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Reviewed by Finzony Finance TeamLast updated:
Niva Bupa AccidentCare is a fixed-benefit personal accident cover sold under the Health Assurance plan. It pays a lump sum if an accident causes death or disability, whatever your actual costs turn out to be. It can be bought by an individual or as a family cover for up to 2 adults and 2 children. Adults can join from 18 to 65 years and dependent children from 2 to 21 years. The sum insured runs from ₹5 lakh to ₹5 crore, subject to 12 times annual income for salaried people and 15 times for the self-employed. Cover applies to accidents anywhere in the world, and the policy renews for life. The core benefits are Accident Death at 100% of the sum insured, Accident Permanent Total Disability at 125% and Accident Permanent Partial Disability as a percentage of the sum insured from a 17-line grid. The plan adds a funeral expense payment and, on the family option, a child education benefit. Accident Temporary Total Disability, which pays 1% of the TTD sum insured per week, and Accident Hospitalization, which reimburses medical bills up to 2% of the sum insured, are optional. There is no waiting period for accident benefits, and the sum insured grows by 5% for each claim-free year, up to 25%. The plan is only for accidents and only for people in lower-risk jobs. Occupations in risk class 1 and 2 are accepted, with a 50% premium loading for class 2, and hazardous occupations are declined. Illness, cancer and routine hospitalisation are not covered, and adventure sports, intoxication, aviation other than as a passenger and military service are excluded.
Lump sum cover of ₹5L to ₹5Cr for accidental death and disability anywhere in the world, paid irrespective of your actual costs.
Finzony sees AccidentCare as a simple income-protection cover for people whose family depends on their earnings. It pays a fixed amount whatever the bills are, and the permanent total disability test is generous: it includes being unlikely to ever work in any occupation, losing the use of two limbs or both eyes, or being unable to do three of six daily activities on your own. Death pays 100% and total disability pays 125%, so a serious accident does not leave the family short of the amount you chose. The weak points are about who can buy it and how claims work. The sum insured cannot exceed 12 or 15 times your income, so a high cover needs a high income. Only lower-risk occupations are accepted, and manual labourers, machine operators and heavy vehicle drivers are declined. Disability claims need a certificate from a government Medical Board, and the disability must last at least 6 months unless it is irreversible. A claim must also be reported within 30 days. For a cover of ₹1 crore or more, the sum insured is cut to a flat ₹1 crore from the renewal after you turn 70. The prospectus on file is from 2016 and its premium illustration excludes service tax and cess, so confirm the current benefits and premium before you buy. AccidentCare pays nothing for illness. It is a top-up to a health plan, not a replacement, and its optional hospitalisation cover is capped at 2% of the sum insured.
Niva Bupa Health Insurance
Key Insights
Founded
2008
Niva Bupa Health Insurance was established 18 years ago and has built strong credibility over time, backed by its long-standing presence in the market.
Claims Experience
91.6% CSR, calculated as a 3-year average
Niva Bupa Health Insurance settles 91.6% of all claims it receives.
Network Hospitals
10,000+
Niva Bupa Health Insurance has a network of 10,000+ hospitals, ensuring wide accessibility and convenience for policyholders.
Pays 100% of the sum insured if an insured person dies solely and directly because of an accidental injury within 365 days of the accident.
Cover for that person ends after the payout, while the other insured members stay covered until the end of the policy period.
Niva Bupa pays a one-time amount for funeral expenses on top of the Accident Death benefit when it accepts an accident death claim.
₹5,000 on the individual option and ₹50,000 on the family option, as read from the benefit table.
Pays 125% of the sum insured if an accident causes permanent total disability within 365 days. It counts if you are unlikely to ever work in any occupation, have lost the use of two limbs, the sight of both eyes, or one limb and the sight of one eye, or cannot independently do three or more of six daily activities.
Needs a certificate from a government Medical Board, and the disability must last at least 6 months unless it is irreversible. It is paid only once in a lifetime. If the person dies before the claim is admitted, the claim is considered under Accident Death.
Pays a percentage of the sum insured as set in a 17-line grid: 100% for loss of both hands or both feet, one hand and one foot, a hand and an eye, a foot and an eye, or speech and hearing together. 50% for loss of hearing in both ears, one hand, one foot, sight in one eye or speech. Smaller amounts, from 40% down to 1%, apply to fingers, thumbs, toes and uniplegia.
Needs a Medical Board certificate and at least 6 months of disability unless it is irreversible. No further claim for the same condition is admitted once a partial disability claim is paid.
If an Accident Death or Accident Permanent Total Disability claim of the proposer is accepted, Niva Bupa makes a one-time payment for each dependent child, for up to 2 children, who is an insured person under the policy. The amount is as set in the product benefit table, about 5% of the sum insured.
Available only on the family option with children.
If an accident causes you temporary total disability within 365 days, Niva Bupa pays 1% of the TTD sum insured for each week the disability continues, for up to 100 weeks in your lifetime. It is paid from the first day if the disability lasts at least 3 continuous days. The TTD sum insured is ₹1 lakh to ₹20 lakh in steps of ₹50,000.
For the proposer only. The TTD sum insured cannot be more than the lower of 2 times annual income or the AccidentCare sum insured. Once 100 weeks are used up, this benefit cannot be renewed, but the policy continues with the other benefits.
If you are hospitalised in India because of an accidental injury during the policy period, Niva Bupa reimburses the medical expenses up to 2% of the AccidentCare sum insured. It covers surgery, nursing, drugs and dressings, doctor and surgeon fees, room rent, operation theatre charges, anaesthesia, X-rays and scans, diagnostics, therapies and prosthetic implants.
