{"uin":"NBHHLIP25041V012425","name":"Rise","url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425","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":"Rise is a Niva Bupa health indemnity policy covering hospitalisation of 2 hours or more in India only, with a twin sharing room, 60 days pre and 180 days post hospitalisation, a yearly Re-fill of the base sum insured and a 10% yearly Loyalty Bonus up to 100%. Treatment outside the Rise-Tiered Network hospital list carries a flat 20% co-payment, modern treatments are capped at INR 50,000 per claim, and the waiting periods are 30 days, 24 months for listed illnesses and 36 months for pre-existing diseases.","analysis":{"state":"extracted","analysed_at":"2026-10-16 07:11:57.009727+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":"not-stated","value":null,"display":null,"note":"The documents describe one product (Rise) with optional covers; no named plans or variants are printed. It can be issued on an individual or family floater basis.","quote":null,"sources":[],"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":"One year by default; two-year and three-year policy terms are also available.","display":"1 year (2 and 3 year terms available)","note":"From the prospectus; the policy wording does not state the term apart from Flexi-Pay timelines for 1, 2 and 3 year tenures.","quote":"The default policy term for all plans is one year. Two year and three-year policy term options are also available under the product.","sources":[{"clause":"1","heading":"Policy Design","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/181#c-1"}],"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 documents MUST be submitted at the earliest possible time' and delays are condoned on merits.","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 hospital bill, lab reports, MLC/FIR for accidents, KYC documents, cancelled cheque","note":"Documents within the Deductible amount must also be submitted if a deductible applies.","quote":"• 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":"8.2.4(b)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-8-2-4-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; delay attracts interest at 2% above bank rate.","display":"Within 15 days of claim submission","note":"Cashless final bill authorisation within three hours of the discharge request (CIS and wording 8.2.4(e)); CIS gives 1 hour for cashless pre-authorisation.","quote":"I) The Company shall settle or reject a claim, as the case may be, within 15 days from the claim ... at a rate of 2% above the bank rate.","sources":[{"clause":"8.1.9(I)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-8-1-9-i"}],"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): 36 months","Specified disease/procedure waiting period (Excl02): 24 months","30-day waiting period (Excl03)","Personal Waiting Period of up to 48 months for conditions specified for an Insured Person","Investigation & Evaluation (Excl04)","Rest Cure, rehabilitation and respite care (Excl05)","Obesity/ Weight Control (Excl06)","Cosmetic or plastic Surgery (Excl08)","Alcoholism, drug or substance abuse (Excl12)","Sterility and Infertility (Excl17)","Maternity Expenses (Excl18)","Conflict & Disaster","External Congenital Anomaly","All dental treatments other than due to accidents and cancers","Treatment taken under any Out Patient Department"],"display":"Waiting periods (PED 36 months, listed illnesses 24 months, first 30 days, personal waiting up to 48 months), standard IRDAI exclusions, maternity, infertility, war, external congenital anomaly, dental, OPD","note":"PED and specific waiting periods can be changed by optional covers (see ped_waiting, specific_waiting). The full list also covers professional hazardous or adventure sports (Excl09), breach of law (Excl10), excluded providers, spas, refractive error, unproven treatment, unrecognised doctors or hospitals, non-medically necessary costs and artificial life maintenance.","quote":"7.1.1 Pre-existing Diseases (Code–Excl01) ... until the expiry of 36 months of continuous coverage ... 7.1.2 Specified disease/procedure waiting period (Code- Excl02) ... until the expiry of 24 months of continuous coverage ... 30-day waiting period (Code- Excl03) ... 7.1.4 Investigation & Evaluation (Code-Excl04) ... 7.1.5 Rest Cure, rehabilitation and respite care (Code-Excl05) ... 7.1.6 Obesity/ Weight Control (Code-Excl06) ... 7.1.7 Cosmetic or plastic Surgery (Code-Excl08) ... Treatment for, alcoholism, drug or substance abuse or any addictive condition and consequences thereof. (Code-Excl12) ... 7.1.15 Sterility and Infertility (Code-Excl17) ... 7.1.16 Maternity Expenses (Code-Excl18) ... Conditions specified for an Insured Person under Personal Waiting Period will be subject to a Waiting Period of up to 48 months ... 7.2.2 Conflict & Disaster ... Screening, counseling or treatment related to external Congenital Anomaly. ... All dental treatments other than due to accidents and cancers. ... Treatment taken under any Out Patient Department","sources":[{"clause":"7.1.1","heading":"Pre-existing Diseases (Code–Excl01)","page":14,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-1-1"},{"clause":"7.1.2","heading":"Specified disease/procedure waiting period (Code- Excl02)","page":14,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-1-2"},{"clause":"7.1.3","heading":"30-day waiting period","page":15,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-1-3"},{"clause":"7.1.4","heading":"Investigation & Evaluation (Code-Excl04)","page":15,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-1-4"},{"clause":"7.1.5","heading":"Rest Cure, rehabilitation and respite care (Code-Excl05)","page":15,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-1-5"},{"clause":"7.1.6","heading":"Obesity/ Weight Control (Code-Excl06)","page":15,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-1-6"},{"clause":"7.1.7","heading":"Cosmetic or plastic Surgery (Code-Excl08)","page":15,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-1-7"},{"clause":"7.1.11","heading":"Treatment for, alcoholism, drug or substance abuse or any addictive condition