{"uin":"NBHHLIP24135V012324","name":"Health+","url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324","insurer":{"slug":"niva-bupa-health-insurance","name":"Niva Bupa Health Insurance Co Ltd.","url":"https://indiainsurances.com/insurer/niva-bupa-health-insurance"},"line":"health","category":"health-indemnity","category_name":"Health insurance (hospitalisation)","irdai_type":null,"kind":"product","status":"active","approved_on":null,"withdrawn_on":null,"summary":"Health+ is an individual indemnity health policy from Niva Bupa covering hospitalisation in India only, with sum insured from Rs 1 lakh to Rs 30 lakh for entry ages 18 to 65. Every claim carries a 20% co-payment, room rent is capped at 2% of base sum insured per day, and listed procedures have fixed rupee sub-limits.","analysis":{"state":"extracted","analysed_at":"2026-10-16 07:11:56.782571+00","note":"Every stated fact carries a verbatim quote found in the cited clause."},"facts":[{"key":"plan_variants","label":"Plans and variants","section":"Overview","meaning":"The named plans inside this product (not cover types or payout options). Facts can differ between them.","status":"cross-checked","value":["Plan 1"],"display":"One plan (Plan 1)","note":"The product benefit table shows a single plan; the policy is issued to individuals only.","quote":"Benefits | Plan 1 ... Health+ can be issued to individual customers only.","sources":[{"clause":"Annexure V","heading":"Product Benefit Table","page":37,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/178#c-annexure-v"},{"clause":"1.1","heading":null,"page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/178#c-1-1"}],"law":[]},{"key":"policy_term","label":"Policy term","section":"Eligibility","meaning":"How long one policy runs before it ends or must be renewed.","status":"cross-checked","value":"The policy runs for 1 year or 2 years.","display":"1 year or 2 years","note":"From the prospectus; the policy wording does not print the term.","quote":"The Policy tenure applicable is 1 year & 2 Year.","sources":[{"clause":"1.3","heading":null,"page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/178#c-1-3"}],"law":[]},{"key":"claim_intimation","label":"Claim intimation deadline","section":"Claims","meaning":"How soon you must tell the insurer about a claim or hospitalisation.","status":"not-stated","value":null,"display":null,"note":"No deadline for telling the insurer about a claim is printed. The wording only says all claim documents must be submitted at the earliest possible time, with reasons in writing for any delay.","quote":null,"sources":[],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 20, 21","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_documents","label":"Claim documents","section":"Claims","meaning":"Documents the insurer asks for when you claim.","status":"cross-checked","value":["Original Discharge summary with first and subsequent consultation papers","Original Final Hospital bill with detailed break-up and payment receipt (including pharmacy bills)","Laboratory investigation reports with supporting prescriptions","MLC/First Information Report (FIR) (in accident cases)","KYC documents","Cancelled cheque"],"display":"Discharge summary, final bill with receipts, lab reports, FIR in accident cases, KYC and cancelled cheque","note":"Policyholder documents are given by the nominee if the policyholder has died. All documents must be submitted at the earliest possible time; delays must be explained in writing.","quote":"b) Documents required with claim form: ... • Original Discharge summary with first and subsequent consultation papers. • Original Final Hospital bill with detailed break-up and payment receipt (including pharmacy bills). • Laboratory investigation reports with supporting prescriptions. • MLC/First Information Report (FIR) (in accident cases). Policyholder documents (Nominee in case of death of Policyholder): • KYC documents • Cancelled cheque","sources":[{"clause":"5.2.4(b)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-5-2-4-b"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 17","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 23","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_settlement_time","label":"Claim settlement time promised","section":"Claims","meaning":"How quickly the policy says a claim is decided or paid, and from when that is counted (intimation or last document).","status":"cross-checked","value":"The insurer settles or rejects a claim within 15 days from the claim submission date.","display":"Within 15 days from claim submission","note":"Delay attracts interest at 2% above the bank rate. Cashless discharge authorization is processed within three hours of the final documents (the CIS says 4 hours for cashless final bill authorization and 2 hours for pre-authorization).","quote":"The Company shall settle or reject a claim, as the case may be, within 15 days from the claim submission date. ... ln the case of delay in the payment of a claim, the Company shall be liable to pay interest to the policyholder from the date of receipt of claim intimation till the date of payment of claim at a rate of 2% above the bank rate. ... Once the final authorization request is received for discharge, the same will be processed within three hours from the final documents received. ... TAT for pre-authorization of cashless facility- 2 Hours - TAT for cashless final bill authorization- 4 Hours","sources":[{"clause":"5.1.9(I)","heading":null,"page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-5-1-9-i"},{"clause":"5.2.4(e)(i)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-5-2-4-e-i"},{"clause":"20(c)","heading":null,"page":4,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/179#c-20-c"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64UM(4) to (6)","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 10","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 15","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 16","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(i), V.3(ii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 23","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"The Motor Vehicles Act, 1988: Chapter XI, insurance of motor vehicles against third party risks","section":"Section 149","url":"https://indiainsurances.com/law/motor-vehicles-act-1988"}]},{"key":"exclusions_main","label":"Main exclusions","section":"Exclusions","meaning":"What the policy does not pay for, in the policy's own words.","status":"cross-checked","value":["Pre-existing Diseases (Excl01) until 36 months of continuous coverage","30-day waiting period (Excl03) for any Illness, except accidents","Investigation & Evaluation (Excl04)","Rest Cure, rehabilitation and respite care (Excl05)","Obesity/ Weight Control (Excl06)","Cosmetic or plastic Surgery (Excl08)","Hazardous or Adventure sports (Excl09)","Alcoholism, drug or substance abuse or any addictive condition (Excl12)","Sterility and Infertility (Excl17)","Maternity Expenses (Excl18)","Conflict & Disaster","Sleep disorders","Any form of Alternate Treatment (Ayurvedic, Homeopathic, Unani, Yoga and Siddha)","OPD Treatment","All dental treatments other than due to accidents and cancers"],"display":"Pre-existing diseases for 36 months, illness in the first 30 days, maternity, infertility, OPD, AYUSH and dental, among others","note":"No specific-illness waiting period (Excl02) is printed in the wording. The 30-day exclusion does not apply after more than twelve months of continuous coverage. The CIS states the PED period as 48 months.","quote":"Pre-existing Diseases (Code–Excl01) ... shall be excluded until the expiry of 36 months of continuous coverage ... 