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Reviewed by Finzony Finance TeamLast updated:
Niva Bupa Health Premia is a comprehensive indemnity plan in three plans: Silver, Gold and Platinum. You can buy it as an individual policy, a family floater, or a Family First policy that covers extended family such as parents and siblings under one policy. The base sum insured runs from ₹5 lakh on Silver to ₹3 crore on Platinum, with Gold at ₹10 lakh to ₹50 lakh and Platinum at ₹1 crore, ₹2 crore or ₹3 crore. Every plan covers hospital bills up to the sum insured, with 90 days of pre-hospitalisation and 180 days of post-hospitalisation expenses, day care, home treatment, AYUSH treatment, organ donor expenses, modern treatments, and mental disorder, LASER and HIV/AIDS cover after their waits. Re-fill adds up to 100% of the base sum insured once a year, and Loyalty Additions add 10% of the base sum insured every year up to 100%, even after a claim. The plans differ in their international features. Gold includes one international trip of up to 15 days with ₹30 lakh cover. Platinum includes annual multi-trip cover of up to ₹1 crore per person, with each trip limited to 45 days, plus worldwide maternity, an OPD benefit and a larger health check-up. Maternity needs a family floater with both spouses or a Family First policy, and is not available on an individual policy. Optional covers include personal accident, critical illness, hospital cash and enhanced loyalty additions.
Silver, Gold and Platinum plans from ₹5L to ₹3Cr with Re-fill and loyalty additions. Platinum adds in-built multi-trip travel cover and worldwide maternity.
Finzony sees Health Premia as a high-cover plan for people who want global benefits built in, not as a plain budget policy. Its strongest ideas are the in-built travel cover, Re-fill, Loyalty Additions that are added even after a claim, and one policy that can cover up to 19 relationships. On Platinum, the ₹1 crore annual multi-trip cover and worldwide maternity are unusual features at this level, and the 12-month wait for specified illnesses and 24-month wait for pre-existing diseases are shorter than many plans. The card says the plan comes with multi-trip cover and worldwide maternity, but that applies to Platinum only. Gold has a single international trip of up to 15 days, which needs a separate policy schedule issued at least 7 days before you travel. Maternity covers up to 2 pregnancies, waits 24 months, is limited to ₹70,000 to ₹1 lakh on Gold and ₹2 lakh on Platinum, and does not pay pre-natal or post-natal expenses. It is not available on an individual policy. Premium waiver and Re-fill also have exceptions: premium waiver is not available on an individual policy, and Re-fill is not available on Family First. The trade-offs are the longer waits on mental health, LASER surgery and HIV/AIDS, which are 36 and 48 months. There is also a 20% co-payment if you choose the cheaper Zone 2 premium and are treated in Mumbai, Delhi NCR, Kolkata or Gujarat. Premium starts higher than the budget plans, and Gold and Platinum sums insured start at ₹10 lakh and ₹1 crore. If you only want a simple plan for a small family, compare it with Aspire or Rise.
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.
Silver starts at ₹5 lakh. Gold offers a base sum insured of ₹10 lakh, ₹15 lakh, ₹20 lakh, ₹30 lakh or ₹50 lakh. Platinum offers ₹1 crore, ₹2 crore or ₹3 crore. On a Family First policy, the base sum insured per person is ₹1 to ₹5 lakh on Silver, ₹5 to ₹10 lakh on Gold and ₹10 to ₹15 lakh on Platinum, plus a floater sum insured.
I could not read the Silver benefit table, so Silver details are not listed here. Check your quote for them.
Pays hospital bills up to the sum insured, including room rent, doctor fees, tests, medicines, operation theatre, internal prosthetics and ICU, when hospitalisation is advised in writing. Day care treatment, home treatment and AYUSH inpatient treatment are covered up to the sum insured.
If you take a room above your eligible category, Niva Bupa pays a pro-rata share of room rent, nursing, doctor and operation theatre charges. On Gold the brochure says cover is up to the sum insured except for a suite or above.
Pays consultations, medicines and tests for 90 days before admission and 180 days after discharge, on a reimbursement basis.
