{"uin":"NBHHLIP26046V032526","name":"GoActive","url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526","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":"Revision","kind":"product","status":"active","approved_on":"2020-08-28","withdrawn_on":null,"summary":"GoActive is a one-year Niva Bupa health indemnity policy for individuals or families, with Base Sum Insured from Rs. 1 lac to 25 lacs, cover in India only, and a Re-fill of up to 100% of Base Sum Insured. It adds OPD consultations, an annual health check-up and telephonic counseling for Sum Insured 3 Lacs and above, with optional I-Protect, Health Coach and Personal Accident covers.","analysis":{"state":"extracted","analysed_at":"2026-10-16 07:11:57.257325+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":"No named plans. The policy is sold as an Individual Policy or a Family Floater Policy, with a choice of Zone 1 or Zone 2 pricing.","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.","display":"1 year","note":"Prospectus also says 'The policy term is one year.'","quote":"Policy term: 1 year","sources":[{"clause":null,"heading":"Operation theatre charges","page":48,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-operation-theatre-charges"}],"law":[]},{"key":"claim_intimation","label":"Claim intimation deadline","section":"Claims","meaning":"How soon you must tell the insurer about a claim or hospitalisation.","status":"cross-checked","value":"Planned cashless treatment must be pre-authorised at least 72 hours before; emergency hospitalisation and reimbursement claims must be notified within 48 hours of admission or before discharge, whichever is earlier.","display":"72 hours before planned treatment; within 48 hours of emergency admission or before discharge, whichever is earlier","note":"Documents for post-hospitalisation expenses are due within 30 days of the end of the post-hospitalisation period; Personal Accident Cover documents within 30 days of death or disability. Delay is condoned on merits if beyond the claimant's control.","quote":"We must be contacted to pre-authorize Cashless Facility for planned treatment at least 72 hours prior to the proposed treatment. ... If the Insured Person has been Hospitalized in an Emergency, We must be contacted to pre-authorize Cashless Facility within 48 hours of the Insured Person's Hospitalization or before discharge from the Hospital, whichever is earlier. ... For all claims for which Cashless Facility have not been pre-authorized or for which treatment has not been taken at a Network Provider, We shall be informed of the claim along with the following details within 48 hours of admission to the Hospital or before discharge from the Hospital, whichever is earlier","sources":[{"clause":"7.2(XIII)(a)(i)","heading":null,"page":32,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-7-2-xiii-a-i"},{"clause":"7.2(XIII)(a)(ii)","heading":null,"page":34,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-7-2-xiii-a-ii"}],"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":["Claim form duly completed and signed by the claimant","Age / Identity proof document","Cancelled cheque/ bank statement / copy of passbook","Original discharge summary","Bar code sticker and invoice for implants and prosthesis (if used)","Original final bill from Hospital with detailed break-up and paid receipt","Room tariff of the entitled room category (Non-Network provider)","Original bills of pharmacy/medicines purchased","Copy of death certificate (in case of demise of the Insured Person)","Original certificate of Disability (Personal Accident Cover)","MLC/First Information Report (FIR) copy (Medico-legal cases or Accident)","Original laboratory investigation, diagnostic & pathological reports with supporting prescriptions","Original X-Ray/ MRI / ultrasound films and other radiological investigations"],"display":"Claim form, ID and age proof, bank details, discharge summary, final bill, pharmacy bills, investigation reports and films; FIR/MLC for accidents","note":"Personal Accident Cover claims have their own lists (death certificate, FIR / Panchnama, post mortem report, disability certificate).","quote":"a) Claim form duly completed and signed by the claimant. ... b) Age / Identity proof document ... c) Cancelled cheque/ bank statement / copy of passbook ... d) Original discharge summary. ... i) Bar code sticker and invoice for implants and prosthesis (if used); ... f) Original final bill from Hospital with detailed break-up and paid receipt. ... g) Room tariff of the entitled room category (in case of a Non-Network provider ... h) Original bills of pharmacy/medicines purchased ... i) Copy of death certificate (in case of demise of the Insured Person). ... j) Original certificate of Disability issued by a Medical Board duly constituted by the Central and the State Government (in case of Personal Accident Cover) ... k) For Medico-legal cases (MLC) or in case of Accident ... MLC/First Information Report (FIR) copy attested by the concerned Hospital / police station (if applicable) ... l) Original laboratory investigation, diagnostic & pathological reports with supporting prescriptions. ... m) Original X-Ray/ MRI / ultrasound films and other radiological investigations.","sources":[{"clause":"7.2(XIII)(a)(ii)","heading":null,"page":34,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-7-2-xiii-a-ii"}],"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":"Claims are settled or rejected within 15 days from the claim submission date; delay attracts interest at 2% above the bank rate.","display":"15 days from claim submission","note":"Cashless discharge requests are processed within three hours of final documents; the CIS states a 1 hour TAT for cashless pre-authorization.","quote":"The Company shall settle or reject a claim, as the case may be, within 15 days from the claim submission date. ... 