Niva Bupa Senior First Plan

Let’s Get To Know The Product Better!

Niva Bupa Senior First is a health insurance policy offered by Niva Bupa Health Insurance Company Limited. It is carefully crafted to cater to the health needs of senior citizens. Choosing this plan gives you the comfort of knowing that your parents will receive the necessary medical care during their golden years, without the added stress of unforeseen financial strains from unexpected medical expenses. The plan offers two options - Gold and Platinum.
 

Eligibility Criteria For The Niva Bupa Senior First Plan

• Minimum Age Of Entry: 61 years
• Maximum Age Of Entry: 75 years
   

Benefits And Coverage Overview Of The Niva Bupa Senior First Plan

In addition to taking care of inpatient hospitalisation costs, which encompass room boarding, nursing charges, medical practitioner’s fees, prescribed medicines and drugs, ICU costs, and associated expenses incurred during a hospital stay lasting more than 24 hours, here's a glimpse of some other expenses that Niva Bupa Senior First Plan extends coverage to -

• Pre- & Post-Hospitalisation Expenses
  You can breathe easy if your doctor orders a series of diagnostic and other tests before or after hospitalisation because Niva Bupa Senior First Plan has got you covered. The policy offers coverage for these tests up to the sum insured for a reasonable period – 60 days before hospital stay and 180 days after discharge. It's important to note that these expenses will be covered only if they are linked to the medical condition for which you were hospitalised, and approval as part of inpatient hospitalisation coverage is required for the claim.
   
• Daycare Treatment Coverage
  With the Niva Bupa Senior First Plan, you're in good hands when it comes to daycare treatments. These are medical procedures or surgeries that used to need extended hospital stays but can now be done within 24 hours, thanks to medical advancements. The best part is, the plan covers all daycare procedures without any limits, ensuring that expenses are covered up to the sum insured.
   
• Domiciliary Treatment Coverage
  In situations where someone is seriously injured or ill and needs urgent medical attention that would typically be provided in a hospital, domiciliary treatments step in. These are administered at home either because it's unsafe to transport the patient to a hospital or due to a lack of available beds nearby. The good news is that with the Niva Bupa Senior First Plan, you're covered for domiciliary treatment costs up to the sum insured.
   
• Organ Donor Coverage
  The Niva Bupa Senior First Plan includes coverage for organ donor expenses, when you are the recipient. The plan takes care of the associated inpatient expenses of the organ donor in the event of an organ transplantation, up to the sum insured that you have chosen for the policy.
   
• Modern Treatment Coverage
  The healthcare field is moving forward at a fast pace, embracing innovative treatments that were once deemed impossible. The Niva Bupa Senior First Plan is tailored to stay in step with these advancements, providing coverage for the expenses related to modern treatments, all the way up to the sum insured. It's important to note that for certain specified robotic surgeries, there is a sub-limit set at Rs 1 Lakh.
   
• Non-Medical Expenses Coverage
  The Niva Bupa Senior First Plan goes beyond covering just medical expenses; it also extends coverage to non-medical expenses. These non-medical costs encompass essential consumables like gloves, nebulization kits, oxygen masks, and other items crucial for treatment. Recognizing that these consumables can be pricey and contribute significantly to overall expenses, the plan offers coverage for these items up to the sum insured if you opt for an add-on. This additional support proves invaluable in easing the financial strain
  associated with these necessary but often costly supplies.
   
• No Claim Bonus
  For each claim-free year, the plan grants a bonus, elevating your base sum insured by 10%. This serves as a special reward for maintaining good health and not making any claims throughout the policy year. You have the opportunity to accumulate this bonus, reaching a maximum of up to 100% of the base sum insured. What's noteworthy is that these accumulated bonuses persist even if you make a claim in the future. In other words, the bonus earned before a claim remains untouched. It's important to keep in mind that this rewarding benefit is exclusive to individuals opting for the Platinum variant of the plan.
   
