. This also reduces the insurers' risk by limiting their liability to pay their customers.

How Sub-Limits Affect Claims?

Sub-limits affect claims in many ways, such as:

When there is a sub-limit, the final claim amount is reduced. For things like hospital room rent, treatments for certain diseases, or post-hospitalisation charges, you can only claim the amount specified by the sub-limit clause; you must pay anything above that.
Even if you have a large sum insured, these sub-limit clauses can prevent you from claiming for all of your hospitalisation or treatment costs.
Remember to carefully read these sub-limit clauses to avoid any last-minute confusion during the stressful period of hospitalisation or filing a claim. This way, you can be assured of a smooth claims process.

Precautions to Take Against Sub-Limits

You can take the following precautions against sub-limits:

Read the document carefully and understand the insurance agent's sum limit in each case. Then, if you are dissatisfied with the terms, look for another plan or insurer willing to provide more benefits.
If you already have an insurance policy with a sub-limit, you can keep track of your expenses and ensure they do not exceed the threshold limit. An ideal place to start can be to select a fully insured room without surpassing the sub-limits.
While buying health insurance online, you can save money on commissions and operational costs. In addition, all information about the sub-limits is available on the insurer's website

What if Sub-Limits in Health Insurance Policies are Mandatory

Suppose you cannot afford a health insurance policy with no sub-limits. In that case, you must ensure that room rent and treatment costs for specific diseases listed in your policy are reimbursable before being admitted to a hospital.

Before signing up for a health insurance policy, you should check the applicable sub-limits. If you believe that the policy's actual coverage falls short of your specific needs or healthcare costs, you can choose to increase your sum insured.
Even if you have a large sum assured, you may be unable to claim your hospitalisation expenses in some cases due to the sub-limit clause.
Furthermore, you should always be admitted to a network hospital listed by your insurance provider because the former's rate structure is generally consistent with the sub-limits specified in your insurance policy.

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Frequently Asked Questions

Why is a sub-limit clause required in health insurance policies?

Do sub-limits apply to all health insurance policies?

Where can you look to see if your health insurance policy has any sub-limits?

Is there a disadvantage to having a health insurance policy with sub-limits?

Why do health insurance companies set sub-limits?

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It is unbelievable how Niva Bupa claim team came to my aid, Monday to Sunday no day off.

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Within few hours we got the claim number and in the next three days the amount was reflected in our bank account.

Vijay Kapoor

With the help of Niva Bupa Health Insurance, I was able to get my son treated without worrying about the high medical cost.

Diviay Chadha

Whenever we have filed for a claim with Niva Bupa, the process was very smooth and people were very helpful.

Parveen Singh

The Niva Bupa team was extremely helpful, be it day or night, someone was always available.

Health and Wellness Blogs

Understand Sub-Limit in Your Health Insurance Policy

This article explains what a sub-limit in health insurance policies is, and things to look for in the sub-limits of your policy of choice. Click here for further details.

What is Covered & Not Covered Under Mediclaim Policy?

Before choosing a mediclaim insurance policy, it is important to know what is covered and what is not. This article explains, what has covered & not covered under a mediclaim policy.

Difference B/W Private Health Insurance and Public Health Insurance

Understanding the distinctions between private and public health insurance is essential for making informed healthcare decisions. Find the right plan for your healthcare needs.

Tips to Understand the Best Family Health Policy

Niva Bupa offers best family health insurance plan with benefits like cashless facility, includes cover for your spouse, children, and parents. Read for more information.

What is Covered & Not Covered Under Mediclaim Policy?

Before choosing a mediclaim insurance policy, it is important to know what is covered and what is not. This article explains, what has covered & not covered under a mediclaim policy.

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Insurance is a subject matter of solicitation. Niva Bupa Health Insurance Company Limited (formerly known as Max Bupa Health Insurance Company Limited) (IRDAI Registration Number 145, Category:Health), 'Bupa' and 'HEARTBEAT' logo are registered trademarks of their respective owners and are being used by Niva Bupa Health Insurance Company Limited (formerly known as Max Bupa Health Insurance Company Limited) under license. CIN: L66000DL2008PLC182918

DISCLAIMERS

*Claim Promise with Zero Deductions:

This is applicable for ReAssure, Reassure 2.0, Aspire and Rise product.

a. Buy your Niva Bupa policy for coverage of 10 Lacs or above, with Safeguard+ add on

b. Intimate Niva Claim helpline (1860-500-8888) 48 hours before hospitalization for non-emergency treatments

c. Choose any hospital from the list of recommendations given by Claim Advisor for your treatment, via cashless facility

d. Receive a claim promise with zero deduction, in accordance with policy inclusions and T&C.

e. Claims Exclusions: the promise will not apply to claims arising due to exclusions stated in the policy (e.g.- non-disclosure, fraud, standard exclusions, waiting periods etc.)