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.","sources":[{"clause":"7.1(IX)","heading":null,"page":28,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-7-1-ix"}],"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 until 36 months of continuous coverage (Excl01)","Specified diseases/procedures until 24 months of continuous coverage (Excl02)","Any Illness within 30 days of first Policy commencement, except Accident (Excl03)","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 (Excl12)","Sterility and Infertility (Excl17)","Maternity (Excl18)","Treatment or medical services received outside the geographical limits of India","Dental/oral treatment, except if Hospitalized due to an Accident","Any form of AYUSH Treatments, except as mentioned under Section 3.15"],"display":"Waiting periods (Excl01 to Excl03), standard exclusions Excl04 to Excl18, and the policy's own exclusions such as treatment outside India","note":"Full list of permanent exclusions under permanent_exclusions. Conditions named for an Insured Person under Personal Waiting Period in the Policy Schedule wait 24 months (policy wording and prospectus); the CIS says 24 months in its exclusions list but 48 months in its waiting period row.","quote":"Pre-existing Diseases (Code-Excl01) ... shall be excluded until the expiry of 36 months of continuous coverage after the date of inception of the first Policy. ... Specified disease/procedure waiting period (Code- Excl02) ... shall be excluded until the expiry of 24 months of continuous coverage after the date of inception of the first Policy. ... 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 (Code-Excl18) ... Any treatment or medical services received outside the geographical limits of India. ... Dental/oral treatment: ... except if required by an Insured Person while Hospitalized due to an Accident. ... Any form of AYUSH Treatments, except as mentioned under Section 3.15","sources":[{"clause":"6.1","heading":"Standard Exclusions","page":21,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-6-1"},{"clause":"6.1(II)(d)(ii)","heading":null,"page":22,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-6-1-ii-d-ii"},{"clause":"Excl14","heading":null,"page":23,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-excl14"},{"clause":"6.2","heading":"Specific Exclusions","page":24,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-6-2"}],"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, toll free 1860-500-8888, e-mail platform, or any branch grievance cell); if not satisfied, the grievance officer (Head - Customer Services, Noida), then escalate to GRO@nivabupa.com, then the Insurance Ombudsman.","display":"Niva Bupa customer services (1860-500-8888), then the grievance officer, then GRO@nivabupa.com, then the Insurance Ombudsman","note":"Senior citizens may write to seniorcitizensupport@nivabupa.com. Grievances may also be lodged at bimabharosa.irdai.gov.in.","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 lf 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 ... 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 lnsurance Ombudsman of the respective area/region","sources":[{"clause":"7.1(VIII)","heading":null,"page":27,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-7-1-viii"}],"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":"Base Sum Insured of Rs. 1 lac, 2 lacs, 3 lacs, 4 lacs, 5 lacs, 7.5 lacs, 10 lacs, 15 lacs or 25 lacs per Policy Year.","display":"Rs. 1 lac to 25 lacs (1, 2, 3, 4, 5, 7.5, 10, 15, 25 lacs)","note":"Optional I-Protect adds 10% of Base Sum Insured each renewal; Re-fill adds up to 100% of Base Sum Insured within a year.","quote":"1 lac | 2 lacs | 3 lacs | 4 lacs | 5 lacs | 7.5 lacs | 10 lacs | 15 lacs | 25 lacs","sources":[{"clause":null,"heading":"Base Sum Insured (SI) per Policy Year","page":48,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-base-sum-insured-si-per-policy-year"}],"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":"Does not apply if the Insured Person has continuous coverage for more than twelve months; applies afresh to enhanced Sum Insured. Not applied to health check-up, second opinion, OPD, Behavioral Assistance, Health Coach and Personal Accident Cover.","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","sources":[{"clause":"6.1","heading":"Standard Exclusions","page":21,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-6-1"}],"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":"Reduced to the extent of prior continuous coverage under portability; 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.","sources":[{"clause":"6.1","heading":"Standard Exclusions","page":21,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-6-1"}],"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":"Not applicable to Accident or Cancer. If a listed condition is also a pre-existing disease, the longer waiting period applies. Conditions named for an Insured Person under Personal Waiting Period in the Policy Schedule wait 