30-day waiting period (Code- Excl03): ... Expenses related to the treatment of any Illness within 30 days from the first Policy commencement date shall be excluded except claims arising due to an Accident ... Investigation & Evaluation (Code-Excl04) ... Rest Cure, rehabilitation and respite care (Code-Excl05) ... Obesity/ Weight Control (Code-Excl06) ... Cosmetic or plastic Surgery (Code-Excl08) ... Hazardous or Adventure sports (Code-Excl09) ... Treatment for, alcoholism, drug or substance abuse or any addictive condition and consequences thereof. (Code-Excl12) ... Sterility and Infertility (Code-Excl17) ... Maternity Expenses (Code-Excl18) ... Conflict & Disaster ... Sleep disorders ... Any form of Alternate Treatment ... a) Ayurvedic, Homeopathic, Unani, Yoga and Siddha streams of treatment; ... Any OPD Treatment is not covered. ... All dental treatments other than due to accidents and cancers.","sources":[{"clause":"4.1.1","heading":"Pre-existing Diseases (Code–Excl01)","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-1-1"},{"clause":"4.1.2","heading":"30-day waiting period","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-1-2"},{"clause":"4.1.3","heading":"Investigation & Evaluation (Code-Excl04)","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-1-3"},{"clause":"4.1.4","heading":"Rest Cure, rehabilitation and respite care (Code-Excl05)","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-1-4"},{"clause":"4.1.5","heading":"Obesity/ Weight Control (Code-Excl06)","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-1-5"},{"clause":"4.1.7","heading":"Cosmetic or plastic Surgery (Code-Excl08)","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-1-7"},{"clause":"4.1.8","heading":"Hazardous or Adventure sports (Code-Excl09)","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-1-8"},{"clause":"4.1.11","heading":"Treatment for, alcoholism, drug or substance abuse or any addictive condition and consequences thereof.","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-1-11"},{"clause":"4.1.16","heading":"Sterility and Infertility (Code-Excl17)","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-1-16"},{"clause":"4.1.17","heading":"Maternity Expenses (Code-Excl18)","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-1-17"},{"clause":"4.2.2","heading":"Conflict & Disaster","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-2-2"},{"clause":"4.2.5","heading":"Sleep disorders","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-2-5"},{"clause":"4.2.6","heading":"Any form of Alternate Treatment","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-2-6"},{"clause":"4.2.7","heading":"OPD Treatment","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-2-7"},{"clause":"4.2.9","heading":"Dental treatment","page":12,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-2-9"}],"law":[{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 11","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grievance","label":"Grievance route","section":"Claims","meaning":"Who to complain to first, as stated in the policy, before going to the Insurance Ombudsman.","status":"cross-checked","value":"Contact Niva Bupa customer service (website, toll-free 1860-500-8888, e-mail platform, fax, courier or any branch grievance cell); if not satisfied, the Head - Customer Services (grievance officer), then GRO@nivabupa.com, then the Insurance Ombudsman.","display":"Niva Bupa customer service (1860-500-8888), then the grievance officer, then GRO@nivabupa.com, then the Ombudsman","note":"Senior citizens may write to seniorcitizensupport@nivabupa.com. Grievances may also be lodged at the IRDAI Bima Bharosa portal.","quote":"ln case of any grievance the insured person may contact the company through: ... Website: www.nivabupa.com Toll- Free: 1860-500-8888 ... lnsured person may also approach the grievance cell at any of the company’s branches with the details of grievance. If lnsured person is not satisfied with the redressal of grievance through one of the above methods, insured person may contact the grievance officer at: ... Head – Customer Services Niva Bupa Health Insurance Company Limited ... If the Insured person is not satisfied with the above, they can escalate to GRO@nivabupa.com. lf lnsured person is not satisfied with the redressal of grievance through above methods, the insured person may also approach the office of lnsurance Ombudsman","sources":[{"clause":"5.1.8","heading":"Redressal of Grievance","page":15,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-5-1-8"}],"law":[{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 3","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 4","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 5","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(11)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(42)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 34","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 69","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Insurance Act, 1938","section":"Section 38","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 12","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 19","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 20","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 13","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 2","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(5), 5(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(9)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 25","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 26","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 11","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 3","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 13","url":"https://indiainsurances.com/law/ombudsman-rules-2017"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 14","url":"https://indiainsurances.com/law/ombudsman-rules-2017"}]},{"key":"sum_insured_options","label":"Sum insured options","section":"Cover","meaning":"The cover amounts you can choose from.","status":"cross-checked","value":"Sum insured from INR 1 lakh to INR 30 lakh: 1, 2, 5, 7, 10, 15, 20, 25 or 30 lakh.","display":"INR 1 lakh to 30 lakh (1, 2, 5, 7, 10, 15, 20, 25, 30 lakh)","note":"The range is from the prospectus; the individual options are listed in the CIS.","quote":"Sum Insured options from INR 1 Lakh to INR 30 Lakhs. ... Sum Insured Options are: INR 1 Lacs, 2 Lacs, 5 Lacs, 7 Lacs, 10 Lacs, 15 Lacs, 20 Lacs, 25 Lacs, 30 Lacs.","sources":[{"clause":"2","heading":"Coverage Options","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/178#c-2"},{"clause":"Row 4","heading":"Sum Insured","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/179#c-row-4"}],"law":[]},{"key":"initial_waiting","label":"Initial waiting period","section":"Waiting periods","meaning":"Days from the start of the first policy during which illness claims are not paid (accidents usually are).","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days","note":"Accidents are covered from day one. Not applied