- 1 Introduction – Niva Bupa family Insurance Plan
- 2 Important Features of Heartbeat Health Insurance Policy
- 3 Benefits are Good to Have
- 4 Value Adds
- 5 Rules & Regulations
- 6 Waiting Time
- 7 Claim Resolution Process for the Niva Bupa Heartbeat Policy
- 8 How do I submit a request for payment of my claim?
- 9 Required Documents for the Claims Process
- 10 Permanent Exclusions
- 11 Analyses of Niva Bupa Heartbeat Health Insurance Policies
- 12 Why Buy Health Insurance Through Niva Bupa?
- 13 What steps must I take to purchase Niva Bupa health insurance?
- 14 FAQ’s about Niva Bupa Health Insurance
- 14.1 Why is purchasing Max Bupa health insurance policies important?
- 14.2 How soon can I expect to receive my claim’s reimbursement?
- 14.3 How do I get the claims to form to download?
- 14.4 When should claim documentation be submitted?
- 14.5 Are all Niva Bupa customers able to submit claims for reimbursement online?
- 14.6 What is the claim notification process for reimbursement when a hospital is not in the network?
- 14.7 Is it possible to modify my mobile number after submitting my online claim?
- 14.8 What types of documents must you upload in order to submit your claim online?
The only health insurance provider recognized as a super brand for two years in a row is Niva Bupa (formerly Max Bupa) Heartbeat Health Insurance Plan for Families. The business also enjoys a high level of customer satisfaction, with 2.9 million people in its customer base. The insured can receive a number of advantages from Niva Bupa Health Insurance.
Introduction – Niva Bupa family Insurance Plan
A partnership between Max India Limited and the UK-based leader in healthcare services, Bupa, has resulted in the formation of Niva Bupa Health Insurance Company Ltd. (Niva Bupa).
The Heartbeat Policy offers to give individuals and extended families (up to 14 members) complete medical coverage. Their Family First Plan offers a floating sum insured to any family member as well as individual sum insureds for each member.
Please take note that on July 5, 2021, Niva Bupa Health Insurance Company Limited will replace Max Bupa Health Insurance Company Limited.
Important Features of Heartbeat Health Insurance Policy
- Three different versions of the health insurance policy are offered: Silver, Gold, and platinum.
- If you choose a two-year policy term, you will receive a premium discount.
- Program of rewards available for the premium paid
- There is no upper or lower age limit for enrollment.
- Benefit from taxes paid on premiums under Section 80D of the Income Tax Act of 1961
DAILY CARE THERAPIES
Science has advanced to the point where some procedures or treatments do not require a hospital stay of at least 24 hours before filing a claim. These processes are covered by this plan.
DONOR COVER ORGAN
This benefit pays medical expenses up to the amount insured for an organ donor’s care prior to the donation of the organ.
30 days prior to your hospitalization, the insurance provider will pay for the medical costs associated with it.
The insurance provider will cover your hospitalization-related medical costs 60 days after your stay.
Benefits are Good to Have
OPD OUTLAY COVER
The OPD costs, which range from Rs. 10,000 to Rs. 40,000 depending on the insured amount, are only covered by the Platinum plan.
AMOUNT PER DAY FOR HOSPITALIZATION
No daily hospital cash is provided by this policy.
According to the plan variant, offers free health checks that include some of the listed tests on an annual or every two-year basis.
DOMICILIARY HOSPITALIZATION AND HOME HOSPITALIZATION
Depending on the plan variant you selected, you may receive treatment at home up to a maximum of Rs.10,000 to Rs.2.5 lakh.
NON-ALLOPATHIC TREATMENT COVERAGE
Only Platinum Plan members are eligible for coverage under this plan for costs associated with non-allopathic treatment.
This plan offers up to the amount insured ambulance coverage at actual costs in the network hospital.
Eye-related medical costs are not covered by this plan.
The maternity expenses covered by this policy range from Rs. 20,000 to Rs. 1 lakh.
Dental services are not covered by this policy.
BENEFIT OF RECOVERY
ESSENTIAL Illness Coverage
Critical illness coverage is not an additional benefit under this policy.
FREE VIEWING PERIOD
If, for any reason, you decide against purchasing the policy, you have 15 days from the date you received the policy document to return it and ask for a refund.
This insurance plan provides a 10% discount off the most recent premium or an increase of 10% on the amount insured up to a maximum of 50%. This benefit takes the place of the no-claim benefit that was provided by some other plans.
The Platinum plan offers coverage for treatment worldwide (except for USA and Canada) in the range of Rs.1.5 lakh to Rs.10 lakh for a family floater and individual coverage and Rs.5 lakh for family first coverage.