24 months (policy wording and prospectus); the CIS says 24 months in its exclusions list but 48 months in its waiting period row.","quote":"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). ... If any of the specified disease/procedure falls under the waiting period specified for pre-Existing diseases, then the longer of the two waiting periods shall apply.","sources":[{"clause":"6.1","heading":"Standard Exclusions","page":21,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-6-1"}],"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":"conflicting","value":["Pancreatitis and Stones in biliary and urinary System","Cataract, Glaucoma and other disorders of lens, disorders of retina","Hyperplasia of prostate, hydrocele and spermatocele","Abnormal utero-vaginal bleeding, female genital prolapse, endometriosis/adenomyosis, fibroids, PCOD, or any condition requiring dilation and curettage or hysterectomy","Hemorrhoids, fissure or fistula or abscess of anal and rectal region","Hernia of all sites","Osteoarthritis, Systemic Connective Tissue disorders, Dorsopathies, Spondylopathies, inflammatory Polyarthropathies, Arthrosis such as RA, Gout, Intervertebral Disc disorders","Chronic kidney disease and failure","Varicose veins of lower extremities","Disease of middle ear and mastoid including Otitis Media, Cholesteatoma, Perforation of Tympanic Membrane","All internal or external benign or In Situ Neoplasms/Tumours, Cyst, Sinus, Polyp, Nodules, Swelling, Mass or Lump","Ulcer, Erosion and Varices of Upper Gastro Intestinal Tract","Tonsils and Adenoids, Nasal Septum and Nasal Sinuses","Internal Congenital Anomaly"],"display":"Stones, cataract, prostate, uterine conditions, piles, hernia, joint and spine disorders, kidney disease, varicose veins, ear disease, benign tumours, GI ulcers, tonsils and sinus, internal congenital anomaly","note":"Policy wording list. The prospectus and the CIS add a further item: 'Diabetes and its related complications'.","quote":"i) Pancreatitis and Stones in biliary and urinary System ... ii) Cataract, Glaucoma and other disorders of lens, disorders of retina ... iii) Hyperplasia of prostate, hydrocele and spermatocele ... iv) Abnormal utero-vaginal bleeding, female genital prolapse, endometriosis/adenomyosis, fibroids, PCOD, or any condition requiring dilation and curettage or hysterectomy ... v) Hemorrhoids, fissure or fistula or abscess of anal and rectal region ... vi) Hernia of all sites, ... vii) Osteoarthritis, Systemic Connective Tissue disorders, Dorsopathies, Spondylopathies, inflammatory Polyarthropathies, Arthrosis such as RA, Gout, Intervertebral Disc disorders ... viii) Chronic kidney disease and failure ... ix) Varicose veins of lower extremities ... x) Disease of middle ear and mastoid including Otitis Media, Cholesteatoma, Perforation of Tympanic Membrane ... xi) All internal or external benign or In Situ Neoplasms/Tumours, Cyst, Sinus, Polyp, Nodules, Swelling, Mass or Lump ... xii) Ulcer, Erosion and Varices of Upper Gastro Intestinal Tract ... xiii) Tonsils and Adenoids, Nasal Septum and Nasal Sinuses ... xiv) Internal Congenital Anomaly ... ix) Diabetes and its related complications ... ix) Diabetes and its related complications","sources":[{"clause":"6.1","heading":"Standard Exclusions","page":21,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-6-1"},{"clause":"Excl02","heading":"Specified disease/procedure waiting period (Code- Excl02)","page":14,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/184#c-excl02"},{"clause":"15(ix)","heading":null,"page":6,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/185#c-15-ix"}],"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":"For an enhanced Sum Insured, the 60 months run from the date of enhancement on the enhanced limit only.","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.","sources":[{"clause":"7.1(X)","heading":null,"page":28,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-7-1-x"}],"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 policyholder can port to another insurer and transfer credits gained for Sum Insured, specific waiting periods, pre-existing disease waiting period and moratorium period.","display":"Yes, with credit for waiting periods","note":"Subject to the acquiring insurer's underwriting. Migration to another Niva Bupa policy is also allowed (7.1 XV).","quote":"A Policyholder has the choice to port his/ her policies from one Insurer to another irrespective of individual or group policy subject to the Board approved underwriting policy of the insurers. 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.","sources":[{"clause":"7.1(XIV)","heading":null,"page":29,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-7-1-xiv"}],"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, lifelong renewal; no maximum cover ceasing age","note":"From the prospectus. Policy wording: renewal can be refused only for established fraud, non-disclosure or misrepresentation. Children must move to a separate policy at Age 22.","quote":"We assure you renewability of your policy for lifetime, if you pay renewal premium within the grace period of 30 days of expiry of your previous policy. ... There is no maximum cover ceasing age in this policy.","sources":[{"clause":null,"heading":"GoActive - Start a healthy relationship","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/184#c-goactive-start-a-healthy-relationship"},{"clause":null,"heading":"Policy