For Heartbeat/Health companion-

i. If the insured person is hospitalised and we have accepted an in-patient hospitalisation claim, we will provide you with hospital cash. This will be applicable for each continuous and completed period of 24 hours of hospitalisation provided that the insured person has been hospitalised for a minimum of 48 hours.

ii. We will not make any payments in respect of an insured person for more than 30 days of hospitalisation in total under any policy year.

iii. We will not make any payments under this option for domiciliary hospitalisation, maternity benefit and new-born care.

For Health Assurance plan-

If the insured person is hospitalised due to an accident or illness, we will pay the daily hospital cash amount as specified under the product benefit table. This will be applicable for each continuous and completed period of 24 hours of hospitalisation provided that:

i. The illness has occurred 30 days from the date of commencement of the policy.

ii. The insured person has been hospitalised for a minimum of 48 hours with continuous and completed period of 24 hours.

iii. We will not make any payment in respect of an insured person for more than 45 days of hospitalisation in total under any policy year (including 7 days of ICU hospitalisation).

iv. The ICU (intensive Care Unit) cash benefit which is equivalent to double the daily cash benefit will be payable for hospitalisation in the ICU for up to a maximum of 7 days.

v. Under the family option, coverage for adults is 100% of the sum insured and the coverage for each child is 50% of the sum insured

Did not completely understand the exclusion here. Please explain further

The network hospital details can be found on our website. Just visit www.nivabupa.com & click on hospital network and select your state and city.    

The hospital may ask you for a security deposit as part of its protocol. However, this may vary from hospital to hospital and the deposit may be refunded as per hospital guidelines.    

For your grievances, please write to Gargi Sahu, the general manager and grievance redressal officer at grievanceredressal@nivabupa.com.

An unrecognised hospital or health facility refers to establishments who aren’t recognised by the relevant authorities in India or any other country where the treatment takes place. We have listed them on our website, and they can also be found on the policy document claims for treatment at hospitals which are not covered.

Un-recognised hospitals can be seen on our website by visiting www.nivabupa.com and clicking on hospital network followed by clicking on List of Un-recognised hospitals.

The following KYC documents are required from the insured person/proposer in cases of reimbursement-

· If claim amount is below 1 lakh- Photo Id proof & address proof

· If claim amount is above 1 lakh- Photo Id proof, address proof and a recent photograph

A printed name cancel cheque under the name of the proposer/ patient has to be submitted. If the name is not printed on the cancel cheque, we will require an attested bank passbook along with the bank statements of the last three months. 

The following KYC documents are required for reimbursement if there is a death of a policyholder-

· Photo Id proof, address proof and a recent photograph of either the patient/proposer.

· Photo id proof, address proof and a recent photograph of the nominee.

Any issues faced by you can be reported to the MaxBupa helpline-1860-500-8888. You can also mail us at customercare@nivabupa.com

A deductible is a cost-sharing requirement. It states that the insurer will not be liable for a specified amount in case of indemnity policies. This is applicable for a specified number of days/hours in case of hospital cash policies which apply before any benefits are payable by the insurer. Remember that a deductible does not reduce your sum insured.

We cover reasonable and customary charges for medical expenses incurred during the insured person’s medically necessary and medically advised in-patient hospitalisation during the policy period for treatments like Ayurveda, Unani, Sidha and Homeopathy (AYUSH). However, treatment must take place in a government hospital or in any institute recognised by the government and/or accredited by the Quality Council of India/the National Accreditation Board of Health.

The medical expenses traceable to childbirth (including complicated deliveries and caesarean sections during hospitalisation) and the expenses incurred towards any lawful medical termination of pregnancy during the policy period will be covered.

For family first- The female insured, in respect of whom a claim for maternity benefits is made must have been covered as an insured person for a period of 24 months of continuous coverage since the inception of the first policy, with maternity as a benefit. 

For family floater- The female insured, in respect of whom a claim for maternity benefits is made must have been covered as an insured person for a period of 24 months along with her legally married spouse since the inception of the first policy, with maternity as a benefit.

*Maternity cover available as per sub-limit of the plan

Health companion, GoActive and Health Recharge do not cover maternity benefits.

Non-medical items are not directly related to your medical needs and hence, we do not cover the expenses incurred for consuming them as per the policy terms and conditions.

*** Non-medical items listed under policy documents.

If the insured person is admitted in the hospital in a room category higher than their eligibility as specified in the product benefits table, then we shall only pay a pro-rated proportion of the total associated medical expenses (including surcharge or taxes thereon) in the proportion of the difference between the room rent actually incurred and the entitled room category.

Yes, we do cover pre and post-hospitalisation expenses for alternative treatments if specified in your existing plan.

Reasonable and customary charges refer to the expenses incurred for medical services/supplies as long as they are the standard charges for the specific provider and consistent with the prevailing charges in the geographical area for identical or similar services. We also take into account the nature of the illness/injury involved.

In-patient hospitalisation refers to the admission of an insured person in a hospital for a minimum of 24 consecutive hours. This is barring specified procedures/treatments, where such admission could be for a period of less than 24 consecutive hours.

Our network hospitals are institutions established for in-patient care and day-care treatment for sickness and/or injuries and have been registered as a hospital with the local authorities, under the Clinical Establishments (Registration and Regulation) Act, 2010 or under the enactments specified under the Schedule of Section 56(1) of the said Act. It must comply with all the following criteria like-

a) Should have a qualified nursing staff under its employment round the clock.

b) Should have atleast 10 in-patient beds, in towns having a population of less than 10,00,000 and 15 in-patient beds in all other places.

c) Should have qualified medical practitioners who are in-charge round the clock.

d) Must have a fully equipped operation theatre of its own where surgical procedures are carried out.

e) Must maintain a daily record of patients which can be accessible for our authorised personnel.

Day-care treatment refers to medical treatment and/or surgical procedure which is undertaken under general or local anaesthesia in a hospital/day care centre in less than 24 hours which would have otherwise required hospitalisation of more than 24 hours.

Treatment normally taken on an OPD Treatment basis is not included in the scope of this definition.

A day care centre means any institution established for treatment of illness and/or injuries. It can also include a medical set-up within a hospital which has been registered with the local authorities, wherever applicable, and is under the supervision of a registered and qualified medical practitioner.

 It must comply with all the following criteria like-

a) Should have a qualified nursing staff under its employment round the clock.

b) Should have atleast 10 in-patient beds, in towns having a population of less than 10,00,000 and 15 in-patient beds in all other places.

c) Should have qualified medical practitioners who are in-charge round the clock.

d) Must have a fully equipped operation theatre of its own where surgical procedures are carried out.

e) Must maintain a daily record of patients which can be accessible for our authorised personnel.

We cover the medical expenses incurred for the medical treatment of the insured person’s new-born from the date of delivery until the expiry of the policy year.    

We cover reasonable and customary charges for the medical expenses incurred for the vaccination of the new-born baby as written in the annexure of the policy. This benefit is applicable until the baby completes one year.

Medical expenses for pre and post-hospitalisation under Maternity Benefit are not covered.