AccidentCare has no initial waiting period, and the 90-day and 36-month waits in the prospectus apply only to CritiCare and HospiCash. Accident benefits are payable from the date the policy starts. Time limits still apply: death or disability must follow the accident within 365 days, a permanent disability must last at least 6 months unless it is irreversible, and Temporary Total Disability is paid only if it lasts at least 3 continuous days.
Initial waiting period
There is no initial waiting period under AccidentCare. Benefits are payable from the date the policy starts.
Temporary Total Disability
The disability must last at least 3 continuous days, and the weekly payout is then made from the first day of onset.
Permanent disability to continue
A permanent total or partial disability must continue for at least 6 continuous months, unless there is no chance of change, as with amputation or loss of limbs.
Time limit after the accident
Death or disability must follow the accident within 365 days for the benefit to be paid.
Conditions or treatments that the policy clearly says it will not cover.
Insurer
Niva Bupa Health Insurance plans and claim process
AccidentCare is the personal accident cover under Niva Bupa's Health Assurance plan. It pays a fixed lump sum if an accident causes death or disability, irrespective of the actual costs. It can be bought by an individual or as a family cover.
Accidental death pays 100% of the sum insured. Permanent total disability pays 125%. Permanent partial disability pays a percentage of the sum insured as set in a 17-line grid, such as 50% for loss of one hand or one eye. A funeral expense payment is added on a death claim. Optional Temporary Total Disability and Accident Hospitalization benefits can be added.
From ₹5 lakh to ₹5 crore. The sum insured cannot exceed 12 times your annual income if you are salaried, or 15 times if you are self-employed. For a sum insured of ₹1 crore or more, cover is reduced to a flat ₹1 crore from the renewal after you turn 70.
Disclaimer: Premium amounts are indicative and may vary based on age, health, and plan selected. Claim settlement ratios are from IRDAI Annual Reports. Finzony is not an insurance broker or agent. Verify all details on the official Niva Bupa Health Insurance website before purchasing.
Contact Details
1860 500 8888
Headquarters: C-98, First Floor, Lajpat Nagar, Part 1, New Delhi – 110024, India.
The aforementioned ratios have been averaged over three years (FY24-FY26)
Emergency ambulance is limited to ₹2,000 per claim and physiotherapy to 10% of the hospitalisation limit. Reimbursement only, India only, and notify within 48 hours of the accident or hospitalisation.
Any one of the following: you are unlikely to ever work in any occupation, you have lost the use of two limbs, the sight of both eyes, or one limb and the sight of one eye, or you cannot independently do three or more of six daily activities such as washing, dressing, feeding, toileting, mobility and transferring. It must follow an accident within 365 days and last at least 6 months, unless it is irreversible, and be certified by a government Medical Board.
It is an optional benefit for the proposer. If an accident leaves you temporarily unable to work, Niva Bupa pays 1% of the TTD sum insured for each week of disability, for up to 100 weeks in your lifetime, from the first day if the disability lasts at least 3 continuous days. The TTD sum insured is ₹1 lakh to ₹20 lakh.
It is an optional benefit that reimburses medical expenses if you are hospitalised in India after an accident, up to 2% of the AccidentCare sum insured. Ambulance is limited to ₹2,000 per claim and physiotherapy to 10% of the limit. It is paid on reimbursement only, and you must notify Niva Bupa within 48 hours.
Adults from 18 to 65 years and dependent children from 2 to 21 years, up to a maximum of 2 children. You can buy it for yourself, or as a family cover of 1 adult with up to 2 children, or 2 adults with up to 2 children. In a family cover, the spouse gets 50% of the sum insured (up to ₹10 lakh) and each child 20% (up to ₹5 lakh).
Only risk class 1 and 2. Class 1 is white-collar, non-hazardous work such as management, accounting, law, teaching and medicine. Class 2 is semi-hazardous supervisory work, with a 50% premium loading. Hazardous occupations such as underground mining, machine operators, mechanics, cash-carrying employees and heavy vehicle drivers are declined.
No. AccidentCare has no initial waiting period, and accident benefits are payable from the date the policy starts. The 90-day and 36-month waits in the Health Assurance prospectus apply to CritiCare and HospiCash.
Suicide and self-inflicted injury, war, nuclear and terrorism-related events, military and police service, criminal acts, injury under the influence of liquor or drugs, aviation or marine activity other than as a passenger, and professional or adventure sports. Illness is not covered at all, and a change of profession that raises the risk must be endorsed.
Yes. An accident anywhere in the world is covered, if it happens during the policy period. The optional Accident Hospitalization benefit is available in India only.
Niva Bupa's prospectus illustration for a 35 year old with a ₹50 lakh sum insured shows ₹5,754 a year for an individual and ₹7,475 for a family, for accidental death, total and partial disability. Adding Temporary Total Disability makes it ₹6,389 and ₹8,110, and adding Accident Hospitalization makes it ₹6,705 and ₹8,705. The rates exclude service tax and cess, and the illustration is dated, so get a live quote for your age, occupation and sum insured.
Tell Niva Bupa within 30 days of the death or disability, and within 48 hours of the accident for an Accident Hospitalization claim. Send the claim form, KYC, FIR or panchnama, medico-legal certificate and hospital records, plus the death certificate for a death claim or a government Medical Board disability certificate for a disability claim. Niva Bupa pays within 15 days of the claim submission. Call 1860-500-8888.
Yes. The policy renews for life if you pay within the 30-day grace period, with no loading for your own claims. For every claim-free year, the sum insured goes up by 5% of the first year sum insured, up to a total of 25%.
No. AccidentCare covers accidents only. Illness and routine hospital bills need a separate health plan, and critical illness and hospital cash are separate Health Assurance benefits.