Design","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/184#c-policy-design"}],"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 on renewals based on individual claims experience.","display":"No loading for claims","note":"A risk loading of up to 180% may apply at issue based on health disclosures; renewal premium changes with age, zone (zip code) and coverage changes.","quote":"No loading shall apply on renewals based on individual claims experience.","sources":[{"clause":"7.1(III)","heading":null,"page":26,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-7-1-iii"}],"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 received in heath hydros, nature cure clinics, spas (Excl13)","Dietary supplements and substances that can be purchased without prescription (Excl14)","Refractive Error less than 7.5 dioptres (Excl15)","Unproven Treatments (Excl16)","Sterility and Infertility (Excl17)","Maternity (Excl18)","Ancillary Hospital Charges","Circumcision unless necessary for the treatment of a disease or necessitated by an Accident","Conflict & Disaster","External Congenital Anomaly","Dental/oral treatment","Hormone Replacement Therapy","Multifocal Lens and ambulatory devices","Sexually transmitted Infections & diseases (other than HIV / AIDS)","Sleep disorders","Any treatment or medical services received outside the geographical limits of India","Unrecognized Physician or Hospital","Artificial life maintenance for the Insured Person who has been declared brain dead or in vegetative state","AYUSH Treatment, except as mentioned under Section 3.15"],"display":"Standard exclusions Excl04 to Excl18 plus the policy's own exclusions (treatment outside India, dental, sleep disorders and others)","note":"Optional Personal Accident Cover has its own exclusions (suicide, armed forces service, intoxication, hazardous sports and others). Annexure II lists non-payable items.","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 (Code-Excl18) ... II) Ancillary Hospital Charges ... Circumcision unless necessary for the treatment of a disease or necessitated by an Accident. ... IV) Conflict & Disaster: ... V) External Congenital Anomaly: ... VI) Dental/oral treatment: ... VII) Hormone Replacement Therapy: ... VIII) Multifocal Lens and ambulatory devices ... IX) Sexually transmitted Infections & diseases (other than HIV / AIDS): ... X) Sleep disorders: ... XI) Any treatment or medical services received outside the geographical limits of India. ... XII) Unrecognized Physician or Hospital: ... XIII) Artificial life maintenance for the Insured Person who has been declared brain dead or in vegetative state ... XIV) AYUSH Treatment Any form of AYUSH Treatments, except as mentioned under Section 3.15","sources":[{"clause":"6.1","heading":"Standard Exclusions","page":21,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-6-1"},{"clause":"6.1(II)(d)(ii)","heading":null,"page":22,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-6-1-ii-d-ii"},{"clause":"Excl14","heading":null,"page":23,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-excl14"},{"clause":"6.2","heading":"Specific Exclusions","page":24,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-6-2"}],"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 one-year policy the proportionate premium for the unexpired period is refunded if no claim has been made.","display":"Proportionate premium for the unexpired period, if no claim made (7 days' notice)","note":"The policy wording does not say what is refunded if a claim has been made.","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.","sources":[{"clause":"7.1(II)","heading":null,"page":26,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-7-1-ii"}],"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. All benefits are available in India only and claims are payable in Indian Rupees.","display":"India only","note":"The optional Personal Accident Cover applies to accidents at any location worldwide.","quote":"All benefits are available in India only and all claims shall be payable in India in Indian Rupees only.","sources":[{"clause":"7.2(VIII)","heading":null,"page":31,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-7-2-viii"}],"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 document to review the terms and conditions of the policy.","sources":[{"clause":"7.1(I)","heading":null,"page":26,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-7-1-i"}],"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":null,"quote":"At the end of the policy period, the policy shall terminate and can be renewed within the Grace Period of 30 days (annual installment) to maintain continuity of benefits without break in policy.","sources":[{"clause":"7.1(III)","heading":null,"page":26,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-7-1-iii"}],"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 65 years (last birthday); dependent children 91 days to 21 years (last birthday).","display":"Adults 18 to 65 years; children 91 days to 21 years","note":"A child who has completed Age 22 at renewal must move to a separate policy.","quote":"Entry age for Adults is 18 years - 65 Years (last birthday) and from 91 days to 21 years (last birthday) for children (dependent children).","sources":[{"clause":null,"heading":"Operation theatre charges","page":48,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-operation-theatre-charges"}],"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":"The