Why Choose Niva Bupa

¹ Niva Bupa processes pre-authorisation requests within 30 minutes for all active policies, subject to receiving all documents and information(s) up to Niva Bupa’s satisfaction. The above commitment does not include pre-authorisation settlement at the time of discharge or system outage.

² Since Inception refers to claim data from 2010 till December 2023.

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Popular

¹Aspire: Quoted premium is inclusive of GST for Gold+ Variant with INR 5 lacs Sum Insured with a policy tenure of 1 year, for 1 Adult aged 25 years living in Delhi

²Reassure2.0: Quoted premium is inclusive of GST for Bronze Variant with ₹ 5 lacs Sum Insured with a policy tenure of 1 year, for 1 Adult aged 25 years living in Delhi. (1) The benefits and limits may vary as per Sum Insured and variant Chosen. Please read the policy terms and conditions for details of coverage.

³Rise: The premium is including taxes and digital discount for “Rise” ₹ 5 lacs base sum insured and 1 year tenure for a 25-year-old individual living in Bangalore and paying the complete premium in one-time.

⁴Health Premia: Quoted premium is inclusive of GST for ₹ 5 lacs Sum Insured with a policy tenure of 1 year for 1 Adult aged 25 years living in Delhi with Zone 1 Option (all India coverage without any co-payment)(1) The benefits and limits may vary as per Sum Insured and Variant Chosen subject to Policy Terms & Conditions.

⁵Health Companion: *Quoted premium is inclusive of GST for Variant 2022 with ₹ 3 lacs Sum Insured with a policy tenure of 1 year, for 1 Adult aged 25 years living in Delhi. (1) The benefits and limits may vary as per Sum Insured Chosen. Please read the policy terms and conditions for details of coverage.

Senior Citizens

¹Health Companion: Quoted premium is inclusive of GST for Variant 2022 with INR 5 lacs Sum Insured with a policy tenure of 1 year, for 1 Adult aged 60 years living in Chennai.”

²Reassure2.0: Quoted premium is inclusive of GST and digital discount for Bronze Variant with INR 5 lacs Sum Insured with a policy tenure of 1 year, for 1 Adult aged 60 years living in Pune

³Senior First: Quoted premium is inclusive of GST for Gold Variant with ₹ 5 lacs Sum Insured with a policy tenure of 1 year, for 1 Adult aged 65 years living in Delhi. (1) The benefits and limits may vary as per Sum Insured and variant Chosen. Please read the policy terms and conditions for details of coverage.

Wellness

¹Health Premia: Quoted premium is inclusive of GST for ₹ 5 lacs Sum Insured with a policy tenure of 1 year for 1 Adult aged 25 years living in Delhi with Zone 1 Option (all India coverage without any co-payment)(1) The benefits and limits may vary as per Sum Insured and Variant Chosen subject to Policy Terms & Conditions.

²Go Active: Quoted premium is inclusive of GST for ₹ 3 lacs Sum Insured with a policy tenure of 1 year, for 1 Adult aged 25 years living in Delhi. (1) The benefits and limits may vary as per Sum Insured Chosen. Please read the policy terms and conditions for details of coverage.

³Heartbeat: (1) The benefits and limits may vary as per Sum Insured and Variant Chosen subject to Policy Terms & Conditions. *Quoted premium is inclusive of GST for ₹ 5 lacs (Gold Variant) Sum Insured with a policy tenure of 1 year for 1 Adult aged 25 years living in Delhi with Zone 1 Option (all India coverage without any co-payment)

Top Up / Combo

¹Health Recharge: The benefits and limits may vary as per Sum Insured Chosen subject to Policy Terms & Conditions. *Quoted premium is inclusive of GST and digital discount for ₹ 90 lacs sum insured with ₹10 Lacs deductible with a policy tenure of 1 year for 1 Adult aged 25 years living in Delhi

²Aspire Max (Aspire + Health Recharge): (1) The benefits and limits will vary as per the sum insured and variant opted. Aspire Max is a combination of two Products (Aspire and Health Recharge). Terms and Conditions of the respective products will apply as per the sum insured offered.*Premium shown are for Aspire (5 Lakhs Sum Insured (Titanium+ Variant) and Health Recharge with ₹ 95 Lakhs Sum insured with ₹ 5 lakhs deductible . Policy Tenure: 1 Year and location Delhi. These are inclusive of GST & in ₹.

³Max Saver(Reassure2.0 + Health Recharge): The benefits and limits will vary as per the sum insured and variant opted. This product is a combination of two Products (ReAssure 2.0 and Health Recharge). Terms and Conditions of the respective products will apply as per the sum insured offered. *Premium shown are for ReAssure 2.0 (10 Lakhs Sum Insured (Bronze Variant) and Health Recharge with 90 Lakhs Sum insured with 10 lakhs deductible . Policy Tenure: 1 Year and location Pune. These are inclusive of GST, online discount & in INR.

Specific Needs

¹Aspire: Quoted premium is inclusive of GST for Gold+ Variant with INR 5 lacs Sum Insured with a policy tenure of 1 year, for 1 Adult aged 25 years living in Delhi

²Accident Care: (1) The benefits and limits may vary as per Sum Insured Chosen subject to Policy Terms & Conditions.*Quoted premium is inclusive of GST for ₹ 5 lacs sum insured with a policy tenure of 1 year for 1 Adult aged 25 years living in Delhi.

³Criti Care: (1) The benefits and limits may vary as per Sum Insured Chosen subject to Policy Terms & Conditions.*Quoted premium is inclusive of GST for ₹ 5 lacs sum insured with a policy tenure of 1 year for 1 Adult aged 25 years living in Delhi with one time payout option.

⁴Corona Kavach: Premium shown is for Sum Insured ₹ 50,000 for a period of 3.5 Months for an insured aged 18 Years living in Delhi. Premium including GST.(1) The benefits and limits may vary as per Sum Insured Chosen subject to Policy Terms & Conditions.

BEWARE OF SPURIOUS / FRAUD PHONE CALLS!

IRDAI is not involved in activities like selling insurance policies, announcing bonus or investment or premium. Public receiving such phone calls are requested to lodge a police complaint.

Beware of misleading telephone calls from people posing as Niva Bupa officials, agents, Officials from ECI (Office of the Executive Council of Insurers) etc. and offering alluring benefits or sharing false information on your policy or on Niva Bupa.

Niva Bupa shall not be responsible for any loss or damages whatsoever for any acts or omissions arising out of such spurious calls and all customers are advised to contact our customer care at 1860-500-8888 and verify any representations or promises made by any such spurious callers before acting upon the same.

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How does Our Claim Process work?

Hospital Admission:

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Gather Documents:

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What is a Sub-Limit in a Health Insurance Plan?

Types of Sub limit in Health Insurance

Sub-limit on Room Rent

Sub-limit on Specific Treatments

Sub-limit on post-Hospitalisation

Importance of Sub Limit in Health Insurance Policy

How Sub-Limits Affect Claims?

Precautions to Take Against Sub-Limits

What if Sub-Limits in Health Insurance Policies are Mandatory

Your Perfect Plan Awaits you

Live Healthy and secure your health with our comprehensive insurance plans

Frequently Asked Questions

Why is a sub-limit clause required in health insurance policies?

Do sub-limits apply to all health insurance policies?

Where can you look to see if your health insurance policy has any sub-limits?

Is there a disadvantage to having a health insurance policy with sub-limits?

Why do health insurance companies set sub-limits?

Health and Wellness Blogs

Health and Wellness Blogs

Understand Sub-Limit in Your Health Insurance Policy

What is Covered & Not Covered Under Mediclaim Policy?

Difference B/W Private Health Insurance and Public Health Insurance

Tips to Understand the Best Family Health Policy

What is Covered & Not Covered Under Mediclaim Policy?

Download the Niva Bupa App Today

Download the
Niva Bupa App Today