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Reviewed by Finzony Finance TeamLast updated:
Niva Bupa Rise is an indemnity health plan built around three unusual features. Return gives back 50% of the premium you pay as a separate sum insured that grows 10% a year. Smart Cash pays ₹5,000 if you choose a government hospital and no claim is paid for that stay. Flexi-Pay lets you start the policy with a small token of the premium and pay the rest during the policy year. It can be bought by individuals or as a family floater with up to 5 children, with a base sum insured from ₹1 lakh to ₹1 crore, and it renews for life. The base cover pays hospital bills up to the sum insured for stays of 2 hours or more (24 hours for AYUSH), in a twin sharing room without co-payment. It also covers 60 days of pre- and 180 days of post-hospitalisation expenses, home care, organ donors, a road ambulance up to ₹2,000, and unlimited digital consultations with a general physician. Re-fill adds an amount equal to the base sum insured once in each policy year, and a Loyalty Bonus adds 10% of the base sum insured every year up to 100%. Two limits shape the plan. A flat 20% co-payment applies to every claim outside the Rise-Tiered Network of hospitals, and modern treatments such as robotic surgery and immunotherapy are capped at ₹50,000 per claim. Pre-existing diseases wait 36 months, and 11 groups of conditions wait 24 months. Maternity, OPD and overseas treatment are not covered.
Get 50% of your premium back as a separate cover that grows 10% a year and pays claims rejected for waiting periods or exclusions, plus ₹5,000 Smart Cash for government hospital treatment.
Finzony sees Rise as an affordability-first plan for first-time buyers and young families, with three features that set it apart. Return is the headline, but read it carefully. The 50% of premium that comes back is a separate pool that grows 10% a year, and it can pay only claims that are completely rejected because of a waiting period or a listed exclusion. It cannot be used for maternity, IVF, OPD, alcoholism, cosmetic treatment, fraud or non-disclosure, and it lapses if you stop renewing. It is a backstop for rejected claims, not cash back. Smart Cash of ₹5,000 is a modest consolation payment, and it is paid only when no claim is paid for that hospital stay. Flexi-Pay helps people with irregular incomes, and the discount schedule rewards paying early, up to 7% on a one-year policy. But it has hard edges. The full premium must be paid within 10 months on a one-year policy, any unpaid balance is deducted from a claim, benefits stop while a minimum monthly payment is overdue, and the policy cannot be renewed if the premium is not fully paid. Term discounts do not apply when you use Flexi-Pay. The bigger trade-off is the hospital network. Treatment outside the Rise-Tiered Network carries a flat 20% co-payment on every claim, modern treatments are capped at ₹50,000, and a room above twin sharing adds another 20% co-payment. The No Co-Pay Network and Modern Treatment+ options remove the first two for extra premium. Premium also climbs steeply with age, from about ₹7,100 at age 18 to about ₹40,400 at age 70 for a ₹5 lakh cover. If you want unlimited restoration with no network co-payment, compare Aspire and ReAssure.
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.
Niva Bupa gives back 50% of the premium you pay as a separate sum insured. The accumulated amount earns a 10% bonus, and it stays for life as long as you keep renewing. You can use it for a claim that is rejected because of a waiting period, a listed exclusion, or a complete rejection of any kind. No waiting period or exclusion applies to this amount itself.
It works only for claims completely rejected under hospitalisation, home care and organ donor. It cannot be used for maternity, IVF, OPD, alcoholism, cosmetic treatment, fraud, misrepresentation or non-disclosure. The unused amount lapses if the policy is not renewed. Return+ raises the 50% to 100%.
Once in a policy year, an amount equal to your base sum insured is added when you have fully or partly used the base sum insured. It works for any illness, the same or a different one, and for the same person.
It is available once a policy year, not unlimited. If you opt for ReAssure Forever, the Re-fill benefit is removed.
Niva Bupa adds an amount equal to 10% of your expiring base sum insured every policy year, which accumulates up to 100% of the base sum insured. You can use it as sum insured in the policy.
Claims use the sum insured in this order: base sum insured, Loyalty Bonus, Safeguard sum insured, then Re-fill.
If you take treatment at a government hospital, Niva Bupa pays you ₹5,000 (up to the sum insured), as long as the claim would have been admissible and you were hospitalised for 24 hours.
It is paid only if no claim is paid for the same hospitalisation, so it does not top up a normal claim. You send the discharge summary from the government hospital.
You can pay a minimum enrolment premium, which works like a token, to get the policy issued, then a small minimum monthly premium to keep it active. The rest can be paid in any amounts, any time in the policy tenure. Early payments earn a discount, up to 7% on a one-year policy, 10.4% on two years and 12.3% on three years.
The full premium must be paid within 10 months on a one-year policy (20 months on two years, 30 on three), or the policy cannot be renewed. The unpaid balance is deducted from any claim. If a minimum monthly payment is missed, you cannot use any benefit until it is paid. Term discounts do not apply with Flexi-Pay.