• ReAssure (Restoration Benefit)
  Understanding that senior citizens may face an increased susceptibility to diseases, the Niva Bupa Senior First Plan introduces a valuable feature called 'ReAssure.' If your sum insured depletes within a policy year, there's no need to worry. With ReAssure, your base sum insured is promptly restored after the first paid claim, ensuring you and your family can confidently embrace the future. Notably, this restoration benefit can be availed of an unlimited number of times in each policy year. ReAssure comes into action with complete or partial utilisation of the base sum insured and No Claim Bonus (NCB), if applicable, and is available for both related and unrelated illnesses. It's important to remember that this valuable feature is exclusive to the Platinum variant of the plan.
   
• Room Rent Limit
  The room rent limit is essentially the maximum coverage your insurance provides for the hospital room during your hospitalisation. Staying within this limit ensures you won't have any extra costs. However, if you opt for a room with a rent higher than this limit, there will be a proportional deduction. This implies that you'll be responsible for a portion of the entire bill, not just the difference in room rent. It's important to note that Niva Bupa Senior First Plan comes with specific room selection restrictions based on the plan variant you choose -

Additionally, it's essential to note that in case you are admitted to a room category higher than the one you are eligible for, a 10% copayment is applicable. This applies irrespective of whether you initially opted for copayment or not. Copayment entails covering a portion of the approved claim amount from your own funds, after which the insurer takes care of the remaining amount.
 

Other Important Features Of The Product

• Health Checkup From Day 1
  The plan includes coverage for the expenses associated with a specified list of health checkups up to a set limit. This coverage is accessible from the first day of the policy and can be utilised once within each policy year. It's important to highlight that this benefit is exclusively available under the Platinum variant of the plan.

• No Financial Limits On Treatments/Diseases
  Unlike many health insurance policies designed for seniors, Senior First breaks the norm by not imposing sub-limits on common health conditions or surgeries - depending on the age factor. This unique feature sets it apart as a preferred option for the elderly. If your insurer hasn't explicitly excluded coverage for a specific illness, you can claim the entire amount up to the sum insured, regardless of the health condition. This means there are no restrictive treatment or disease-wise sub-limits for procedures like cataract treatments, joint replacement surgeries, etc., providing comprehensive coverage for a range of medical needs.
   
• Inflation Protection
  It is a highly beneficial aspect to consider for the well-being of your elderly parents, particularly in light of the ongoing rise in inflation. The Niva Bupa Senior First Plan introduces this feature to tackle the impact of inflation on healthcare expenses over time. This feature automatically increases your base sum insured on a cumulative basis at the commencement of each policy year, taking into account the inflation rate from the previous year. It's a proactive measure to ensure that your insurance coverage aligns with the escalating costs of healthcare as time progresses.
   

Understanding Waiting Periods!

A waiting period in health insurance is a specific time frame during which certain medical conditions are not covered after purchasing a health insurance policy. Various types of waiting periods exist, including -

• Initial Waiting Period
  Upon purchasing your health insurance plan, there is a standard 30-day waiting period for all medical conditions, excluding accidents. During this initial waiting period, claims for hospitalisation are not applicable except in the event of accidents.
   
• Waiting Period For Pre-existing Diseases
  Any health condition you experienced in the 48 months before obtaining your health insurance policy is considered a pre-existing disease. Under the Niva Bupa Senior First Plan, there is a waiting period of 24 months specifically for pre-existing diseases. During this period, the policy does not cover expenses related to these pre-existing conditions.
   
• Waiting Period For Specific Diseases
  Insurance companies maintain a list of specific medical conditions or illnesses that come with a waiting period, distinct from any pre-existing conditions. This waiting period is applicable regardless of your medical history and is determined solely by the insurance company, unaffected by your current health status. With the Niva Bupa Senior First Plan, there's a waiting period of 24 months for these specific diseases.
   

Know About The Exclusions!