and consequences thereof.","page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-1-11"},{"clause":"7.1.15","heading":"Sterility and Infertility (Code-Excl17)","page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-1-15"},{"clause":"7.1.16","heading":"Maternity Expenses (Code-Excl18)","page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-1-16"},{"clause":"7.2.1","heading":"Personal Waiting Period","page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-2-1"},{"clause":"7.2.2","heading":"Conflict & Disaster","page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-2-2"},{"clause":"7.2.3","heading":"External Congenital Anomaly","page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-2-3"},{"clause":"7.2.4","heading":"Dental treatment","page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-2-4"},{"clause":"7.2.8","heading":null,"page":17,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-2-8"}],"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 services (website www.nivabupa.com, toll-free 1860-500-8888, service platform, fax, courier or any branch grievance cell); if not satisfied, the grievance officer (Head, Customer Services) and then GRO@nivabupa.com, before the Insurance Ombudsman.","display":"Niva Bupa customer services (1860-500-8888), then Head of Customer Services, then GRO@nivabupa.com","note":"Senior citizens may write to seniorcitizensupport@nivabupa.com. Grievances may also be lodged on the IRDAI Bima Bharosa portal.","quote":"ln case of any grievance the insured person may contact the company through: ... 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. ... the insured person may also approach the office of insurance Ombudsman","sources":[{"clause":"8.1.8","heading":"Redressal of Grievance","page":20,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-8-1-8"}],"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":"conflicting","value":"Base Sum Insured of 1L, 2L, 3L, 5L, 7.5L, 10L, 15L, 20L, 25L, 50L, 75L or 1Cr.","display":"1L, 2L, 3L, 5L, 7.5L, 10L, 15L, 20L, 25L, 50L, 75L, 1Cr","note":"From the prospectus benefit table; the policy wording prints no amounts. The prospectus text also says 'The coverage options start from INR 50,000 up to INR 1 Crore'. CIS says: '3 Lacs, 5 Lacs, 7.5 Lacs, 10 Lacs, 15 Lacs, 20 Lacs, 25 Lacs, 50 Lacs, 100 Lacs' (no 1L, 2L or 75L).","quote":"Base Sum Insured | 1L, 2L, 3L, 5L, 7.5L, 10L, 15L, 20L, 25L, 50L, 75L, 1Cr ... Sum Insured Options are: 3 Lacs, 5 Lacs, 7.5 Lacs, 10 Lacs, 15 Lacs, 20 Lacs, 25 Lacs, 50 Lacs, 100 Lacs","sources":[{"clause":null,"heading":"Product Benefit Table","page":29,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/181#c-product-benefit-table"},{"clause":"Row 4","heading":"Sum Insured","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/182#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 covered from day 1. Does not apply if the person has continuous coverage for more than twelve months.","quote":"a) 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.","sources":[{"clause":"7.1.3","heading":"30-day waiting period","page":15,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-1-3"}],"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":"cross-checked","value":{"unit":"months","amount":36},"display":"36 months","note":"Optional Pre-Existing Disease Waiting Time Modification at purchase: the prospectus table says 'Choose to reduce to 12 month or 24 months' (the wording says reduce or increase). Reduced by prior continuous cover on portability.","quote":"a) 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. ... Pre-Existing Disease Wait Time Modification | Choose to reduce to 12 month or 24 months.","sources":[{"clause":"7.1.1","heading":"Pre-existing Diseases (Code–Excl01)","page":14,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-1-1"},{"clause":null,"heading":"Optional Benefits","page":29,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/181#c-optional-benefits"}],"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":"cross-checked","value":{"unit":"months","amount":24},"display":"24 months","note":"Optional Specific Disease Wait Time Modification at purchase: 'Choose to increase to 36 months or reduce to 12 months' (prospectus). Separate Personal Waiting Period of up to 48 months for conditions named for an insured person.","quote":"a) Expenses related to the treatment of the listed conditions, surgeries/treatments shall be excluded until the expiry of 24 months of continuous coverage after the date of inception of the first Policy. This exclusion shall not be applicable for claims arising due to an Accident (covered from day 1) or Cancer (covered after 30-day waiting period). ... Specific Disease Wait Time Modification | Choose to increase to 36 months or reduce to 12 months ... Conditions specified for an Insured Person under Personal Waiting Period will be subject to a Waiting Period of up to 48 months","sources":[{"clause":"7.1.2","heading":"Specified disease/procedure waiting period (Code- Excl02)","page":14,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-1-2"},{"clause":null,"heading":"Optional Benefits","page":29,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/181#c-optional-benefits"},{"clause":"7.2.1","heading":"Personal Waiting Period","page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-2-1"}],"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":"cross-checked","value":["Pancreatitis and stones in biliary and urinary system","Cataract, glaucoma and retinal detachment","Hyperplasia of prostate, hydrocele and spermatocele","Prolapse uterus or cervix, endometriosis, Fibroids, Polycystic ovarian disease (PCOD), hysterectomy (unless necessitated by Malignancy)","Hemorrhoids, fissure, fistula or abscess of anal and rectal region","Hernia of any site or type","Osteoarthritis, joint replacement, osteoporosis, systemic connective tissue disorders, inflammatory polyarthropathies, Rheumatoid Arthritis, gout, intervertebral disc disorders, arthroscopic surgeries for ligament repair","Varicose veins of lower extremities","All internal or external benign neoplasms/tumours, cyst, sinus, polyps, nodules, mass