All costs associated with taking care of a newborn child are covered up to the insured amount.
Rules & Regulations
RENT A ROOM / ROOM TYPE
The plan’s defined room rental caps are equal to:
- 1% of the Silver Plan’s insured sum
- Room rental for Gold and Platinum variants is not restricted.
- 1% of the Silver Plan’s total insured amount
- Room rental for Gold and Platinum variants is not restricted.
Individuals under the age of 65 can choose a 10% to 20% co-pay under this plan. Anyone over the age of 65 must, however, complete it. At each renewal, this co-pay drops by 5% until the fourth renewal, when it is zero.
SLOWING DOWN SECONDARY
All claims, with the exception of those resulting from unintentional injuries, have a 90-day cooling-off period.
Some specific illnesses and treatments are only covered by the policy after 24 months. These include myomectomy for fibroids, hysterectomy, and cataract surgery, among others.
ALREADY EXISTING DISEASES
For Silver plans, you have 48 months from the policy start date to file a claim, while Gold and Platinum plans have 24 months.
Claim Resolution Process for the Niva Bupa Heartbeat Policy
This is applicable if a policyholder or insured member of Niva Bupa Heartbeat is admitted to one of the insurer’s network hospitals.
- Along with your Niva Bupa Health Card or Policy Number, present any form of identification, such as a passport, PAN card, or voter’s ID.
- Your identity will be confirmed by the network hospital, which will then submit the pre-authorization request form to the insurance provider.
- The insurer then examines the cashless claim and decides by fax and/or email whether to approve or reject it. As a confirmation of your claim, the insurer also sends you an email and a text message on your registered mobile number. Within 30 minutes of the hospital submitting a claim request, the insurer responds.
- Following the conclusion of all formalities, Niva Bupa pays the claim amount for which you are qualified directly to the network hospital, in accordance with the terms and conditions of the policy.
Claims for Reimbursement
This is applicable if a policyholder for Niva Bupa Heartbeat has never been admitted to one of the insurer’s network hospitals.
- If you are admitted to a non-network hospital, you must first make a payment to the facility before submitting a reimbursement claim.
- Make sure to meticulously gather all receipts, bills, doctor’s prescriptions, medical reports, and the hospital’s discharge certificate in original form.
- Send the insurance provider the completed claims form, the aforementioned records, and a valid copy of your proof of identity and proof of age.
- Following a review, the insurer decides whether to accept or reject the reimbursement claim. According to the terms and conditions of the policy, it may also choose to raise a question or reject the request.
- You receive payment from the insurer in your bank account for the approved amount
How do I submit a request for payment of my claim?
Which documents do I require?
Step 1: If you qualify, visit a doctor for an OPD consultation or get admitted to a recognized hospital for treatment.
Step 2: Pay the hospital or the doctor directly (as appropriate)
Step 3: Gather all pertinent paperwork, including bills, prescriptions, hospital discharge certificates in their original forms, and payment receipts.
4. Add documents to the page.
Required Documents for the Claims Process
- Health Card from Niva Bupa
- Number of the Niva Bupa Heartbeat Policy
- PAN Card
- Voter’s ID
- Driving License
The following conditions’ treatment-related liabilities are not covered by the Plan:
- Suicide attempt
- Use of drugs or alcohol
- Birth, miscarriage, and abortion all occur during pregnancy.
- A congenital condition
- In vitro fertilization and infertility.
- hospitalization due to conflict, riots, strikes, and the use of nuclear weapons
The policy wording contains a detailed list of what the policy specifically excludes.
Analyses of Niva Bupa Heartbeat Health Insurance Policies
The Heartbeat Family First plan from Niva Bupa is an option to take into account if you need to ensure a sizable family under one policy. The plan includes pertinent medical costs for diagnostic procedures and newborn babies among its many benefits. At any time, if you want to receive medical care abroad, you can think about the Platinum plan.
Why Buy Health Insurance Through Niva Bupa?
There are a lot of good reasons to purchase health insurance. It is essential to have health insurance plans, regardless of your financial situation, age, or whether you have been diagnosed with a disease that necessitates hospitalization. Here, we’ll go over the benefits of purchasing health insurance through Niva Bupa.
- Niva Bupa health insurance policies can be purchased conveniently and quickly online.
- One crore rupees is the maximum insured amount provided by health insurance policies.
- Offers coverage for the entire family, including newborn babies and senior citizens
- after the one-year waiting period since the purchase of a Niva Bupa health insurance policy has expired, covers maternity-related expenses for mothers and newly born babies.
- includes the option of lifetime renewal
- The insured can take advantage of cashless facilities when hospitalized at any of Niva Bupa’s 3,500+ network hospitals in India.
- Through its global network of hospitals, the Niva Bupa health insurance company is able to provide international cashless services for a number of serious illnesses, including cancer and organ transplants.
- Offers direct claim settlement, so TPA (Third Party Aggregator) is omitted.
- Focuses on its customer-first strategy, which prioritizes customer satisfaction.
- Contains tax benefits in accordance with Section 80D of the Income Tax Act of 1961.
What steps must I take to purchase Niva Bupa health insurance?
- Visit the official website of Niva Bupa health insurance, fill out the form there with the necessary information (such as your name, phone number, email address, etc.), and ask for a callback. For help with the procedure, contact Niva Bupa health insurance customer service.
- Online third-party aggregators or third-party websites can be used to purchase Niva Bupa health insurance plans that are offered for purchase online.
- Visit any Niva Bupa health insurance branch that’s convenient for you, and the executives will walk you through the purchasing process.
The procedure for renewing Niva Bupa health insurance
The flexibility of offline and online renewal options is provided by Niva Bupa health insurance. You can start the offline renewal process by going to any Niva Bupa health insurance branch. If you’d rather renew it online, go to the business’s official website, click the “Renew” button, and then pay online to finish the renewal process.
FAQ’s about Niva Bupa Health Insurance
Why is purchasing Max Bupa health insurance policies important?
● Lots of features and benefits are available in Max Bupa Health Insurance policies to meet your needs. Here are some reasons you ought to purchase a health insurance plan from Max Bupa:
1. provides guaranteed lifetime renewability
2. There are no sub-limits for room rent.
3. Its provision of maternity and new-born child benefits makes it one of the most popular health plans.
4. provides a direct claim settlement option that excludes the use of a third party
5. provides international cashless treatment as part of its Heartbeat Platinum Plan, which offers coverage for
foreign countries. This treatment is provided for nine serious illnesses, including cancer and organ transplants.
6. provides individualized health insurance plans that provide coverage for every member of the family, from newborns to senior citizens
How soon can I expect to receive my claim’s reimbursement?
Closure for a reimbursement claim varies depending on the circumstances. They work to process each reimbursement request as quickly as possible.
How do I get the claims to form to download?
Go to www.nivabupa.com and select “claims.”
After that, choose “Claim Form” from the drop-down menu, then “Services Form,” and download the form in accordance with your plan.
When should claim documentation be submitted?
Within 30 days of the insured person’s discharge from the hospital (in the case of pre-hospitalization medical expenses and hospitalization medical expenses), within 30 days of the end of the post-hospitalization medical expenses period (in the case of post-hospitalization medical expenses), or within 30 days of death or disability as a result of a covered event, the document should be filled out with the necessary information regarding all claims at your/the insured person’s expense.
Are all Niva Bupa customers able to submit claims for reimbursement online?
No, only those who have a Niva Bupa retail policy, or those who are covered under the Health Premia, ReAssure, GoActive, Health Companion, Heartbeat, Health Recharge, Health Assurance, Corona Kavach, Health Pulse, and Arogya Sanjeevani plans, are eligible to submit claims online for reimbursement.
What is the claim notification process for reimbursement when a hospital is not in the network?
You should notify customer service of any claims that haven’t had the cashless facility pre-authorized or for which you haven’t received treatment from a network provider, along with the information listed below. Depending on when it is done, this must be completed within 48 hours of hospital admission or prior to hospital discharge:
1. The policy number.
2 The name of the sufferer.
3 The name, full address, and phone number of the hospital.
4 The name of the attending physician.
5 The expected date of discharge and the date of admission.
6 The type of disease or injury, as well as the medication or procedure used.
Is it possible to modify my mobile number after submitting my online claim?
You can change your mobile number, but only your registered number will be used for reference numbers and acknowledgments; all other claims communications will only be sent to your registered number.
What types of documents must you upload in order to submit your claim online?
original copy of the discharge summary, which includes the following information: the patient’s discharge condition, significant findings, procedures and treatments given, and the attending physician’s signature.
Original copy of Hospital bill & Payment details (Copy of original receipts of payment made to the Hospital against final bill and other charges like Medicines, investigations, implant, etc.)
Original copies of pertinent research and lab reports
Personalized canceled checks or the front page of a passbook with the account holder’s name and account information,
KYC document: Required if the claimed amount is greater than rs100,000
● PAN card
● Aadhaar cards, voter identification cards, licenses, and passports
● Most recent passport photo