Removes the 20% co-payment that applies to treatment outside the Rise-Tiered Network. All other conditions stay the same.
Removes the ₹50,000 limit on modern treatments and covers them up to the sum insured.
Gives back 100% of the premium you pay as a separate sum insured, with the same 10% bonus on the accumulated amount.
A 30-day wait applies to any illness except accidents, and it does not apply if you have more than 12 months of continuous cover. Cancer is covered after the 30-day wait, and accidents are covered from day 1. Pre-existing diseases wait 36 months, which you can reduce to 24 or 12 months at purchase. The 11 listed groups of conditions and procedures wait 24 months, which you can reduce to 12 or increase to 36 months at purchase. Conditions listed against an insured person under a Personal Waiting Period wait up to 48 months. 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 and for a newly added member. The grace period is 30 days (15 days for monthly instalments), and cover is available during it.
Initial waiting period
Expenses for any illness in the first 30 days of the policy are excluded, except for accidents. This does not apply if you have more than 12 months of continuous cover.
Cancer
Cancer is not held to the 24-month specified disease wait. It is covered after the initial 30-day wait.
Specified diseases and procedures
The 11 listed groups, such as cataract, hernia, joint replacement, stones, piles and benign tumours, wait 24 months of continuous cover, except accidents. You can reduce the wait to 12 months or increase it to 36 months when you buy the policy.
Conditions or treatments that the policy clearly says it will not cover.
These listed conditions and procedures are excluded for the first 24 months of continuous cover, even if they begin after the policy starts and even if you declared them. The wait does not apply to accidents, and cancer is covered after the 30-day wait. If one of them is also a pre-existing disease, the longer wait applies.
Insurer
Niva Bupa Health Insurance plans and claim process
Rise is a health insurance plan from Niva Bupa with a Return benefit that gives back 50% of your premium as a growing sum insured, Smart Cash of ₹5,000 for government hospital treatment, and Flexi-Pay, which lets you start with a token premium. It covers hospital bills up to a sum insured of ₹1 lakh to ₹1 crore and renews for life.
Niva Bupa gives back 50% of the premium you pay as a separate sum insured, and adds a 10% bonus on the accumulated amount. It can pay claims that are completely rejected because of waiting periods or listed exclusions. It is not available for maternity, IVF, OPD, alcoholism, cosmetic treatment, fraud or non-disclosure, and it lapses if you do not renew. Return+ gives back 100% instead.
If you get treatment at a government hospital and Niva Bupa pays no claim for that stay, you receive ₹5,000, provided the claim would have been admissible and you were hospitalised for 24 hours. You send the discharge summary. Smart Cash+ can raise the amount.
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)
You have either Return or Return+ at a time. You lose the accumulated Return amount if you opt out of this benefit at any point.
Raises Smart Cash from ₹5,000 to a higher amount in multiples of ₹5,000.
The benefit description says up to ₹25,000, but the benefit table says up to ₹50,000. Confirm in your quote. You have either Smart Cash or Smart Cash+ at a time.
Gives an unlimited sum insured. Your first paid claim in the life of the policy triggers it, and it stays for life as long as you renew without a break. Each claim paid from it is capped at the base sum insured.
It is described in the prospectus but is not in the optional benefits table, so confirm it is offered with your quote. If you opt for it, the Re-fill benefit is removed.
Safeguard pays items on List I of the non-payable list and raises your base sum insured each renewal in line with consumer price inflation. Safeguard+ covers items on all four non-payable lists and gives the same inflation increase.
You can have Safeguard or Safeguard+ at a time. The charges must still be reasonable and customary. You lose the accumulated sum insured if you opt out.
Choose a co-payment of 0%, 10%, 20%, 30%, 40% or 50% on every claim.
Co-payment and the annual aggregate deductible cannot be opted together. The co-payment does not apply to the health check-up, second opinion, digital consultations, Return, Smart Cash, personal accident and hospital cash benefits.
Pick a yearly deductible of ₹10,000, ₹20,000, ₹30,000, ₹50,000, ₹1 lakh, ₹2 lakh, ₹3 lakh, ₹4 lakh or ₹5 lakh. Niva Bupa pays the part of your yearly expenses above it.
You cannot take it together with a co-payment. You must still send claim documents for expenses within the deductible.
Change the room you are eligible for to a general ward, a single private room or any room category.
A higher room than you are eligible for adds a co-payment.
Reduce the pre-existing disease wait from 36 to 24 or 12 months. Reduce the specific disease wait from 24 to 12 months, or increase it to 36 months.
Available only when you buy the policy. It cannot be added, changed or removed at renewal.