or lump","Ulcer, erosion or varices of gastro intestinal tract","Surgical treatment for diseases of middle ear and mastoid (including otitis media, cholesteatoma, perforation of tympanic membrane), Tonsils and adenoids, nasal septum and nasal sinuses"],"display":"Stones, cataract, prostate, uterine conditions and hysterectomy, piles and fistula, hernia, joint and spine disorders, varicose veins, benign tumours and cysts, GI ulcers, ENT surgery","note":null,"quote":"i) Pancreatitis and stones in biliary and urinary system ii) Cataract, glaucoma and retinal detachment iii) Hyperplasia of prostate, hydrocele and spermatocele iv) Prolapse uterus or cervix, endometriosis, Fibroids, Polycystic ovarian disease (PCOD), hysterectomy (unless necessitated by Malignancy) v) Hemorrhoids, fissure, fistula or abscess of anal and rectal region vi) Hernia of any site or type, vii) Osteoarthritis, joint replacement, osteoporosis, systemic connective tissue disorders, inflammatory polyarthropathies, Rheumatoid Arthritis, gout, intervertebral disc disorders, arthroscopic surgeries for ligament repair viii) Varicose veins of lower extremities ix) All internal or external benign neoplasms/tumours, cyst, sinus, polyps, nodules, mass or lump x) Ulcer, erosion or varices of gastro intestinal tract xi) Surgical treatment for diseases of middle ear and mastoid (including otitis media, cholesteatoma, perforation of tympanic membrane), Tonsils and adenoids, nasal septum and nasal sinuses","sources":[{"clause":"7.1.2","heading":"Specified disease/procedure waiting period (Code- Excl02)","page":14,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-1-2"}],"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":"cross-checked","value":{"unit":"months","amount":60},"display":"60 months","note":"Applies afresh to enhanced sum insured from the date of enhancement. The wording text is interleaved with a side column.","quote":"After completion of sixty continuous months of coverage (including portability and migration) in ... no policy and claim shall be contestable by the insurer on the grounds ... of non-disclosure, misrepresentation, except on grounds of established fraud.","sources":[{"clause":"8.1.10","heading":null,"page":21,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-8-1-10"}],"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, transferring credits for sum insured, no claim bonus, specific waiting periods, pre-existing disease waiting period and moratorium.","display":"Yes, with credit for waiting periods","note":"Subject to the Board approved underwriting policy of the insurers. Migration to another Niva Bupa product is also allowed.","quote":"A Policyholder has the choice to port his/ her policies from one Insurer to another ... 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","sources":[{"clause":"8.1.13","heading":null,"page":22,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-8-1-13"}],"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 cover ceasing age","note":"From the prospectus. Renewal can be refused only on grounds of established fraud or non-disclosure or misrepresentation.","quote":"There is no maximum cover ceasing age on renewals.","sources":[{"clause":"1","heading":"Policy Design","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/181#c-1"}],"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 loading on renewal based on individual claims. A Favourable Claim Experience Discount of up to 39% on the renewal premium moves down the grid after claims above INR 40,000.","display":"No claim-based loading; claim-linked renewal discount","note":"Discount grid runs from 39% (Level -3) to 0% (Level 10); new policies start at Level 0 with 30%. A no-claim year moves up one level; claims above INR 40,000, 75,000 and 1,50,000 move down 1, 2 or 3 levels. Any underwriting risk loading applied at issue continues at all renewals.","quote":"d) No loading shall apply on renewals based on individual claims experience. ... Favourable Claim Experience Discount: You will get a discount on your policy of up to 39% on the renewal premium basis the value of the claims paid in a policy year. ... Claim up to INR 40,000 | Stays in the same level ... More than INR 40,000- and up to INR 75,000 | Moves down the grid by 1 level ... More than INR 75,000- and up to INR 1,50,000 | Moves down the grid by 2 levels ... More than INR 1,50,000 | Moves down the gird by 3 levels","sources":[{"clause":"8.1.3","heading":null,"page":18,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-8-1-3"},{"clause":"1","heading":"Policy Design","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/181#c-1"}],"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)","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)","Health hydros, nature cure clinics, spas (Excl13)","Refractive Error (Excl15)","Unproven Treatments (Excl16)","Sterility and Infertility (Excl17)","Maternity Expenses (Excl18)","Conflict & Disaster","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 brain dead or vegetative state","Treatment taken under any Out Patient Department"],"display":"Standard exclusions Excl04 to Excl18 as printed, plus war, external congenital anomaly, dental, unrecognised providers, non-medically necessary costs, artificial life maintenance and OPD","note":"Excl07 and Excl14 are not printed in this policy. The optional Return / Return+ sum insured can pay for claims rejected under listed exclusions, except Maternity, IVF, OPD, Alcoholism, Cosmetics, Fraud, Misrepresentation and Non-disclosures.","quote":"7.1.4 Investigation & Evaluation (Code-Excl04) ... 7.1.5 Rest Cure, rehabilitation and respite care (Code-Excl05) ... 7.1.6 Obesity/ Weight Control (Code-Excl06) ... 7.1.7 Cosmetic or plastic Surgery (Code-Excl08) ... 7.1.8 Hazardous or Adventure sports (Code-Excl09) ... 7.1.9 Breach of law (Code-Excl10) ... 7.1.10 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) ... 7.1.13 Refractive Error (Code-Excl15) ... 7.1.14 Unproven Treatments (Code-Excl16) ... 7.1.15 Sterility and Infertility (Code-Excl17) ... 7.1.16 Maternity Expenses (Code-Excl18) ... 7.2.2 Conflict & Disaster ... 