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Niva Bupa Senior First Policy

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What is the Senior First Policy?

Having the right health insurance for seniors is crucial in ensuring they can access the care they need without worrying about the financial burden. As healthcare expenses rise, comprehensive insurance plans can provide the security and peace of mind necessary for older individuals to maintain their well-being.

Niva Bupa’s Senior First Health Insurance plan is designed specifically for individuals aged 60 and above, offering a wide range of coverage including modern treatments, AYUSH therapies and pre/post-hospitalization care. With up to 10 lakh rupees in coverage, this plan ensures that you or your loved ones receive top-quality healthcare. It also provides additional options such as domiciliary hospitalization and comprehensive ambulance coverage for immediate and suitable medical attention.

The right health insurance plan is crucial for your health and financial security. Niva Bupa offers more than just insurance, it provides a commitment to care and support you as you age. Take the time to understand the coverage options, benefits and features of the Senior First Health Insurance plan to safeguard yourself and your family in various health scenarios.

Types of Senior First Health Insurance Policies

Understanding the coverage options and benefits of different health insurance plans is essential for making the right choice. Whether you prefer a comprehensive plan with higher coverage limits or a more budget-friendly option, selecting the right policy can offer peace of mind and financial security. 

Niva Bupa Senior First Gold Plan

The Gold plan is designed for individuals and families seeking affordable yet comprehensive health coverage. It offers up to 10 lakh rupees in coverage and includes room accommodation, ambulance cover and air ambulance cover. With starting coverage at 5 lakh rupees and premiums as low as 13,453 rupees per year, this plan provides significant protection at a reasonable cost. 

Niva Bupa Senior First Platinum Plan

On the other hand, the Platinum Plan is perfect for those who desire maximum coverage and added benefits. With coverage up to ₹25 lakhs, this plan not only offers the same ambulance cover as the Gold Plan but also includes a single private room for added comfort.

The Platinum plan also includes a health check-up benefit of up to 500 rupees for every 1 lakh rupees of base sum insured and a No Claim Bonus that can boost coverage by 10%, up to a maximum of 100% of the base sum insured. Additionally, the ReAssure Benefit provides the opportunity to avail unlimited sum insured, ensuring comprehensive protection in any situation.

With an annual premium of just 13,453 rupees, the Platinum plan offers top-tier health insurance coverage.  

Senior First Health Insurance Policy Specifications

Specification

Details

Product Name

Senior First

Product UIN

MAXHLIP21575V012021

Plan Variants

Gold, Platinum

Base Sum Insured

  • Gold: ₹5 Lakhs / ₹10 Lakhs;
  • Platinum: ₹5 Lakhs / ₹10 Lakhs / ₹15 Lakhs / ₹20 Lakhs / ₹25 Lakhs

Entry Age

The minimum and maximum age requirements for this policy are 61 and 75 years respectively

Family Composition

Choose between the Individual or Family Gloater plans, which cover up to 2 adults

Policy Term

1, 2, or 3 years

Waiting Period

General coverage lasts for 30 days, pre-existing diseases are covered after 24 months and specified illnesses are covered after 24 months

Renewability

Lifetime renewability

In-patient Care

Covered up to Sum Insured

Room Category

  • Gold: Shared Room;
  • Platinum: Single Private Room
Pre-HospitalizationCovered for up to 60 days
Post-HospitalizationCovered for up to 180 days
Day Care TreatmentCovered up to Sum Insured
M-iracle Waiting Period9 to 48 months depending on the variant
Ambulance Charges
  • Road ambulance: up to ₹2,000;
  • Air ambulance: up to ₹2,50,000
AYUSH TreatmentsCovered up to Sum Insured
Domiciliary HospitalizationCovered up to Sum Insured
Organ Donor CoverageCovered up to Sum Insured
ReAssure BenefitUnlimited sum insured for all illnesses after the first claim
Health Check-upYearly check-up from the start, including different tests
No Claim Bonus10% increase in base sum insured for each claim-free year, max up to 100%
Co-payment OptionsYou can choose between a co-payment of 0%, 20%, 30%, or 40%, and also have the option of an available deductible.
ExclusionsWar, self-injury, diseases at birth, treatments after waiting periods
Tax BenefitsTax relief under Section 80D of the Income Tax Act
Network HospitalsOver 10,000 hospitals across India
Incurred Claim Ratio54.05%
Solvency Ratio1.7

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Coverage Benefits of Senior First Health Insurance Policy

AttributeGold PlanPlatinum Plan

Base Sum Insured

5 Lacs / 10 Lacs

5 Lacs / 10 Lacs / 15 Lacs / 20 Lacs / 25 Lacs

In-patient Care

Covered up to Sum Insured

Room Category

Shared Room

Single Private Room

Pre-Hospitalization (60 days)

Covered up to the sum insured.

Post-Hospitalization (180 days)

Covered up to the sum insured.