The expenses must relate to the same condition for which your hospital claim is paid.
If your base sum insured and any loyalty additions are used up, Niva Bupa adds up to 100% of the base sum insured once in a policy year, for any illness. On a floater it is shared by all members.
It is available once a year, cannot be carried forward, and is not available on a Family First policy.
When you renew without a break, Niva Bupa adds 10% of the previous year's base sum insured, up to 100%, even if you claimed. The optional Enhanced Loyalty Additions raise this to 20% a year up to 200%.
Sub-limits do not rise with the additions, and the additions cannot be used for benefits such as health check-up, e-consultation and international cover.
A lump sum for accidental death and disability for insured adults aged 18 and above. The cover is up to ₹50 lakh on Gold and ₹1 crore on Platinum. Death pays the sum insured, permanent total disability pays 125% of it, and partial disability pays a set share.
Disability must continue for at least 6 months unless it is irreversible, and the cover ends once death or permanent total disability is paid.
A lump sum on first diagnosis of 20 listed illnesses such as cancer, heart attack, open chest CABG, stroke and kidney failure. The sum insured options are ₹10, ₹15 or ₹25 lakh on Gold and ₹25, ₹50 or ₹100 lakh on Platinum.
A 30-day wait applies to any illness except accidents, which are covered from day 1. Cancer is covered after the 30-day wait. Pre-existing diseases wait 24 months, and a list of specified conditions and procedures waits 12 months, such as cataract, hernia, internal congenital anomaly and spinal disorder. Maternity and newborn cover wait 24 months, mental disorder treatment and LASER surgery wait 36 months, and HIV/AIDS waits 48 months. Conditions listed against an insured person under a Personal Waiting Period wait 24 months. Critical Illness cover has a 90-day wait, a 3-year pre-existing wait and a 30-day survival period. Waits are reduced to the extent of prior cover if you port or migrate without a break, and start again for any increase in sum insured. The waits do not apply to e-consultation, health check-up, premium waiver, pharmacy, personal accident and health coach.
Initial waiting period
Expenses for any illness in the first 30 days of the policy are excluded, except for accidents, which are covered from day 1. Cancer is covered after this wait. It does not apply to renewals.
Specified conditions and procedures
A list of conditions, such as cataract, hernia, internal congenital anomaly and spinal disorder, waits 12 months of continuous cover, except accidents and cancer. Check the policy wording for the full list.
Pre-existing diseases
Declared and accepted pre-existing diseases are covered after 24 months. If a listed condition is also pre-existing, the longer wait applies.
Conditions or treatments that the policy clearly says it will not cover.
Insurer
Niva Bupa Health Insurance plans and claim process
Health Premia is a comprehensive health plan from Niva Bupa in three plans, Silver, Gold and Platinum, with base cover from ₹5 lakh to ₹3 crore. It can be bought as an individual, family floater or Family First policy, and renews for life.
Silver starts at ₹5 lakh. Gold offers ₹10 lakh to ₹50 lakh and includes one international trip of up to 15 days with ₹30 lakh. Platinum offers ₹1 crore, ₹2 crore or ₹3 crore and adds annual multi-trip international cover of up to ₹1 crore, worldwide maternity, an OPD benefit of ₹50,000 per policy and a ₹10,000 health check-up.
No. Annual multi-trip cover, up to 45 days a trip, is on Platinum. Gold has one single trip of up to 15 days, which needs a policy schedule issued at least 7 days before you travel. Additional single trips can be added on Gold for extra premium.
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)
It has a 90-day wait, a 3-year pre-existing wait and a 30-day survival period. It is paid once in a lifetime.
Pays ₹5,000 a day on Gold or ₹7,500 a day on Platinum for each 24 hours of hospitalisation, for up to 30 days a year.
You must be admitted for at least 48 hours continuously.
Raises Loyalty Additions from 10% to 20% of the base sum insured each year, up to 200%.
Doubles the international sum insured, from ₹30 lakh to ₹60 lakh on Gold and from ₹1 crore to ₹2 crore on Platinum. Gold can also add extra single trips of 1 to 30 days. Enhanced Geographical Scope includes USA and Canada.
Waiting periods apply afresh to USA and Canada cover.
Safeguard pays items on List I of the non-payable list and raises the base sum insured in line with inflation. Safeguard+ covers all four non-payable lists.
You can have Safeguard or Safeguard+ at a time.
Personalised health coaching through the Niva Bupa app for insured adults, for any 90 days in a policy year.
Maternity and newborn baby cover
Maternity needs 24 months of continuous cover with maternity as a benefit. Newborn baby cover follows the same condition.
Personal waiting period
Conditions listed against an insured person in the policy schedule wait 24 months from the start of the first policy with Niva Bupa.
Mental disorder treatment and LASER surgery
Both benefits need 36 months of continuous cover with the benefit.
HIV/AIDS cover
HIV/AIDS hospitalisation needs 48 months of continuous cover with the benefit.
Specified illness cover abroad and premium waiver
Specified illness treatment abroad and premium waiver need the symptoms and the diagnosis to occur after 90 days from the first policy.
Critical Illness cover (optional)
A 90-day initial wait, a 3-year pre-existing disease wait and a 30-day survival period apply to all listed illnesses.
Higher sum insured or a new member
If you raise your sum insured, the waits start again only for the added amount. A member added later serves the waits afresh.
It is available on a family floater with both spouses or on a Family First policy, not on an individual policy. It needs 24 months of continuous cover, covers up to 2 pregnancies, and pays up to ₹70,000 to ₹1 lakh on Gold and ₹2 lakh on Platinum. Pre-natal and post-natal expenses are not paid. The newborn is covered until the end of the policy year if added within 90 days.
Once in a policy year, if your base sum insured and any loyalty additions are used up, Niva Bupa adds up to 100% of the base sum insured, for any illness. On a floater it is shared by all members. It is not available on Family First and cannot be carried forward.
When you renew without a break, Niva Bupa adds 10% of the base sum insured each year, up to 100%, even if you claimed. The optional Enhanced Loyalty Additions raise this to 20% a year, up to 200%.
If the policyholder dies or is diagnosed or treated for the first time for a specified illness, such as cancer or a heart attack, the cover is extended for one policy year without premium. It is available once in a lifetime, after 90 days from the first policy, and not on an individual policy.
A Family First policy covers extended family, such as parents, in-laws, siblings and grandparents, up to 19 relationships. Each person has their own base sum insured, and a floater sum insured is shared once a person's own cover is used. The premium follows each person's age.
Any illness waits 30 days, except accidents. Specified conditions wait 12 months and pre-existing diseases 24 months. Maternity waits 24 months, mental disorder treatment and LASER surgery 36 months, and HIV/AIDS 48 months.
Zone 1 pricing lets you be treated anywhere in India. Zone 2 pricing lowers your premium if you live outside Mumbai, Delhi NCR, Kolkata and Gujarat, but you pay a 20% co-payment if you are treated in those cities.
Platinum includes OPD consultations, diagnostics and prescribed medicines up to ₹50,000 per policy, with 80% of the unused amount carried forward up to 2.5 times the limit. Gold does not include OPD.
Yes, after waits. Mental disorder inpatient treatment is covered after 36 months, with a sub-limit of ₹50,000 on Gold and ₹1 lakh on Platinum for listed conditions. HIV/AIDS hospitalisation is covered up to ₹50,000 after 48 months.
Personal Accident, Critical Illness, Hospital Cash, Enhanced Loyalty Additions, International coverage extension, Enhanced Geographical Scope for USA and Canada, Safeguard or Safeguard+, and Health Coach.
Adults from 18 to 65 years can buy it. Children can be covered from 91 days to 30 years on a floater. A floater covers up to 6 insured persons, with up to 4 children.
For cashless treatment, use a network hospital and get pre-authorisation, which Niva Bupa aims to process in 30 minutes. For reimbursement, send the discharge summary, final bill with receipts, lab reports with prescriptions and your KYC. Call 1860-500-8888 for help.
Yes. Niva Bupa assures renewal for life if you pay the renewal premium within the 30-day grace period. Renewal premium changes with age and not with your claims.