7.2.3 External Congenital Anomaly ... All dental treatments other than due to accidents and cancers. ... 7.2.5 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 ... Treatment taken under any Out Patient Department","sources":[{"clause":"7.1.4","heading":"Investigation & Evaluation (Code-Excl04)","page":15,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-1-4"},{"clause":"7.1.5","heading":"Rest Cure, rehabilitation and respite care (Code-Excl05)","page":15,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-1-5"},{"clause":"7.1.6","heading":"Obesity/ Weight Control (Code-Excl06)","page":15,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-1-6"},{"clause":"7.1.7","heading":"Cosmetic or plastic Surgery (Code-Excl08)","page":15,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-1-7"},{"clause":"7.1.8","heading":"Hazardous or Adventure sports (Code-Excl09)","page":15,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-1-8"},{"clause":"7.1.9","heading":"Breach of law (Code-Excl10)","page":15,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-1-9"},{"clause":"7.1.10","heading":"Excluded Providers (Code-Excl11)","page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-1-10"},{"clause":"7.1.11","heading":"Treatment for, alcoholism, drug or substance abuse or any addictive condition and consequences thereof.","page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-1-11"},{"clause":"7.1.12","heading":null,"page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-1-12"},{"clause":"7.1.13","heading":"Refractive Error (Code-Excl15)","page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-1-13"},{"clause":"7.1.14","heading":"Unproven Treatments (Code-Excl16)","page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-1-14"},{"clause":"7.1.15","heading":"Sterility and Infertility (Code-Excl17)","page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-1-15"},{"clause":"7.1.16","heading":"Maternity Expenses (Code-Excl18)","page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-1-16"},{"clause":"7.2.2","heading":"Conflict & Disaster","page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-2-2"},{"clause":"7.2.3","heading":"External Congenital Anomaly","page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-2-3"},{"clause":"7.2.4","heading":"Dental treatment","page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-2-4"},{"clause":"7.2.5","heading":"Unrecognized Physician or Hospital","page":17,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-2-5"},{"clause":"7.2.6","heading":null,"page":17,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-2-6"},{"clause":"7.2.7","heading":null,"page":17,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-2-7"},{"clause":"7.2.8","heading":null,"page":17,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-2-8"}],"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 may cancel at any time with 7 days' written notice. For a policy term up to one year, proportionate premium for the unexpired period is refunded if no claim was made; for longer terms, premium for policy years not yet commenced is refunded. No refund if a claim has been paid.","display":"Proportionate refund for the unexpired period if no claim; 7 days' notice","note":"Clause (b) and the 'no refund after a claim' note are quoted from the prospectus because the wording prints them interleaved with a side column.","quote":"The policy holder may cancel his/her policy at any time during the term, by giving 7 days’ notice in ... a) Refund proportionate premium for unexpired policy period, if the term of the policy up to 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":"8.1.2","heading":"Cancellation","page":17,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-8-1-2"},{"clause":"8.1.2(a)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-8-1-2-a"},{"clause":"6.1.2","heading":"Cancellation","page":14,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/181#c-6-1-2"},{"clause":null,"heading":"Simplified for you","page":14,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/181#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 only.","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/rise-nbhhlip25041v012425/document/180#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":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days","note":"Not available on renewals. Refund less proportionate risk premium, medical examination expenses and stamp duty.","quote":"The insured person shall be allowed free look period of thirty days from date of receipt of the policy","sources":[{"clause":"8.1.1","heading":"Free Look Period | Free look","page":17,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-8-1-1"}],"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 (15 days for monthly instalments)","note":"Flexi-Pay: premiums should be paid within 10 months for 1-year tenure, 20 months for 2 years and 30 months for 3 years.","quote":"i) Grace Period of 30 days in all types of policies, and a period of 15 days in case of monthly instalments.","sources":[{"clause":"8.1.17","heading":"Premium Payment in Instalments","page":22,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-8-1-17"}],"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 18 to 99 years; dependent children 91 days to 30 years.","display":"91 days to 99 years (adults from 18)","note":"From the prospectus; the policy wording does not print entry ages.","quote":"This policy covers persons in the age group 91 days and 99 years. The minimum entry age for adult is 18 years and for dependent child is 91 days. The maximum entry age limit for adult is 99 years, and dependent child is 30 years.","sources":[{"clause":"1","heading":"Policy Design","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/181#c-1"}],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"cross-checked","value":["One time","Monthly","Quarterly","Half Yearly","Flexi-Pay"],"display":"One time, monthly, quarterly, half-yearly or Flexi-Pay","note":"Flexi-Pay: an enrollment premium, minimum monthly premiums and lump sums at any time, with earlier payment earning a higher discount (Annexure 4). Term discount does not apply to Flexi, monthly, half-yearly or quarterly payment.","quote":"1. One time: the complete premium for the policy tenure is paid up front. 2. Monthly: the policy premium for the complete tenure is paid on a monthly basis. 3. Quarterly: the policy premium for the complete tenure is paid on a quarterly basis. 4. Half Yearly: the policy premium for the complete tenure is paid in a half-yearly basis. 5. Flexi-Pay","sources":[{"clause":"6","heading":"Payment Methods","page":13,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-6"}],"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":"cross-checked","value":["Hospital Cash","Personal Accident","Safeguard","Safeguard+","Health Checkup (Only Cashless)","Health Checkup (Cashless & Reimbursement)","Second Medical Opinion","Co-Payment","Pre-Existing Disease Waiting Time Modification","Room Type Modification","Specific Disease Waiting Time Modification","Annual Aggregate Deductible","No Co-Pay Network","Modern Treatment+","Smart Cash+","Return+","ReAssure Forever"],"display":"Hospital Cash, Personal Accident, Safeguard, Safeguard+, health check-ups, room, waiting-period, co-pay and deductible options, Modern Treatment+, Smart Cash+, Return+, ReAssure Forever","note":"The same covers are listed in the CIS. Hospital Daily Cash INR 1000 per day up to 30 days; Personal Accident up to 5 times Base Sum Insured, maximum INR 1 Crore (prospectus). ReAssure Forever replaces the base Re-fill.","quote":"4.2.1 Hospital Cash ... 4.2.2 Personal Accident ... 4.2.3 Safeguard ... 4.2.4 Safeguard+ ... 4.2.5 Health Checkup (Only Cashless) ... 4.2.6 Health Checkup (Cashless & Reimbursement) ... 4.2.7 Second Medical Opinion ... 4.2.8 Co-Payment ... 4.2.9 Pre-Existing Disease Waiting Time Modification ... 4.2.10 Room Type Modification ... 4.2.11 Specific Disease Waiting Time Modification ... 4.2.12 Annual Aggregate Deductible ... 4.2.13 No Co-Pay Network ... 4.2.14 Modern Treatment+ ... 4.2.15 Smart Cash+ ... 4.2.16 Return+ ... 4.2.17 ReAssure Forever ... Hospital Daily Cash | Get INR 1000 per day for hospitalization. Maximum 30 days in a year. ... Personal Accident | Up to 5X of Base Sum Insured. Maximum up to INR 1 Crore ... If this benefit is opted, the base Re-fill benefit will be removed","sources":[{"clause":"4.2.1","heading":"Hospital Cash","page":7,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-2-1"},{"clause":"4.2.2","heading":"Personal Accident","page":8,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-2-2"},{"clause":"4.2.3","heading":"Safeguard","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-2-3"},{"clause":"4.2.4","heading":"Safeguard+","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-2-4"},{"clause":"4.2.5","heading":"Health Checkup (Only Cashless)","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-2-5"},{"clause":"4.2.6","heading":"Health Checkup (Cashless & Reimbursement)","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-2-6"},{"clause":"4.2.7","heading":"Second Medical Opinion","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-2-7"},{"clause":"4.2.8","heading":"Co-Payment","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-2-8"},{"clause":"4.2.9","heading":"Pre-Existing Disease Waiting Time Modification","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-2-9"},{"clause":"4.2.10","heading":"Room Type Modification","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-2-10"},{"clause":"4.2.11","heading":"Specific Disease Waiting Time Modification","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-2-11"},{"clause":"4.2.12","heading":"Annual Aggregate Deductible","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-2-12"},{"clause":"4.2.13","heading":"No Co-Pay Network","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-2-13"},{"clause":"4.2.14","heading":"Modern Treatment+","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-2-14"},{"clause":"4.2.15","heading":"Smart Cash+","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-2-15"},{"clause":"4.2.16","heading":"Return+","page":12,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-2-16"},{"clause":"4.2.17","heading":"ReAssure Forever","page":12,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-2-17"},{"clause":"4.2.17(c)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-2-17-c"},{"clause":null,"heading":"Optional Benefits","page":29,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/181#c-optional-benefits"}],"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":"The renewal clause says coverage is available during the grace period, and instalment policies are covered during the grace period; but a side note in the same clause says you are not insured during the grace period.","display":"Covered (wording contradicts itself)","note":"The policy wording and prospectus both print 'Coverage is available during the grace period' and 'You are NOT insured during the grace period' in the same renewal clause. Under Flexi-Pay, benefits cannot be used until missed minimum monthly payments are made, but claims in the inactive period are considered once the policy is made active.","quote":"c) Coverage is available during the grace period. ... Note: You are NOT insured during the grace period. ... ii) For policies where premium is paid in instalments only, the coverage will be given during grace period.","sources":[{"clause":"8.1.3","heading":null,"page":18,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-8-1-3"},{"clause":"8.1.17","heading":"Premium Payment in Instalments","page":22,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-8-1-17"}],"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":"Twin Sharing Room (any room with minimum 2 beds) is paid without co-payment; a higher room category attracts a 20% co-payment.","display":"Twin sharing room; 20% co-pay above it","note":"Optional Room Type Modification: General Ward (co-pay 20% or 30% for higher rooms), Single Private Room (20% for All Room Category) or All Room Category. Proportionate deduction of associated expenses also applies (8.2.4(d)).","quote":"We will pay for expenses incurred in a Twin Sharing Room (which means any room with