Day Care Treatment

Covered up to the sum insured.

Modern Treatments

Certain robotic surgeries are covered up to the Sum Insured amount, with a sub-limit of 1 lakh rupees per claim

Ambulance

  • Road ambulance coverage of up to 2,000 rupees per hospitalization
  • Air ambulance coverage provided up to 2,50,000 rupees per hospitalization

AYUSH Treatments

Covered up to Sum Insured

Domiciliary Hospitalization

Covered up to Sum Insured

Organ Donor

Covered up to Sum Insured

No Claim Bonus

Not applicable

The base sum insured amount increases by 10% annually with no reduction for claims

ReAssure

Not applicable

Unlimited coverage of up to the policy limit for both same and different illnesses

Health Check-up

Not applicable

Yearly coverage of up to 500 rupees per 1 lakh rupees of the base sum insured for specific tests.

  • Individual policy: max INR 5,000 per Insured. 
  • Family Floater policy: max INR 10,000 per policy.

Co-payment

50%

Co-payment modification is available at 40%/30%/20%

Optional Benefits

Annual aggregate deductible options include 1 lakh, 2 lakhs, 3 lakhs, 4 lakhs, and 5 lakhs.

Senior First Health Insurance Inclusions

  • Day Care Treatments
  • In-patient Care
  • Pre-hospitalization Expenses
  • Post-hospitalization Expenses
  • Modern Treatments
  • Ambulance Cover (Both Road Ambulance and Air Ambulance)
  • AYUSH Treatments
  • Treatment at Home
  • Organ Donor

Senior First Health Insurance Waiting Periods

  • Initial Waiting Period – 30 days
  • Pre-existing Diseases Waiting Period – 24 months
  • Specific Diseases Waiting Period – 24 months

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Senior First Health Insurance Claim Process

Below is the Niva Bupa Senior First health insurance claims procedure for your convenience.

Cashless Claims

Step 01

Admit yourself at a Niva Bupa network hospital

Step 02

Use the Niva Bupa Health Card or provide the policy number at the hospital with ID proof

Step 03

The Network hospital will verify your identity and submit the pre-authorization request to the insurer

Step 04

The insurer validates, reviews and confirms the network hospital by fax and email. You will be notified by text message and email. Niva Bupa usually responds within 30 minutes of filing the claim request

Step 05

Finalize the insurance claim settlement with the hospital after completing the formalities
 

Reimbursement Claims

Step 01

Notify the insurer within 48 hours of admission in its network or non-network hospital. Pay the amount directly to the hospital.

Step 02

Get your documents after leaving the hospital for reimbursement

Step 03

Send the completed and signed claim form along with your valid ID proof and age proof to the insurer. The claim form can be found on Niva Bupa’s website or in your policy document

Step 04

The insurer will review the claim request upon receipt of your documents and either approve, query or reject it based on the policy terms and conditions

Step 05

The insurer will settle and reimburse the approved amount according to the policy terms

 

OPD Reimbursements

Diagnostic Center Reimbursements

  1. Access “My Account” and then select “Raise a Claim” under the OPD tab
     
  2. Search for the doctor by entering the details
     
  3. Click “Raise a Claim” from the search results against the doctor who provided OPD services
     
  4. Complete the health claim form with accurate bill and bank details, along with the required documents uploaded. Submit after completion
     
  5. The insurer will review the insurance claim and approve, send a query or reject based on the policy terms
  1. Have a valid copy of the diagnostic claim reimbursement
     
  2. Access “My Account” and select “Reimbursement Claim” in the annual health check-up tab
     
  3. Fill out the claim form with accurate bill and bank details and upload specified documents. Submit after completion
     
  4. The insurer will review your claim and then approve/send a query\reject it according to the policy terms

Other Insurance Plans

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Niva Bupa Senior First Health Insurance Contact Details

For any assistance or query regarding Niva Bupa health insurance, kindly use the following channels to get in touch with Niva Bupa representatives.

Website: Niva Bupa Health Insurance

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fax - +91 11 41743397
Toll-Free Number - 1860-500-8888
Office Address - 14th Floor, Capital Cyberscape, Sector 59, Gurgaon

Best Health Insurance Plans In India

When it comes to the best health insurance, there is no “one-size-fits-all” policy. It is like choosing a Netflix or OTT plan - different plans offer different benefits and have different costs. However, this age is designed to meet the diverse needs of most users, making it a versatile and comprehensive health insurance comparison page.

It is essential to conduct a thorough comparison to find the policy that best suits your needs. We have created a comprehensive table of how some of the top mediclaim policies in India compare to others in the industry.

Insurance Provider Plan Name Coverage Type Sum Insured Range Age Limit (Adults) Important Parameters
Care Advantage Health Insurance Plan Individual & Family Floater ₹2 Lakh - ₹6 Crore 18-65 years
  • Extensive network hospitals
  • Customizable coverage options
  • Wellness programs
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ICICI Elevate Health Insurance Policy Individual & Family Floater ₹2 Lakh - ₹6 Crore 18-65 years
  • Extensive network hospitals
  • Customizable coverage options
  • Wellness programs
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IFFCO Tokio Family Health Protector Policy Individual & Family Floater ₹2 Lakh - ₹6 Crore 18-65 years
  • Extensive network hospitals
  • Customizable coverage options
  • Wellness programs
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Niva Bupa Aspire Policy Individual & Family Floater ₹2 Lakh - ₹6 Crore 18-65 years
  • Extensive network hospitals
  • Customizable coverage options
  • Wellness programs
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Arogya Supreme Policy Individual & Family Floater ₹2 Lakh - ₹6 Crore 18-65 years
  • Extensive network hospitals
  • Customizable coverage options
  • Wellness programs
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TATA AIG Medicare Lite Policy Individual & Family Floater ₹2 Lakh - ₹6 Crore 18-65 years
  • Extensive network hospitals
  • Customizable coverage options
  • Wellness programs
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Frequently Asked Questions (FAQs)

A.

The age range for the Niva Bupa Senior First Health Insurance plan is 61 to 75 years. Seniors can keep their coverage for life with the option of lifelong renewability.

A.

The waiting period for the Senior First plan is structured as follows:

  • Initial Waiting Period: The initial waiting period for hospitalization due to non-accident-related conditions is 30 days. 
  • Pre-existing Conditions: A waiting period of 2 years is in place for pre-existing conditions, as well as specific diseases and procedures including cataracts, hernias and joint replacements. 

A.

Most senior citizen mediclaim policies have an entry age limit between 60 and 75 years, like the Niva Bupa Senior First plan. Some policies may extend coverage of up to 80 years or beyond, depending on the insurer’s terms. 

A.

Niva Bupa’s Senior First plan is frequently recommended for individuals above 60 years who are seeking health insurance. This plan offers comprehensive coverage, ensuring that they have their healthcare needs met:

  • Pre-existing conditions are covered after the waiting period
  • There are no sub-limits on common health conditions
  • Co-payment and deductible options to lower premiums
  • Coverage up to 25 lakh rupees

Max Bupa, Star Health and Religre are other insurance providers that have notable plans for seniors. These plans are designed to meet the specific healthcare needs of older adults.

A.

The Senior First plan offers comprehensive coverage but does not include certain benefits such as -

  • Vaccinations expenses
  • Outpatient department (OPD) charges 

A.

The Pradhan Mantri Senior Citizen Health Scheme, a part of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), offers extensive health insurance coverage to economically vulnerable populations, especially senior citizens. Under this scheme, families can avail of health cover of up to 5 lakh rupees per year for secondary and tertiary hospitalization expenses. Ultimately, the scheme is intended to ease the financial strain of healthcare costs for senior citizens, guaranteeing access to high-quality medical services without the worry of out-of-pocket expenses. 

A.

The PM-SCHS does not have a specific financial limit for senior citizens, as it falls under the wider Ayushman Bharat scheme. However, eligible families can receive up to 5 lakh rupees per year for hospitalizations, offering significant protection for health expenses, including senior citizens.

A.

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) stands out as a top scheme for senior citizens, offering comprehensive coverage and benefits. It provides cashless treatment at both public and private hospitals nationwide, encompassing various treatments and procedures. Moreover, the scheme prioritizes inclusivity, specifically catering to vulnerable populations and ensuring that senior citizens can access essential healthcare without financial burden.

A.

Eligibility for the PM-SCHS is based on the Socio-Economic Caste Census (SECC) 2011 data, with individuals not meeting the outlined deprivation criteria being ineligible for the scheme. This ensures that the benefits of the scheme are directed towards those who are genuinely in need and meet the specified criteria.

A.
  • TATA AIG: Renowned for its wide-ranging coverage and exceptional customer service. The company specializes in providing insurance plans tailored to meet the unique medical requirements of seniors. 
  • Niva Bupa (formerly Max Bupa): Provides lifelong renewability and access to extensive hospital networks, ensuring comprehensive coverage for their healthcare needs. It also offers a range of options tailored to meet their specific requirements, providing peace of mind and security in their golden years. 
  • Star Health and Allied Insurance: Offers tailored coverage options for seniors, encompassing pre-existing condition coverage with a waiting period.
  • HDFC ERGO: Provides extensive coverage for a wide range of medical expenses, including hospitalization, medication and diagnostic tests. With a wide network of hospitals, policyholders can benefit from cashless treatment and access quality healthcare facilities conveniently. 

A.

Yes, there are insurance plans available for senior citizens aged 70 or above. These plans are designed to meet the healthcare needs of older individuals. Several insurance providers offer such plans to provide coverage for a range of medical services and treatments.

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