documents speak of payment of the full premium in advance and a grace period for 'annual installment' but do not list payment frequencies.","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":"cross-checked","value":["I-Protect (Sum Insured increase of 10% of Base Sum Insured each renewal)","Health Coach (renewal premium discount up to 20% based on health score)","Personal Accident Cover (Accident Death, Permanent Total Disability, Permanent Partial Disability)","Annual Aggregate Deductible (25,000 / 50,000 / 1 lac / 2 lacs / 3 lacs / 5 lacs / 10 lacs)"],"display":"I-Protect, Health Coach, Personal Accident Cover, Annual Aggregate Deductible","note":"I-Protect can be opted only at inception. Health Coach and Personal Accident Cover are for the Primary Insured Person or with spouse. Personal Accident Sum Insured options of 10 lacs, 25 lacs or 50 lacs depending on base Sum Insured.","quote":"each Policy Year We will increase the Sum Insured applicable under the Policy by 10% of the Base Sum Insured of the immediately preceding Policy Year. ... Optional Covers: ... Deductible | 25,000 / 50,000 / 1 lac / 2 lacs / 3 lacs / 5 lacs / 10 lacs ... I-Protect | Additional 10% of Base Sum Insured every policy year at renewal ... Health Coach (4) | Personalized health coaching ... Personal Accident cover - Accident Death - Accident Permanent Total Disability - Accident Permanent Partial Disability | 10 lacs | 25 lacs | 25 lacs / 50 lacs ... Discount in renewal base premium up to 20% shall be provided based on the health score.","sources":[{"clause":"4.1","heading":"I-Protect","page":15,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-4-1"},{"clause":null,"heading":"Operation theatre charges","page":48,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-operation-theatre-charges"}],"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. Coverage is available during the grace period.","display":"Yes, covered during grace period","note":null,"quote":"c) Coverage is available during the grace period.","sources":[{"clause":"7.1(III)","heading":null,"page":26,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-7-1-iii"}],"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 1% of Base Sum Insured per day on the lower sums insured; no restriction (except suite or above room category) on the higher sums insured.","display":"Up to 1% of Base Sum Insured per day, or no limit except suite or above, depending on sum insured","note":"The benefit table does not print which sums insured take each limit (the CIS leaves room rent blank as '<>'). For ICU, the CIS splits at 5 Lacs.","quote":"Room Rent (per day) | Up to 1% of Base Sum Insured | No restriction (except suite or above room category) (Limit included in Inpatient Care SI)","sources":[{"clause":null,"heading":"Operation theatre charges","page":48,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-operation-theatre-charges"}],"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":"No restriction on room category except suite or above, on the sums insured where the 1% per day limit does not apply.","display":"Any room except suite or above (higher sums insured)","note":"On the lower sums insured, room rent is limited to 1% of Base Sum Insured per day instead. The table does not print the cut-off sum insured.","quote":"Room Rent (per day) | Up to 1% of Base Sum Insured | No restriction (except suite or above room category)","sources":[{"clause":null,"heading":"Operation theatre charges","page":48,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-operation-theatre-charges"}],"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":"For Sum Insured less than 5 Lacs, up to 2% of Base Sum Insured per day; for 5 Lacs and above, covered up to Sum Insured.","display":"2% of Base Sum Insured per day below 5 Lacs; up to Sum Insured from 5 Lacs","note":"The sum insured split is printed in the CIS; the benefit table shows the two limits without legible column headings.","quote":"Intensive Care Unit / Critical Care Unit charges (per day) | Up to 2% of Base Sum Insured | Covered up to Sum Insured ... ICU charges: for Sum Insured less than 5 Lacs - 2% of Base Sum Insured per day. For Sum Insured 5 Lacs and above - covered up to Sum Insured.","sources":[{"clause":null,"heading":"Operation theatre charges","page":48,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-operation-theatre-charges"},{"clause":"15(xv)","heading":null,"page":6,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/185#c-15-xv"}],"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 category or Room Rent is above eligibility, only a pro-rated portion of the total Associated Medical Expenses is paid.","display":"Yes, associated medical expenses pro-rated","note":null,"quote":"If the Insured Person is admitted in the 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 (including surcharge or taxes thereon) ... Associated Medical Expenses shall include Room Rent, nursing charges, Medical Practitioners' fees and operation theatre charges","sources":[{"clause":"3.1(c)","heading":null,"page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-3-1-c"},{"clause":"2.1(IV)","heading":"Associated Medical Expenses","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-2-1-iv"}],"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":"None by default. If Zone 2 is chosen, a 20% Co-payment applies to treatment in Mumbai, