Loading...
Loading...
Reviewed by Finzony Finance TeamLast updated:
Niva Bupa Senior First is an indemnity health plan for people aged 61 to 75. You can buy it for yourself or as a couple, on an individual sum insured or a family floater basis, and it renews for life. It pays hospital bills up to the sum insured for stays of 2 hours or more (24 hours for AYUSH), with all day care procedures, 60 days of pre-hospitalisation and 180 days of post-hospitalisation expenses, organ donor expenses, 12 listed modern treatments, road ambulance up to ₹2,000 and air ambulance up to ₹2.5 lakh. There are two variants. Gold offers a ₹5 lakh or ₹10 lakh sum insured and a shared room. Platinum offers ₹5 lakh to ₹25 lakh, a single private room, ReAssure (unlimited restoration up to the base sum insured), Loyalty Additions of 10% a year up to 100%, and an annual health check-up. Every claim carries a default co-payment of 50%. At purchase you can reduce it to 40%, 30% or 20% for extra premium, or swap it for an annual aggregate deductible. Pre-existing diseases and 11 groups of listed conditions wait 24 months, and a general 30-day wait applies. OPD, maternity and treatment outside India are not covered.
For adults aged 61 to 75, with a 50% default co-payment that you can reduce to 40%, 30% or 20% when you buy.
Finzony reads Senior First as a straightforward cover for the 61-plus age group whose price is held down by a 50% co-payment. That co-payment is the main thing to understand. On a ₹4 lakh bill you pay ₹2 lakh yourself, and the sum insured is not reduced by it. You can reduce it to 40%, 30% or 20%, but the premium goes up by 18.5%, 37% or 55.5%, and the choice is final. You can also swap it for an annual aggregate deductible of one-fifth of the sum insured, which comes with a premium discount of 15% to 75%. Decide this at purchase, because it cannot be changed later. Gold and Platinum are very different products. Gold has a shared room, only ₹5 lakh or ₹10 lakh, and no ReAssure, Loyalty Additions or health check-up. Platinum adds a single private room, up to ₹25 lakh, unlimited reinstatement for the same and different illness, 10% yearly Loyalty Additions and a check-up of ₹500 per ₹1 lakh, up to ₹5,000 per person. If you can afford Platinum, it is the version with the useful features. Taking a room above your category adds a further 10% co-payment, even if you chose a deductible. The waits are shorter than the 36-month limit many plans use, with 24 months for pre-existing diseases. But the 24-month list includes cataract, joint replacement and hernia, which are common at this age. Premium also rises steeply with age. Compare it with other senior plans and get a quote for your own age and city.
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 treatment expenses up to the sum insured when you are admitted for 2 hours or more. AYUSH treatment needs 24 hours in an AYUSH hospital. Angiography, dialysis (hemo or peritoneal), and radiotherapy or chemotherapy for cancer are also covered.
Admissions only for investigations, such as an MRI, CT scan or endoscopy, are not paid. Invasive angiography is paid, and non-invasive angiography is not.
Gold covers a shared room and Platinum covers a single private room. There is no rupee cap on room rent, only the room category.
If you take a higher room category than you are eligible for, you pay an additional 10% co-payment, even if you chose a deductible.
You pay 50% of every admissible claim amount by default, and Niva Bupa pays the rest. The co-payment does not reduce your sum insured.
It does not apply to the ambulance and health check-up benefits, and once chosen it cannot be changed.
All day care treatments, which would otherwise need more than 24 hours in hospital, and AYUSH treatments are covered up to the sum insured.
Covers 12 listed modern treatments up to the sum insured, including uterine artery embolization and HIFU, balloon sinuplasty, deep brain stimulation, oral chemotherapy, monoclonal antibody immunotherapy, robotic surgery, stereotactic radiosurgery, bronchial thermoplasty and IONM.
A limit of ₹1 lakh per claim applies to robotic surgeries, except total radical prostatectomy, cardiac surgeries, partial nephrectomy and surgeries for malignancies.
Reduce your co-payment from the default 50% to 40%, 30% or 20% when you buy the policy. The base premium rises by 18.5% for 40%, 37% for 30% and 55.5% for 20%.
Can be chosen only at the start of the first policy, and cannot be changed later.
Pay no co-payment, and instead bear a yearly deductible of one-fifth of the base sum insured (₹1 lakh on ₹5 lakh up to ₹5 lakh on ₹25 lakh). Niva Bupa pays the balance. Premium discounts are 15% for ₹1 lakh, 30% for ₹2 lakh, 55% for ₹3 lakh, 70% for ₹4 lakh and 75% for ₹5 lakh.
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. Pre-existing diseases wait 24 months, and 11 listed groups of conditions and procedures wait 24 months, except after an accident. Any condition listed against an insured person in the schedule carries a personal waiting period of 24 months. The waits apply to each insured person separately, 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 or for a new member. The grace period is 30 days.
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.
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, unless an accident caused them.
Pre-existing diseases
Declared and accepted pre-existing diseases are covered after 24 months. If a listed disease is also pre-existing, the longer wait applies.
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 claims arising from an accident. If one of them is also a pre-existing disease, the longer wait applies.
Insurer
Niva Bupa Health Insurance plans and claim process
Senior First is a health plan from Niva Bupa for people aged 61 to 75. It pays hospital bills up to the sum insured, with a 50% default co-payment, in two variants called Gold and Platinum. It can be bought for one adult or a couple and renews for life.
The first adult must be 61 to 75 years old. You can cover yourself, or yourself and your spouse, on an individual sum insured or a family floater basis. On a floater, the second member can join from 18 to 75 years.
Gold has a ₹5 lakh or ₹10 lakh sum insured and a shared room. Platinum has ₹5 lakh to ₹25 lakh, a single private room, ReAssure, Loyalty Additions of 10% a year up to 100%, and an annual health check-up. Gold has no ReAssure, Loyalty Additions or health check-up.
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)
Cannot be changed once chosen. The 10% extra co-payment for a higher room still applies, and the deductible does not apply to the health check-up.
Niva Bupa lists a Zero Co-Pay add-on in its product list, and an older Senior First brochure shows a 0% co-payment option.
The current prospectus does not give its terms or price, so ask Niva Bupa whether it is offered with your variant.
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.
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 all waits afresh. The waits apply to each insured person individually.
Niva Bupa's rate table starts at ₹12,541 a year for Gold with a ₹5 lakh sum insured, for one adult aged 61 to 65 in the rest of India (Zone 2), before any co-payment loading. The premium is higher for Platinum and larger sums insured, rises with age, and is about 20% higher in Zone 1: Delhi NCR, Mumbai, Kolkata and Gujarat. Get a quote for your own age and city.
You pay 50% of every admissible claim amount by default, and Niva Bupa pays the rest. The co-payment does not reduce your sum insured and does not apply to the ambulance and health check-up benefits. At purchase you can reduce it to 40%, 30% or 20% for 18.5%, 37% or 55.5% more premium, and you cannot change it later.
You can swap it for an annual aggregate deductible of one-fifth of your base sum insured, such as ₹1 lakh on ₹5 lakh, with a premium discount of 15% to 75%. Niva Bupa lists a Zero Co-Pay add-on too, but its terms are not in the current prospectus, so ask before relying on it.
There is no rupee cap, but there is a room category: a shared room on Gold and a single private room on Platinum. If you take a higher category, you pay an extra 10% co-payment. ICU charges are covered up to the sum insured.
Both are on Platinum only. ReAssure restores your base sum insured after your first paid claim, for the same and a different illness, with each claim capped at the base sum insured. Loyalty Additions add 10% of the base sum insured each completed policy year, up to 100%.
Pre-existing diseases wait 24 months of continuous cover. After that they are covered only if you declared them and Niva Bupa accepted them. The wait is reduced if you port or migrate with prior cover and no break.
Eleven listed groups, including cataract, glaucoma, hernia, piles, stones, joint replacement, osteoarthritis, benign tumours, hysterectomy and prostate hyperplasia, wait 24 months. The wait does not apply to claims arising from an accident.
There is no fixed pre-policy medical check-up, but Niva Bupa can ask for tests or past records based on what you declare. If your proposal is accepted, Niva Bupa pays for the tests, and if it is declined, you pay.
On Platinum, you get a check-up once every policy year from day 1, worth ₹500 for each ₹1 lakh of base sum insured, up to ₹5,000 per person on an individual policy or ₹10,000 per floater policy. You choose tests from a list that includes blood, lipid, liver, kidney and thyroid tests, ECG and ultrasound.
No. OPD expenses, maternity, infertility treatment and any treatment outside India are excluded.
For cashless treatment, use a network hospital and get pre-authorisation, or use Cashless Everywhere. For reimbursement, send the original discharge summary, final bill with receipts, lab reports with prescriptions, an FIR for accidents and your KYC. Niva Bupa must settle or reject within 15 days. Senior citizens can also write to seniorcitizensupport@nivabupa.com or 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.