minimum 2 beds), without any Co-Payment. ... Twin Sharing Room | Single Private Room | 20% ... Twin Sharing Room | All Room Category | 20%","sources":[{"clause":"4.1.2(a)","heading":null,"page":5,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-1-2-a"},{"clause":"4.2.10","heading":"Room Type Modification","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-2-10"}],"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":"cross-checked","value":"Twin Sharing Room by default; optionally General Ward, Single Private Room or All Room Category.","display":"Twin sharing room (optional General Ward, Single Private Room or any room)","note":"Room choice other than twin sharing is via the optional Room Type Modification cover.","quote":"We will pay for expenses incurred in a Twin Sharing Room (which means any room with minimum 2 beds), without any Co-Payment. ... You can choose between a General Ward (any room with 4 beds and more), Single Private Room or All Room Category.","sources":[{"clause":"4.1.2(a)","heading":null,"page":5,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-1-2-a"},{"clause":"4.2.10","heading":"Room Type Modification","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-2-10"}],"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":"ICU admission is paid up to the Sum Insured.","display":"Up to sum insured","note":null,"quote":"Admission in any ICU ward will always be paid up to Sum Insured.","sources":[{"clause":"4.1.2(a)","heading":null,"page":5,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-1-2-a"}],"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 is above the eligible category, only a pro-rated portion of associated medical expenses (room rent, nursing, doctors' fees, operation theatre charges) is paid.","display":"Yes, associated expenses pro-rated","note":"Separately, the Room Type Modification table and the prospectus benefit table charge a co-payment (20%, or 30% from General Ward to All Room Category) for a higher room.","quote":"d) If you opt for a Hospital room which is higher than the eligible room category as specified in your Policy Schedule, then We will pay only a pro-rated portion of the total Associated Medical Expenses (including surcharge or taxes thereon) as per the following formula: (Eligible Room Rent limit / Room Rent actually incurred) * total Associated Medical Expenses Associated Medical Expenses shall include Room Rent, nursing charges, Medical Practitioners’ fees and operation theatre charges.","sources":[{"clause":"8.2.4(d)","heading":null,"page":24,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-8-2-4-d"}],"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 to every claim for treatment taken outside the Rise-Tiered Network hospital list; none inside it.","display":"20% outside the Rise-Tiered Network","note":"Removed by the optional No Co-Pay Network cover. Optional voluntary co-payment of 0%, 10%, 20%, 30%, 40% or 50% (prospectus), not with the deductible. Room upgrades carry 20% or 30% co-pay. Health Check-up reimbursement has 20% co-pay.","quote":"If any treatment is taken outside this network, then a flat 20% co-payment will be applicable to the admissible claim amount. This co-payment you would have to bear for every claim.","sources":[{"clause":"4.1.6","heading":"Rise-Tiered Network","page":6,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-1-6"}],"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":"None unless the optional Annual Aggregate Deductible is chosen.","display":"None unless opted","note":"Optional Annual Aggregate Deductible of INR 10,000 to INR 5,00,000 (prospectus); the CIS adds INR 10,00,000. Cannot be combined with optional Co-Payment.","quote":"Annual Aggregate Deductible | INR 10,000; INR 20,000; INR 30,000; INR 50,000; INR 1,00,000; INR 2,00,000; INR 3,00,000; INR 4,00,000; INR 5,00,000","sources":[{"clause":null,"heading":"Optional Benefits","page":29,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/181#c-optional-benefits"},{"clause":"4.2.12","heading":"Annual Aggregate Deductible","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-2-12"}],"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":["Modern treatments: maximum INR 50,000 per claim"],"display":"Modern treatments: INR 50,000 per claim","note":"Removed by optional Modern Treatment+. No other disease or procedure sub-limits are printed.","quote":"Note: A limit of maximum INR 50,000 per claim will apply to all modern treatments","sources":[{"clause":"4.1.2(a)","heading":null,"page":6,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-1-2-a-2"}],"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":60},"display":"60 days","note":null,"quote":"We will pay expenses incurred on consultations, medicines, physiotherapy, diagnostic tests for 60 days before the date of admission","sources":[{"clause":"4.1.3","heading":"Expenses before and after hospitalization (Pre & Post hospitalization)","page":6,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-1-3"}],"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":180},"display":"180 days","note":null,"quote":"180 days after date of discharge IF these are related to the condition for which hospitalization claim is paid.","sources":[{"clause":"4.1.3","heading":"Expenses before and after hospitalization (Pre & Post hospitalization)","page":6,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-1-3"}],"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":"All day care treatments are covered; hospital admission of 2 hours or more qualifies.","display":"All day care treatments covered","note":"Admissions with only investigations and no treatment are not paid.","quote":"• Admitted for 2 hours or more (minimum 24 hours for AYUSH treatment in a AYUSH Hospital) ... • All Day Care Treatments covered.","sources":[{"clause":"4.1.2(a)","heading":null,"page":5,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-1-2-a"},{"clause":"Row 5","heading":"Policy Coverage","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/182#c-row-5"}],"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 / Domiciliary Treatment is covered up to Sum Insured when