Your health insurance policy may not cover certain situations, and these are referred to as exclusions. Let's take a look at some of the types of exclusions -

• Standard Permanent Exclusions: Insurance companies are bound by a set of regulations referred to as "standard permanent exclusions," as outlined by the Insurance Regulatory and Development Authority of India(IRDAI). These exclusions encompass -
  • Investigation And Evaluation: Getting admitted to a hospital solely for observation or monitoring.
  • Rest Cure, Rehabilitation, And Respite Care: Being admitted to a facility for rest without any active treatment.
  • Obesity/Weight Control: Surgery or treatment for weight control or obesity.
  • Gender Change Treatment: Treatment designed for changing one's characteristics to the opposite sex.
  • Plastic/Cosmetic Surgery: Treatment intended to change body characteristics or appearance.
  • Hazardous Or Adventurous Sports: Treatment expenses incurred for injuries or illnesses resulting from engaging in hazardous sports like mountaineering, rafting, scuba diving and so on.
  • Breach Of Law: Expenses linked to treating a person involved in a criminal act.
  • Excluded Providers: Treatment from a doctor or hospital excluded by the insurance company.
  • Narcotics: Treatment for alcohol addiction, drug usage, etc.
  • Domestic Establishments: Treatment in health spas, nursing homes, or similar establishments meant for domestic purposes.
  • Dietary Supplements: Vitamins, minerals, etc., not prescribed by a medical practitioner.
  • Refractive Error: Expenses linked with correcting refractive errors up to 7.5 diopters for better eyesight.
  • Unproven Treatments: Medical procedures or treatments not proven to be effective.
  • Birth Control, Sterility And Infertility: Expenses related to contraception, artificial insemination, sterilisation, advanced reproductive technologies like ZIFT, GIFT, ICSI, gestational surrogacy, IVF, etc.
  • Maternity Expenses: Childbirth-related hospitalisation expenses, pre/post-natal costs, etc.
• Additional Permanent Exclusions: Beyond the standard permanent exclusions mentioned earlier, insurance companies may add extra exclusions for particular situations or medical conditions. If you have a specific medical condition that is considered risky by insurers, they might permanently exclude it from your policy. It's essential to understand that insurers are constrained by a list of illnesses specified by IRDAI for which they can impose a permanent exclusion.
• Specific Exclusions (Non-Standard Exclusions): These exclusions are distinct and extend beyond the standard permanent exclusions outlined by the IRDAI. They can differ among insurance companies and may hinge on the specific terms and conditions of the policy. Let's delve into some notable specific exclusions under the Niva Bupa Senior First Plan -
  • Circumcision unless required for the treatment of a disease or necessitated by an accident.
  • Treatment for any injury or illness from nuclear, radiological emissions, rebellion (act of armed resistance to an established government or leader), war or war-like situations (whether war is declared or not), acts of terrorism, directly or indirectly.
  • Expenses related to screening, counselling or treatment for external congenital anomaly.
  • Treatment, preventive, diagnostic, restorative, cosmetic services linked to disease, disorder and medical conditions related to natural teeth and gingiva unless required while you are hospitalised as a result of an accident.
  • Treatment expenses for any medical condition/illness that requires hormone replacement therapy.
  • Multifocal Lens and ambulatory devices such as walkers, crutches, splints, stockings of any type and also any medical equipment used at home.
  • Expenses related to screening, prevention and treatment for sexually related infection or disease (other than HIV / AIDS).
  • Treatment for any medical conditions linked to disturbance of normal sleep patterns or behaviours.
  • Treatment expenses arising from intentional self-inflicted Injury or attempted suicide by any means.
  • Expenses related to artificial life maintenance if you are declared brain dead or in a vegetative state as indicated by -
    • Deep coma and unresponsiveness to all types of stimulation; or
    • Absent pupillary light reaction; or
    • Absent oculovestibular and corneal reflexes; or
    • Complete apnea

Summary

Navigate Your Coverage Specifics With Our Reading Material!

• Brochure: https://transactions.nivabupa.com/pages/doc/brochure/SENIOR_FIRST_0_Co_Payment_SS.pdf?v=1.0
• Policy Wording: https://transactions.nivabupa.com/pages/doc/policy_wording/Senior-First-Policy-Wording.pdf
   

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