Pays a lump sum for accidental death and disability, with a sum insured up to 5 times the base sum insured, up to ₹1 crore. Accidental death pays the sum insured. Permanent total disability pays 125% for loss of two limbs, both eyes, speech and hearing, or a limb and an eye, and 50% for one limb or one eye. Permanent partial disability pays a set share, such as 50% for each hand at the wrist or each eye.
Death or disability must occur within 365 days of the accident. The benefit ends once accidental death or permanent total disability is paid.
Pays ₹1,000 for each day of hospitalisation, for up to 30 days in a year. One day means 24 continuous hours in hospital.
Available once a policy year from day 1, for adults only, with tests booked through the Niva Bupa app. Choose from tests such as CBC, lipid profile, liver and kidney tests, HbA1c, thyroid, vitamin D, ECG, treadmill test or 2D echo, chest X-ray and ultrasound.
There are two options: cashless only, or cashless and reimbursement with a flat 20% co-payment on reimbursement. All tests must be done within 7 days, and a test cannot be repeated in a policy year.
Lets you take a second opinion from a medical practitioner, as many times as you want in a policy year, for any condition for which a hospitalisation claim has been paid.
Pre-existing diseases
Declared and accepted pre-existing diseases are covered after 36 months. If a listed disease is also pre-existing, the longer wait applies. You can reduce the wait to 24 or 12 months when you buy the policy.
Personal waiting period
Conditions listed against an insured person in the policy schedule wait up to 48 months from the start of the first policy with Niva Bupa.
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 pre-existing disease wait, exclusions and waits afresh.
You pay a minimum enrolment premium to start the policy, then a small minimum monthly premium to keep it active, and pay the rest in any amounts during the policy tenure. Paying early earns a discount of up to 7% on a one-year policy. The full premium has to be paid within 10 months on a one-year policy, any unpaid balance is deducted from a claim, and benefits stop if a monthly payment is overdue.
Niva Bupa gives you a list of hospitals where no network co-payment applies. If you are treated at a hospital outside that list, you pay a flat 20% of the admissible claim for every claim and Niva Bupa pays the rest. The No Co-Pay Network option removes this co-payment for extra premium.
Re-fill adds an amount equal to your base sum insured once in a policy year after you use it, for any illness. Loyalty Bonus adds 10% of the base sum insured every year, up to 100%. Claims use the base sum insured first, then Loyalty Bonus, then Safeguard sum insured, then Re-fill.
There is no rupee cap. The default is a twin sharing room with no co-payment, and ICU is paid up to the sum insured. If you take a higher room category, you pay a 20% co-payment, or 30% from a general ward to any room, and the associated charges are paid pro rata. You can change the room category when you buy the policy.
Yes, 12 listed treatments such as robotic surgery, immunotherapy and oral chemotherapy are covered, but a limit of ₹50,000 per claim applies. Modern Treatment+ removes the limit and covers them up to the sum insured.
Any illness waits 30 days, except accidents. Cancer is covered after the 30 days. The 11 listed groups of conditions wait 24 months, and pre-existing diseases wait 36 months. You can reduce or change the pre-existing and specified disease waits when you buy the policy.
Yes, after 36 months of continuous cover, if you declared them and Niva Bupa accepted them. The wait is reduced if you port or migrate with prior cover and no break. You can reduce it to 24 or 12 months at purchase.
No. Maternity, OPD, and treatment outside India are not covered, and claims are paid in India in rupees. Digital consultations with a general physician are included.
No Co-Pay Network, Modern Treatment+, Return+, Smart Cash+, Safeguard or Safeguard+, a co-payment or annual deductible, room type changes, waiting period changes, Personal Accident, Hospital Daily Cash, a health check-up and Second Medical Opinion. ReAssure Forever is also described in the prospectus, so confirm it is offered with your quote.
Adults from 18 to 99 years can buy it, and dependent children can be covered from 91 days to 30 years. You can buy an individual policy or a family floater with up to 5 children. There is no maximum cover-ceasing age on renewal.
Niva Bupa's prospectus shows a standard premium of ₹7,116 a year for a ₹5 lakh cover at age 18 in Zone 3, rising to ₹8,892 at 39, ₹11,074 at 45, ₹18,495 at 55, ₹33,757 at 63 and ₹40,392 at 70. These are before discounts and loadings and exclude tax. Discounts of up to 10% for multiple members, 5% for buying online and up to 39% for a good claim record can lower the cost, so get a quote for your age and city.
For cashless treatment, use a network hospital and get pre-authorisation, or use Cashless Everywhere. For reimbursement, send the original discharge summary, the final bill with receipts and pharmacy bills, lab reports with prescriptions, an FIR in accident cases, your KYC and a cancelled cheque. Niva Bupa must settle or reject within 15 days. Call 1860-500-8888.
Yes. Renewal cannot be refused because you claimed, and there is no loading for your own claims. After 60 continuous months, no claim can be contested except for proven fraud.