if the person had more than twelve months of continuous prior coverage; applies afresh to any increase in sum insured.","quote":"Expenses related to the treatment of any Illness within 30 days from the first Policy commencement date shall be excluded except claims arising due to an Accident, provided the same are covered. b) This exclusion shall not, however, apply if the Insured Person has continuous coverage for more than twelve months","sources":[{"clause":"4.1.2","heading":"30-day waiting period","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-1-2"}],"law":[]},{"key":"ped_waiting","label":"Pre-existing disease waiting period","section":"Waiting periods","meaning":"How long you wait before conditions you already had when you bought the policy are covered. The law caps it at 36 months.","status":"conflicting","value":{"unit":"months","amount":36},"display":"36 months","note":"CIS says: '48 months of continuous coverage'. The wording and prospectus say 36 months. Cover after 36 months requires the disease to have been declared and accepted; applies afresh to any sum insured increase.","quote":"Expenses related to the treatment of a Pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 36 months of continuous coverage after the date of inception of the first Policy. ... shall be excluded until the expiry of 48 months of continuous coverage after the date of inception of the first policy with us.","sources":[{"clause":"4.1.1","heading":"Pre-existing Diseases (Code–Excl01)","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-1-1"},{"clause":"20","heading":"Screening, prevention and treatment for sexually","page":2,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/179#c-20"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.6","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting","label":"Specific illness waiting period","section":"Waiting periods","meaning":"Waiting period for a list of named illnesses and procedures (cataract, hernia, joint replacement...). With several tiers (24 and 36 months), the shortest in the answer, the others in the note.","status":"not-stated","value":null,"display":null,"note":"The documents print no specific illness or procedure waiting period (no Excl02 clause); only the general 'Specific Waiting period' definition appears, without a figure for this product.","quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting_list","label":"Illnesses with a specific waiting period","section":"Waiting periods","meaning":"The named illnesses and procedures that carry the specific waiting period.","status":"not-stated","value":null,"display":null,"note":"No list of illnesses with a specific waiting period is printed.","quote":null,"sources":[],"law":[]},{"key":"moratorium","label":"Moratorium period","section":"Renewal and rights","meaning":"After this many months of continuous cover, the insurer cannot reject a claim for non-disclosure, except for proven fraud or permanent exclusions. The law sets 60 months.","status":"conflicting","value":{"unit":"months","amount":60},"display":"60 months","note":"CIS says: 'After completion of eight continuous years under the policy no look back to be applied.' The wording and prospectus say sixty months. For an increased sum insured the period runs from the enhancement.","quote":"After completion of sixty continuous months of coverage (including portability and migration) in health insurance policy, no policy and claim shall be contestable by the insurer on the grounds of non-disclosure, misrepresentation, except on grounds of established fraud. ... After completion of eight continuous years under the policy no look back to be applied.","sources":[{"clause":"5.1.10","heading":"Moratorium Period","page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-5-1-10"},{"clause":"20(c)","heading":null,"page":4,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/179#c-20-c"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 13","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 8","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"portability","label":"Portability","section":"Renewal and rights","meaning":"Whether you can move this policy to another insurer and keep waiting-period credit.","status":"cross-checked","value":"Yes. The policy can be ported to another insurer, carrying over credits for the sum insured, specific waiting periods, the pre-existing disease waiting period and the moratorium period.","display":"Yes, with waiting-period credit","note":"Subject to the acquiring insurer's Board approved underwriting policy. Migration to another Niva Bupa product is also allowed.","quote":"A Policyholder has the choice to port his/ her policies from one Insurer to ... The policyholder is entitled to transfer the credits gained to the extent of the Sum Insured, No Claim Bonus, specific waiting periods, waiting period for pre-existing disease, Moratorium period etc. from the Existing Insurer to the Acquiring Insurer in the previous policy.","sources":[{"clause":"5.1.13","heading":null,"page":17,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-5-1-13"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 11","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.6","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, VII.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 24","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.4 and 1.5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 10","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"lifelong_renewal","label":"Lifelong renewal","section":"Renewal and rights","meaning":"Whether the policy can be renewed for life without a maximum age.","status":"cross-checked","value":true,"display":"Yes, no maximum renewal age","note":"The no-ceasing-age statement is from the prospectus.","quote":"There is no maximum cover ceasing age on renewals. ... A health insurance policy shall be renewable except on grounds of established fraud or non-disclosure or misrepresentation by the insured.","sources":[{"clause":"1.4","heading":null,"page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/178#c-1-4"},{"clause":"5.1.3","heading":"Renewal of Policy","page":13,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-5-1-3"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II D.II","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"claim_loading","label":"Premium loading after claims","section":"Renewal and rights","meaning":"Whether the premium can go up at renewal because you made a claim.","status":"cross-checked","value":"No. No loading applies at renewal based on individual claims experience.","display":"No claim-based loading","note":"Clause 5.2.3(a) also says 'Renewal premium will alter based on Age (in case of claim)'. A risk loading applied at underwriting continues for all renewals.","quote":"No loading shall apply on renewals based on individual claims experience. ... Renewal premium will alter based on Age (in case of claim).","sources":[{"clause":"5.1.3","heading":"Renewal of Policy","page":13,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-5-1-3"},{"clause":"5.2.3(a)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-5-2-3-a"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 4","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"permanent_exclusions","label":"Permanent exclusions","section":"Exclusions","meaning":"Conditions or treatments that are never covered: the standard IRDAI exclusion codes Excl04 to Excl18 and the product's own permanent exclusions. Excl01 to Excl03 are waiting periods, not permanent exclusions.","status":"cross-checked","value":["Investigation & Evaluation (Excl04)","Rest Cure, rehabilitation and respite care (Excl05)","Obesity/ Weight Control (Excl06)","Change-of-Gender treatments (Excl07)","Cosmetic or plastic Surgery (Excl08)","Hazardous or Adventure sports (Excl09)","Breach of law (Excl10)","Excluded Providers (Excl11)","Alcoholism, drug or substance abuse or any addictive condition (Excl12)","Treatments in heath hydros, nature cure clinics, spas or similar establishments (Excl13)","Dietary supplements and substances that can be purchased without prescription (Excl14)","Refractive Error below 7.5 dioptres (Excl15)","Unproven Treatments (Excl16)","Sterility and Infertility (Excl17)","Maternity Expenses (Excl18)","Circumcision unless necessary for the treatment of a disease or necessitated by an Accident","Conflict & Disaster (nuclear, war, rebellion, terrorism)","Multifocal Lens and ambulatory devices such as walkers, crutches, splints, stockings","Sexually transmitted Infections & diseases (other than HIV / AIDS)","Sleep disorders","Any form of Alternate Treatment (Ayurvedic, Homeopathic, Unani, Yoga and Siddha; Hydrotherapy, Acupuncture, Reflexology, Chiropractic)","OPD Treatment","External Congenital Anomaly","Dental treatment other than due to accidents and cancers","Unrecognized Physician or Hospital","Costs which are not Reasonable and Customary and treatments which are not Medically Necessary","Artificial life maintenance for a person declared brain dead or in vegetative state"],"display":"Standard exclusions Excl04 to Excl18 and the product's own exclusions (OPD, AYUSH, dental, sleep disorders and others)","note":"Excl11 allows expenses up to stabilization in life threatening situations or after an accident. Excl08 allows reconstruction after an Accident, Burn(s) or Cancer. Excl06 allows bariatric surgery when the listed conditions are met.","quote":"Investigation & Evaluation (Code-Excl04) ... Rest Cure, rehabilitation and respite care (Code-Excl05) ... Obesity/ Weight Control (Code-Excl06) ... Change-of-Gender treatments (Code-Excl07) ... Cosmetic or plastic Surgery (Code-Excl08) ... Hazardous or Adventure sports (Code-Excl09) ... Breach of law (Code-Excl10) ... Excluded Providers (Code-Excl11) ... Treatment for, alcoholism, drug or substance abuse or any addictive condition and consequences thereof. (Code-Excl12) ... Treatments received in heath hydros, nature cure clinics, spas or similar establishments ... (Code-Excl13) ... Dietary supplements and substances that can be purchased without prescription ... Excl14 ... Refractive Error (Code-Excl15) ... Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres. ... Unproven Treatments (Code-Excl16) ... Sterility and Infertility (Code-Excl17) ... Maternity Expenses (Code-Excl18) ... Circumcision unless necessary for the treatment of a disease or necessitated by an Accident ... Conflict & Disaster ... nuclear, radiological emissions, war or war like situations (whether war is declared or not), rebellion ... acts of terrorism ... Multifocal Lens and ambulatory devices such as walkers, crutches, splints, stockings of any kind ... Sexually transmitted Infections & diseases (other than HIV / AIDS) ... Sleep disorders ... Any form of Alternate Treatment ... a) Ayurvedic, Homeopathic, Unani, Yoga and Siddha streams of treatment; b) Hydrotherapy, Acupuncture, Reflexology, Chiropractic Treatment ... Any OPD Treatment is not covered. ... External Congenital Anomaly ... All dental treatments other than due to accidents and cancers. ... Unrecognized Physician or Hospital ... Costs which are not Reasonable and Customary and treatments which are not Medically Necessary. ... Artificial life maintenance for the Insured Person who has been declared brain dead or in vegetative state","sources":[{"clause":"4.1.3","heading":"Investigation & Evaluation (Code-Excl04)","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-1-3"},{"clause":"4.1.4","heading":"Rest Cure, rehabilitation and respite care (Code-Excl05)","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-1-4"},{"clause":"4.1.5","heading":"Obesity/ Weight Control (Code-Excl06)","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-1-5"},{"clause":"4.1.6","heading":"Change-of-Gender treatments (Code-Excl07)","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-1-6"},{"clause":"4.1.7","heading":"Cosmetic or plastic Surgery (Code-Excl08)","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-1-7"},{"clause":"4.1.8","heading":"Hazardous or Adventure sports (Code-Excl09)","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-1-8"},{"clause":"4.1.9","heading":"Breach of law (Code-Excl10)","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-1-9"},{"clause":"4.1.10","heading":"Excluded Providers (Code-Excl11)","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-1-10"},{"clause":"4.1.11","heading":"Treatment for, alcoholism, drug or substance abuse or any addictive condition and consequences thereof.","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-1-11"},{"clause":"4.1.12","heading":null,"page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-1-12"},{"clause":"4.1.13","heading":null,"page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-1-13"},{"clause":"Excl14","heading":null,"page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-excl14"},{"clause":"4.1.14","heading":"Refractive Error (Code-Excl15)","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-1-14"},{"clause":"4.1.15","heading":"Unproven Treatments (Code-Excl16)","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-1-15"},{"clause":"4.1.16","heading":"Sterility and Infertility (Code-Excl17)","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-1-16"},{"clause":"4.1.17","heading":"Maternity Expenses (Code-Excl18)","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-1-17"},{"clause":"4.2.1","heading":"Circumcision","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-2-1"},{"clause":"4.2.2","heading":"Conflict & Disaster","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-2-2"},{"clause":"4.2.3","heading":null,"page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-2-3"},{"clause":"4.2.4","heading":"Sexually transmitted Infections & diseases (other than HIV / AIDS)","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-2-4"},{"clause":"4.2.5","heading":"Sleep disorders","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-2-5"},{"clause":"4.2.6","heading":"Any form of Alternate Treatment","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-2-6"},{"clause":"4.2.7","heading":"OPD Treatment","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-2-7"},{"clause":"4.2.8","heading":"External Congenital Anomaly","page":12,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-2-8"},{"clause":"4.2.9","heading":"Dental treatment","page":12,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-2-9"},{"clause":"4.2.10","heading":"Unrecognized Physician or Hospital","page":12,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-2-10"},{"clause":"4.2.11","heading":null,"page":12,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-2-11"},{"clause":"4.2.12","heading":null,"page":12,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-2-12"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"cancellation_refund","label":"Cancellation by you","section":"Renewal and rights","meaning":"What you get back if you cancel during the year.","status":"cross-checked","value":"You can cancel at any time with 7 days' written notice. If no claim has been made, the premium for the unexpired period is refunded in proportion; no refund if a claim has been paid.","display":"Proportionate refund for the unexpired period if no claim; none after a claim","note":"For a policy term above one year, premium for policy years whose cover has not started is refunded.","quote":"The policy holder may cancel his/her policy at any time during the term, by giving 7 days’ notice in writing. The insurer shall: a) Refund proportionate premium for unexpired policy period, if the term of the policy upto one year and there is no claim(s) made during the policy period. b) Refund premium for the unexpired policy period, in respect of policies with term more than 1 year and risk coverage for such policy years are not commenced. ... Note: We will NOT refund any premium if we have paid a claim.","sources":[{"clause":"5.1.2","heading":"Cancellation","page":12,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-5-1-2"},{"clause":null,"heading":"Simplified for you","page":12,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-simplified-for-you-2"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64VB","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 8","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 6","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 17","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, IV.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"territory","label":"Where it covers","section":"Overview","meaning":"Geographic area of cover: India only, worldwide, or listed countries. 'As stated in the schedule' is not an answer.","status":"cross-checked","value":"India only.","display":"India only","note":"All claims are payable in India in Indian Rupees.","quote":"This Policy covers Allopathic and AYUSH treatments taken in India ONLY.","sources":[{"clause":"1","heading":"Preamble","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-1"}],"law":[]},{"key":"free_look","label":"Free-look period","section":"Renewal and rights","meaning":"Days after you receive the policy in which you can return it for a refund if you do not agree with its terms.","status":"conflicting","value":{"unit":"days","amount":30},"display":"30 days","note":"CIS says: 'within 15 days (30 days for policies with a term of 3 years, if sold through distance marketing) days from the beginning of the policy'. The wording and prospectus say thirty days from receipt. Refund less proportionate risk premium, medical examination and stamp duty costs; not on renewals.","quote":"The insured person shall be allowed free look period of thirty days from date of receipt of the policy document to review the terms and conditions of the policy. ... You may cancel the insurance policy if you do not want it, within 15 days (30 days for policies with a term of 3 years, if sold through distance marketing) days from the beginning of the policy","sources":[{"clause":"5.1.1","heading":"Free Look Period","page":12,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-5-1-1"},{"clause":"20(c)","heading":null,"page":4,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/179#c-20-c"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 5","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(1), 20(2)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, II.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grace_period","label":"Grace period","section":"Renewal and rights","meaning":"Days you get after the due date to pay without losing cover or continuity.","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days","note":"The Grace Period definition gives fifteen days where premium is paid monthly and thirty days in other cases.","quote":"can be renewed within the Grace Period of 30 days (annual installment) to maintain continuity of benefits without break in policy. c) Coverage is available during the grace period. ... fifteen days where premium payment mode is monthly and thirty days in all other cases","sources":[{"clause":"5.1.3","heading":"Renewal of Policy","page":13,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-5-1-3"},{"clause":"2.1.14","heading":"Grace Period","page":2,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-2-1-14"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 50","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 9","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 8","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule I, Para 1.2","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.3","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"eligibility_entry_age","label":"Entry age","section":"Eligibility","meaning":"The youngest and oldest age at which you can buy this policy.","status":"cross-checked","value":"Adults aged 18 to 65 years at entry.","display":"18 to 65 years","note":"From the prospectus. Individual customers only.","quote":"The minimum entry age for adult is 18 years. The maximum entry age limit for adults in this product is 65 years.","sources":[{"clause":"1.2","heading":null,"page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/178#c-1-2"}],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"not-stated","value":null,"display":null,"note":"No premium payment frequency is listed. The renewal clause refers to the grace period for an 'annual installment' and the Grace Period definition mentions monthly mode generically.","quote":null,"sources":[],"law":[]},{"key":"optional_covers","label":"Optional covers","section":"Cover","meaning":"Covers you can add for an extra premium. They change the answers above only if you buy them.","status":"not-stated","value":null,"display":null,"note":"No optional covers or add-ons are described in the documents.","quote":null,"sources":[],"law":[]},{"key":"grace_cover","label":"Cover during the grace period","section":"Renewal and rights","meaning":"Whether a claim during the grace period is paid.","status":"cross-checked","value":"Yes. Cover is available during the grace period.","display":"Yes","note":null,"quote":"c) Coverage is available during the grace period.","sources":[{"clause":"5.1.3","heading":"Renewal of Policy","page":13,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-5-1-3"}],"law":[]},{"key":"room_rent","label":"Room rent limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for the hospital room, or the room category allowed. If you take a costlier room, other bills can be cut in proportion.","status":"cross-checked","value":"Up to 2% of the Base Sum Insured per day.","display":"Up to 2% of Base Sum Insured per day","note":"From the prospectus benefit table (the wording points to the Policy Schedule). A costlier room leads to proportionate deduction of associated expenses.","quote":"Hospital accommodation- Room Rent/day | Maximum up to 2% of Base Sum Insured","sources":[{"clause":"Annexure V","heading":"Product Benefit Table","page":37,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/178#c-annexure-v"}],"law":[]},{"key":"room_category","label":"Room category allowed","section":"Limits and co-pay","meaning":"Shared room, single private room or any room, by plan, when the limit is a room type rather than a rupee amount.","status":"not-applicable","value":null,"display":null,"note":"The room limit is a percentage of the sum insured per day (2% of Base Sum Insured), not a room type.","quote":null,"sources":[],"law":[]},{"key":"icu_limit","label":"ICU limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for intensive care.","status":"cross-checked","value":"Double the room rent limit, up to 4% of the Base Sum Insured per day.","display":"Up to 4% of Base Sum Insured per day","note":"From the prospectus benefit table.","quote":"Hospital accommodation- ICU/day | Double of Room Rent. Maximum up to 4% of Base Sum Insured","sources":[{"clause":"Annexure V","heading":"Product Benefit Table","page":37,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/178#c-annexure-v"}],"law":[]},{"key":"proportionate_deduction","label":"Proportionate deduction","section":"Limits and co-pay","meaning":"If you choose a room above your limit, whether the insurer reduces associated charges (doctor fees, tests, procedures) by the same proportion.","status":"cross-checked","value":"Yes. If the room exceeds the eligible limit, room rent, nursing, doctors' fees and operation theatre charges are paid in the ratio of eligible to actual room rent.","display":"Yes","note":"Not applied where the hospital does not follow differential billing by room category. The CIS applies it to Room/ICU/ICCU rent.","quote":"If the Insured Person is admitted in a Hospital room where the room category opted or Room Rent incurred is higher than the eligibility as specified in the Policy Schedule, then We shall be liable to pay only a pro-rated portion of the total Associated Medical Expenses ... Associated Medical Expenses shall include Room Rent, nursing charges, Medical Practitioners’ fees and operation theatre charges. Proportionate deductions will not be applied If the claim is of a hospital which do not follow differential billing","sources":[{"clause":"3.1","heading":"Inpatient Care","page":5,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-3-1"}],"law":[]},{"key":"copay","label":"Co-payment","section":"Limits and co-pay","meaning":"The share of every admissible claim you pay yourself, and when it applies (age, zone, choice of hospital).","status":"cross-checked","value":"A flat 20% co-payment applies on each claim.","display":"20% on every claim","note":"Not applied to ground ambulance or to claims under the specified illness sub-limits. The CIS also states 20% on each and every claim.","quote":"Co-payment | Flat 20% on each claim ... Note: Co-payment will NOT apply to Emergency Ground Ambulance- within India (Section 3.8) and to Sub-limit on Specified Illness/Conditions (Section 3.2)","sources":[{"clause":"Annexure V","heading":"Product Benefit Table","page":37,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/178#c-annexure-v"},{"clause":"3.9","heading":"Co-Payment","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-3-9"}],"law":[]},{"key":"deductible","label":"Deductible","section":"Limits and co-pay","meaning":"An amount of each claim or each year that you bear before the policy pays.","status":"cross-checked","value":"No deductible.","display":"None","note":"From the CIS.","quote":"iii. Annual Aggregate Deductible - NA","sources":[{"clause":"20(c)","heading":null,"page":4,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/179#c-20-c"}],"law":[]},{"key":"disease_sublimits","label":"Disease or procedure sub-limits","section":"Limits and co-pay","meaning":"Caps on what is paid for named treatments (cataract, knee replacement...), even if the sum insured is higher.","status":"cross-checked","value":["Appendectomy: INR 32,000","Cataract per eye including Cost of Lens: INR 18,000","Cholecystectomy: INR 26,000","Hernioplasty/Herniorraphy- Unilateral: INR 32,000","Hernioplasty/Herniorraphy- Bilateral: INR 37,000","Hydrocele: INR 18,000","Hysterectomy (Abdominal/Vaginal): INR 40,000","Total Knee Replacement (Unilateral): INR 72,000","Total Knee Replacement (Bilateral): INR 1,09,000","Haemorrhoidectomy: INR 29,000","PCNL- Unilateral: INR 37,000","PCNL- Bilateral: INR 43,000","Valve Replacement: INR 1,45,000","Temporary Pacemaker Implantation: INR 14,000","Hip Replacement (Unilateral): INR 72,000","Hip Replacement (Bilateral): INR 1,09,000","Arthroscopic Surgery (Other Than ACL / Meniscectomy): INR 29,000","Angioplasty: INR 1,09,000","Coronary Artery Bypass Graft (CABG): INR 1,45,000","Robotic surgeries: INR 1 Lac (except listed ones)"],"display":"Fixed rupee caps on named procedures (e.g. cataract INR 18,000 per eye, CABG INR 1,45,000) and INR 1 Lac on most robotic surgeries","note":"Caps include implants, lens, mesh or stapler costs as listed. The robotic surgery cap does not apply to robotic total radical prostatectomy, cardiac surgeries, partial nephrectomy and surgeries for malignancies. Co-payment does not apply to the specified illness sub-limits.","quote":"Appendectomy | 32,000 Cataract per eye including Cost of Lens | 18,000 Cholecystectomy | 26,000 Hernioplasty/Herniorraphy- Unilateral including cost of mesh and tacker | 32,000 Hydrocele | 18,000 Hysterectomy (Abdominal/Vaginal) | 40,000 ... Total Knee Replacement (Unilateral) including cost of implants | 72,000 Total Knee Replacement (Bilateral) including cost of implants | 1,09,000 Haemorrhoidectomy including Cost of stapler | 29,000 PCNL- Unilateral | 37,000 Valve Replacement including cost of implants | 1,45,000 ... Hernioplasty/Herniorraphy- Bilateral including Cost of mesh and tacker | 37,000 PCNL- Bilateral | 43,000 Temporary Pacemaker Implantation including cost of temporary pacemaker | 14,000 ... Hip Replacement (Unilateral) including cost of implants | 72,000 Hip Replacement (Bilateral) including cost of implants | 1,09,000 Arthroscopic Surgery ( Other Than ACL / Meniscectomy) | 29,000 ... Angioplasty including cost of implants and angiography | 1,09,000 Coronary Artery Bypass Graft (CABG) | 1,45,000 ... A limit of maximum INR 1 Lac will apply to all robotic surgeries, except the following: ... Co-payment will NOT apply to Emergency Ground Ambulance- within India (Section 3.8) and to Sub-limit on Specified Illness/Conditions (Section 3.2)","sources":[{"clause":"Annexure III","heading":"List of Sub-limits on Specified Illness/Conditions","page":28,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-annexure-iii"},{"clause":"3.3","heading":"Modern Treatments","page":6,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-3-3"},{"clause":"3.9","heading":"Co-Payment","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-3-9"}],"law":[]},{"key":"pre_hospitalisation","label":"Pre-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days before admission that are paid if related to the hospitalisation.","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days","note":"Only if the in-patient claim is accepted; reimbursement basis only.","quote":"We will pay expenses incurred on consultations, medicines, physiotherapy, diagnostic tests for 30 days before the date of admission","sources":[{"clause":"3.5","heading":"Pre-hospitalization Medical Expenses & Post-Hospitalization Medical Expenses","page":7,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-3-5"}],"law":[]},{"key":"post_hospitalisation","label":"Post-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days after discharge that are paid if related to the hospitalisation.","status":"cross-checked","value":{"unit":"days","amount":60},"display":"60 days","note":"Only if the in-patient claim is accepted; reimbursement basis only.","quote":"We will pay expenses incurred on consultations, medicines, physiotherapy, diagnostic tests for 30 days before the date of admission and 60 days after date of discharge","sources":[{"clause":"3.5","heading":"Pre-hospitalization Medical Expenses & Post-Hospitalization Medical Expenses","page":7,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-3-5"}],"law":[]},{"key":"day_care","label":"Day-care treatments","section":"Cover","meaning":"Treatments needing less than 24 hours in hospital (chemotherapy, dialysis, cataract) and whether all or only listed ones are covered.","status":"cross-checked","value":"Listed day care treatments (Annexure IV) are covered up to the Base Sum Insured.","display":"Listed day care treatments, up to Base Sum Insured","note":"OPD treatment and diagnostic services are not covered under this benefit.","quote":"The list of admissible Day Care Treatment would be as per the list attached in Annexure IV ... Day Care Treatment | Covered up to Base Sum Insured ... We shall not cover any OPD Treatment and Diagnostic Services under this Benefit.","sources":[{"clause":"3.4","heading":"Day Care Treatment","page":7,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-3-4"},{"clause":"Annexure V","heading":"Product Benefit Table","page":37,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/178#c-annexure-v"}],"law":[]},{"key":"domiciliary","label":"Treatment at home","section":"Cover","meaning":"Whether treatment at home is covered when hospital admission is not possible or a doctor advises it.","status":"cross-checked","value":"Yes. Home care treatment on a doctor's advice is covered, up to 10% of the Base Sum Insured.","display":"Yes, up to 10% of Base Sum Insured","note":"Needs daily monitoring by a doctor and a signed daily chart. Home medical devices are not paid. The CIS coverage row says 'covered up to Sum Insured' but its financial limits say 10% of Base Sum Insured.","quote":"The medical practitioner advices the insured person to undergo treatment at home ... Domiciliary Hospitalization | Maximum Up to 10% of Base Sum Insured","sources":[{"clause":"3.6.1","heading":"The medical practitioner advices the insured person to undergo treatment at home","page":7,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-3-6-1"},{"clause":"Annexure V","heading":"Product Benefit Table","page":37,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/178#c-annexure-v"}],"law":[]},{"key":"ayush","label":"AYUSH treatment","section":"Cover","meaning":"Ayurveda, Yoga, Unani, Siddha and Homeopathy treatment in a recognised hospital, and any limit.","status":"cross-checked","value":"Not covered. AYUSH (Ayurvedic, Homeopathic, Unani, Yoga and Siddha) treatment is excluded.","display":"Not covered","note":"The wording's preamble says 'This Policy covers Allopathic and AYUSH treatments taken in India ONLY', but no AYUSH benefit is described and the specific exclusion (repeated in the CIS) removes it.","quote":"Any form of Alternate Treatment ... a) Ayurvedic, Homeopathic, Unani, Yoga and Siddha streams of treatment;","sources":[{"clause":"4.2.6","heading":"Any form of Alternate Treatment","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-2-6"}],"law":[{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 1","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 2","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 1","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II A.I(1)","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"modern_treatments","label":"Modern treatments","section":"Cover","meaning":"Robotic surgery, immunotherapy, oral chemotherapy, stem cell therapy and the like, and any cap on them.","status":"cross-checked","value":"Covered up to the Base Sum Insured, including robotic surgery, oral chemotherapy, immunotherapy and stem cell therapy; most robotic surgeries are capped at INR 1 Lac.","display":"Covered up to Base Sum Insured; robotic surgery capped at INR 1 Lac","note":"The robotic cap does not apply to robotic total radical prostatectomy, cardiac surgeries, partial nephrectomy and surgeries for malignancies.","quote":"iv) Oral chemotherapy v) Immunotherapy- Monoclonal Antibody to be given as injection ... vii) Robotic surgeries ... xii) Stem cell therapy: ... A limit of maximum INR 1 Lac will apply to all robotic surgeries, except the following: ... Modern Treatments | Covered up to Base Sum Insured.","sources":[{"clause":"3.3","heading":"Modern Treatments","page":6,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-3-3"},{"clause":"Annexure V","heading":"Product Benefit Table","page":37,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/178#c-annexure-v"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 2","url":"https://indiainsurances.com/law/irdai-health-mc-2024"}]},{"key":"organ_donor","label":"Organ donor expenses","section":"Cover","meaning":"Whether the donor's hospital costs for an organ transplant are paid.","status":"cross-checked","value":"Yes. The living donor's inpatient costs for harvesting the organ are covered up to the Base Sum Insured.","display":"Yes, up to Base Sum Insured","note":"Donor's pre/post hospitalisation, screening, acquisition costs and complications are not covered; the recipient's claim must be accepted. The same clause also lists 'The living organ donor's stay in a Hospital that is needed for them to donate their organ' as not covered.","quote":"We will indemnify the Medical Expenses incurred for a living organ donor’s Inpatient treatment for the harvesting of the organ donated during the Policy Period. ... Organ Transplant | Covered up to Base Sum Insured","sources":[{"clause":"3.7","heading":"Organ Transplant","page":8,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-3-7"},{"clause":"Annexure V","heading":"Product Benefit Table","page":37,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/178#c-annexure-v"}],"law":[]},{"key":"ambulance","label":"Ambulance cover","section":"Cover","meaning":"Road (and air) ambulance cover and its limit.","status":"cross-checked","value":"Road ambulance up to INR 1,000 per hospitalisation, one transfer per hospitalisation.","display":"Road ambulance up to INR 1,000 per hospitalisation","note":"Only by surface transport and only if the inpatient claim is accepted. No air ambulance is described. Co-payment does not apply.","quote":"Emergency Ground Ambulance- Within India | Up to INR 1,000 per hospitalization ... c) This Benefit is available for only one transfer per period of Hospitalization. ... Co-payment will NOT apply to Emergency Ground Ambulance- within India (Section 3.8)","sources":[{"clause":"Annexure V","heading":"Product Benefit Table","page":37,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/178#c-annexure-v"},{"clause":"3.8","heading":"Emergency Ground Ambulance- within India","page":8,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-3-8"},{"clause":"3.9","heading":"Co-Payment","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-3-9"}],"law":[]},{"key":"restoration","label":"Restoration of sum insured","section":"Cover","meaning":"Whether the sum insured is refilled after it is used up in a year, how much, how often, and whether it works for the same illness.","status":"not-stated","value":null,"display":null,"note":"No restoration or recharge of the sum insured is described.","quote":null,"sources":[],"law":[]},{"key":"no_claim_bonus","label":"No-claim or cumulative bonus","section":"Cover","meaning":"How much the cover grows each year, the maximum, whether it depends on not claiming, and what happens after a claim.","status":"not-stated","value":null,"display":null,"note":"Only the standard Cumulative Bonus definition appears; no bonus rate is given for this product.","quote":null,"sources":[],"law":[]},{"key":"consumables","label":"Consumables and non-medical items","section":"Cover","meaning":"Gloves, PPE, syringes and other items hospitals bill that standard policies exclude; whether this policy pays them.","status":"cross-checked","value":"Not covered. Items in Annexure I List I (such as gloves and masks) are not paid; only allowable consumables are payable.","display":"Not covered (non-payable items list applies)","note":"Inpatient cover includes 'allowable consumables'.","quote":"The expenses that are not covered or subsumed into room charges / procedure charges / costs of treatment are placed as Annexure I. ... List I – Expenses not covered ... | GLOVES ... | MASK ... Intravenous fluids, blood transfusion, injection administration charges, allowable consumables and / or enteral feedings.","sources":[{"clause":"5.2.4(c)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-5-2-4-c"},{"clause":"5.2.8","heading":"Assignment","page":20,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-5-2-8"},{"clause":"3.1","heading":"Inpatient Care","page":5,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-3-1"}],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Whether childbirth costs are covered, the limit and the waiting period.","status":"cross-checked","value":"Not covered. Childbirth and termination of pregnancy expenses are excluded (Excl18).","display":"Not covered","note":"Ectopic pregnancy is not excluded.","quote":"Maternity Expenses (Code-Excl18) ... a) Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during Hospitalization) except ectopic pregnancy;","sources":[{"clause":"4.1.17","heading":"Maternity Expenses (Code-Excl18)","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-1-17"}],"law":[]},{"key":"newborn","label":"Newborn baby cover","section":"Cover","meaning":"Whether a newborn is covered from birth and for what.","status":"not-stated","value":null,"display":null,"note":"No newborn cover is described. Maternity is excluded (Excl18) and the prospectus gives a minimum entry age of 18 years.","quote":null,"sources":[],"law":[]},{"key":"mental_illness","label":"Mental illness","section":"Cover","meaning":"Cover for in-patient treatment of mental illness.","status":"not-stated","value":null,"display":null,"note":"Mental illness treatment is not mentioned.","quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 3","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch III I","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(4)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 2(1)(s)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(1)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"}]},{"key":"health_checkup","label":"Health check-up","section":"Cover","meaning":"Free preventive check-ups and how often.","status":"not-stated","value":null,"display":null,"note":"No preventive health check-up is described.","quote":null,"sources":[],"law":[]},{"key":"opd","label":"Out-patient (OPD) cover","section":"Cover","meaning":"Doctor consultations, tests and medicines without admission, and the limit.","status":"cross-checked","value":"Not covered.","display":"Not covered","note":null,"quote":"Any OPD Treatment is not covered.","sources":[{"clause":"4.2.7","heading":"OPD Treatment","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-4-2-7"}],"law":[]},{"key":"zone_pricing","label":"Zone or city-based premium","section":"Premium","meaning":"Whether premium or co-pay depends on the city you are treated in.","status":"not-stated","value":null,"display":null,"note":"The documents do not mention zone-based premium or co-payment.","quote":null,"sources":[],"law":[]},{"key":"cashless","label":"Cashless treatment","section":"Claims","meaning":"Whether and where the insurer pays the hospital directly instead of you paying and claiming back.","status":"cross-checked","value":"Yes, at network hospitals; the insurer also offers 'Cashless Everywhere', including non-network hospitals.","display":"Yes, network hospitals and Cashless Everywhere","note":"The two sentences of the wording point in different directions; the process for non-network cashless is on the insurer's website.","quote":"a) Cashless claim facility is available at our network hospitals ONLY. ... ii) We offer Cashless Everywhere, even in hospitals which are not part of our network.","sources":[{"clause":"5.2.4(a)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-5-2-4-a"},{"clause":"5.2.4(e)(ii)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177#c-5-2-4-e-ii"}],"law":[]},{"key":"claims_handled_by","label":"Claims handled by","section":"Claims","meaning":"The insurer itself or a third-party administrator (TPA).","status":"not-stated","value":null,"display":null,"note":"The documents do not say whether claims are handled in-house or by a TPA.","quote":null,"sources":[],"law":[]},{"key":"family_floater","label":"Family floater available","section":"Cover","meaning":"Whether one sum insured can be shared by the whole family.","status":"cross-checked","value":false,"display":"No, individual policies only","note":"The benefit illustration shows the family floater columns as NA. Clause 5.2.3(a) still mentions a 'Floater plan' for premium calculation.","quote":"Health+ can be issued to individual customers only.","sources":[{"clause":"1.1","heading":null,"page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/178#c-1-1"}],"law":[]}],"documents":[{"kind":"wording","label":"Health+ Policy Wording","pages":45,"fetched_at":"2026-10-16 07:11:41.938836+00","source_url":"https://transactions.nivabupa.com/pages/doc/policy_wording/Healthplus_Policy_Wordings.pdf?v=1.4","url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/177"},{"kind":"prospectus","label":"Health+ Prospectus","pages":38,"fetched_at":"2026-10-16 07:11:41.938836+00","source_url":"https://transactions.nivabupa.com/pages/doc/prospectus/Healthplus_Prospectus_cum_Sales_Literature.pdf?v=1.4","url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/178"},{"kind":"cis","label":"Health+","pages":11,"fetched_at":"2026-10-16 07:11:41.938836+00","source_url":"https://transactions.nivabupa.com/pages/doc/Customer-Information/CIS_HealthPulsePulse.pdf?v=1.2","url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324/document/179"}],"versions":[],"where_to_buy":[],"claims_and_complaints":[],"notice":"Information, not advice. IndiaInsurances is not an insurer or an insurance intermediary, does not sell insurance and earns no commission. Policy terms change and your own policy schedule can differ: always confirm with the policy document and the insurer before you buy or claim.","cite_as":"Health+ (UIN NBHHLIP24135V012324), IndiaInsurances, https://indiainsurances.com/policy/niva-bupa-health-insurance/health-nbhhlip24135v012324"}