the doctor advises treatment at home, with daily monitoring.","display":"Covered up to sum insured","note":"Needs a continuous active line of treatment and a daily monitoring chart. Pre and post hospitalisation apply. Peritoneal dialysis and chemotherapy at home are paid; medical and ambulatory devices used at home are not.","quote":"a) The medical practitioner advices the insured person to undergo treatment at home ... Home Care/Domiciliary | Covered up to Sum Insured","sources":[{"clause":"4.1.4(a)","heading":null,"page":6,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-1-4-a"},{"clause":null,"heading":"Product Benefit Table","page":29,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/181#c-product-benefit-table"}],"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":"AYUSH treatment is covered for admission of 24 hours or more in an AYUSH Hospital, up to Sum Insured.","display":"Covered, 24+ hours in an AYUSH hospital","note":null,"quote":"• Admitted for 2 hours or more (minimum 24 hours for AYUSH treatment in a AYUSH Hospital) ... Expenses During Hospitalization | Covered up to Sum Insured for 2+ Hours of Hospitalization. (24+ Hours for AYUSH Treatment)","sources":[{"clause":"4.1.2(a)","heading":null,"page":5,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-1-2-a"},{"clause":null,"heading":"Product Benefit Table","page":29,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/181#c-product-benefit-table"}],"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":"conflicting","value":"Listed modern treatments (including robotic surgery, oral chemotherapy, immunotherapy, stem cell therapy) are covered up to INR 50,000 per claim.","display":"Covered up to INR 50,000 per claim","note":"CIS row 5 says: 'Modern treatments Up to Sum Insured.' (CIS row 8 repeats the INR 50,000 limit). Optional Modern Treatment+ removes the sub-limit.","quote":"a) We pay for Modern treatments as specified below: ... 6. Oral Chemotherapy | 7. Robotic surgeries ... Note: A limit of maximum INR 50,000 per claim will apply to all modern treatments ... Modern treatments Up to Sum Insured.","sources":[{"clause":"4.1.2(a)","heading":null,"page":6,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-1-2-a-2"},{"clause":"Row 5","heading":"Policy Coverage","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/182#c-row-5"}],"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 donor's hospitalisation expenses for harvesting the organ are paid, only when your hospitalisation claim is paid; up to Sum Insured.","display":"Yes, up to sum insured","note":"Also pays the harvesting expenses if the insured person donates an organ.","quote":"If you ever undergo an organ transplant, we will pay the hospitalization expenses of the donor for harvesting the organ, ONLY when your Hospitalisation claim is paid. ... Organ Donor | Covered up to Sum Insured","sources":[{"clause":"4.1.5","heading":"Organ donor","page":6,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-1-5"},{"clause":null,"heading":"Product Benefit Table","page":29,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/181#c-product-benefit-table"}],"law":[]},{"key":"ambulance","label":"Ambulance cover","section":"Cover","meaning":"Road (and air) ambulance cover and its limit.","status":"conflicting","value":"Road ambulance up to INR 2000 per hospitalisation, only if the hospitalisation claim is paid.","display":"Road ambulance up to INR 2,000 per hospitalisation","note":"CIS row 5 says: 'Road ambulance & Air Ambulance covered up to Sum Insured'; the wording has no air ambulance (CIS row 8 repeats INR 2000). A registered ambulance provider must be used.","quote":"a) Road Ambulance: We will pay you up to INR 2000 per hospitalization. ... Road ambulance & Air Ambulance covered up to Sum Insured","sources":[{"clause":"4.1.1","heading":"Expenses in reaching a Hospital","page":5,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-1-1"},{"clause":"Row 5","heading":"Policy Coverage","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/182#c-row-5"}],"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":"cross-checked","value":"Re-fill: once in a policy year an amount equal to the Base Sum Insured is added on complete or partial use of the Base Sum Insured, for the same or a different illness.","display":"Equal to base sum insured, once a year, same or different illness","note":"Optional ReAssure Forever replaces Re-fill: after the first paid claim, unlimited refills each up to Base Sum Insured per claim, for life while renewed without break.","quote":"Once in a policy year, we will add an amount equal to the base sum insured. This amount will be added at complete or partial utilization of Base Sum Insured. NOTE: Benefit applies for any illness (same or different).","sources":[{"clause":"4.1.7","heading":"Re-fill","page":7,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-1-7"}],"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":"cross-checked","value":"Loyalty Bonus: 10% of the expiring Base Sum Insured is added every policy year, up to 100% of Base Sum Insured.","display":"10% a year, up to 100%","note":"The wording does not make it depend on a claim-free year or say what happens after a claim. Separately, Return gives back 50% of premium as a sum insured for rejected claims (100% under optional Return+).","quote":"We will add an amount equal to 10% of your expiring Base Sum Insured, every policy year. This will accumulate up to 100% of Base Sum Insured.","sources":[{"clause":"4.1.8","heading":"Loyalty Bonus","page":7,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-1-8"}],"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 paid in the base cover: Annexure 1 List I items (such as gloves, masks) are not covered. Optional Claim Safeguard covers List I items; Claim Safeguard+ covers Lists I to IV.","display":"Not covered unless Safeguard or Safeguard+ is opted","note":"Reasonable and Customary Charges still apply under Safeguard.","quote":"List I – Expenses not covered ... 56 | GLOVES ... a) Claim Safeguard: Items in mentioned in Annexure 1 in ‘List I – Expenses not covered’ of non-payable items will be covered. ... a) Claim Safeguard+: Items in mentioned in Annexure 1 in ‘List I,II,III,IV – Expenses not covered’ of non-payable items will be covered.","sources":[{"clause":"Annexure 1","heading":null,"page":26,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-annexure-1"},{"clause":"4.2.3(a)","heading":"Claim Safeguard","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-2-3-a"},{"clause":"4.2.4(a)","heading":"Claim Safeguard+","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-2-4-a"}],"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 lawful termination of pregnancy are excluded (Excl18).","display":"Not covered","note":"Ectopic pregnancy is not excluded.","quote":"7.1.16 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":"7.1.16","heading":"Maternity Expenses (Code-Excl18)","page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-1-16"}],"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 printed; children can be covered from 91 days of age, and maternity is excluded.","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":"The documents do not mention mental illness treatment.","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":"cross-checked","value":"Only under optional Health Check-up covers: once every policy year from day 1, for adults, booked digitally, up to INR 500 per INR 1 Lac Base Sum Insured.","display":"Optional only: once a year from day 1","note":"Two optional covers: Health Checkup (Only Cashless) and Health Checkup (Cashless & Reimbursement), the latter with a flat 20% co-payment on reimbursement. Limit amounts are from the CIS: maximum INR 5,000 per insured (individual) or INR 10,000 per policy (floater).","quote":"Available once every Policy Year, from day 1 of the policy. ... This benefit is only available for the Adults in the policy. The tests MUST be booked through digital assets (e.g. Mobile App). ... up to INR 500 for every INR 1 Lac Base Sum Insured. (Individual: Maximum INR 5,000 per Insured; Family Floater: Maximum INR 10,000 per policy). ... A flat 20% co-payment will apply on reimbursement basis.","sources":[{"clause":"4.2.5","heading":"Health Checkup (Only Cashless)","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-2-5"},{"clause":"4.2.6","heading":"Health Checkup (Cashless & Reimbursement)","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-2-6"},{"clause":null,"heading":"Specific Exclusions","page":3,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/182#c-specific-exclusions"}],"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":"Out-patient treatment is excluded; unlimited digital consultations with a General Practitioner in the partner network are included.","display":"Not covered; unlimited digital GP consultations","note":null,"quote":"Treatment taken under any Out Patient Department (like Consultations, Pharmacy, Diagnostics, fracture etc.) ... You can take unlimited Digital Consultations with a General Practitioner our Partner Network.","sources":[{"clause":"7.2.8","heading":null,"page":17,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-7-2-8"},{"clause":"4.1.11","heading":"Digital Consultations","page":7,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-4-1-11"}],"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":"cross-checked","value":"Yes. Premium depends on the residential city, grouped into Zone 1 (Delhi NCR, Nasik, Surat, Vadodara) to Zone 4 (rest of India).","display":"Yes, premium by zone of residence","note":"The clause says the country is divided into '2 zones' but lists 4. Co-payment depends on the hospital network, not the zone.","quote":"i) Zone 1: Delhi NCR ... iv) Zone 4: Rest of India (Including Bengaluru and Pune) Your premium depends upon your residential city.","sources":[{"clause":"8.2.8","heading":"Zonal pricing","page":25,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-8-2-8"}],"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, cashless at network hospitals; the wording also offers 'Cashless Everywhere', including hospitals not in the network.","display":"Yes, network hospitals and Cashless Everywhere","note":"The two sentences of the same section are inconsistent. Health check-up (Only Cashless) is cashless only.","quote":"a) Cashless claim facility is available at our network hospitals ONLY. ... • We offer Cashless Everywhere, even in hospitals which are not part of our network.","sources":[{"clause":"8.2.4(a)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-8-2-4-a"},{"clause":"8.2.4(e)","heading":null,"page":24,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180#c-8-2-4-e"}],"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 describe claims decided by the Company ('We will provide our decision on claim') but do not say whether a TPA is used.","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":true,"display":"Yes","note":"From the prospectus. Individual policies can cover up to 6 members.","quote":"Rise can be issued to individual customer(s) or to a family with up to 5 children (refer to as family floater).","sources":[{"clause":"1","heading":"Policy Design","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/181#c-1"}],"law":[]}],"documents":[{"kind":"wording","label":"Rise Policy Wording","pages":34,"fetched_at":"2026-10-16 07:11:42.269502+00","source_url":"https://transactions.nivabupa.com/pages/doc/policy_wording/Rise_Policy_Wordings.pdf?v=1.0","url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/180"},{"kind":"prospectus","label":"Rise Prospectus","pages":32,"fetched_at":"2026-10-16 07:11:42.269502+00","source_url":"https://transactions.nivabupa.com/pages/doc/prospectus/Rise_Prospectus.pdf?v=1.0","url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/181"},{"kind":"cis","label":"Rise","pages":12,"fetched_at":"2026-10-16 07:11:42.269502+00","source_url":"https://transactions.nivabupa.com/pages/doc/Customer-Information/CIS_Rise.pdf","url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425/document/182"}],"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":"Rise (UIN NBHHLIP25041V012425), IndiaInsurances, https://indiainsurances.com/policy/niva-bupa-health-insurance/rise-nbhhlip25041v012425"}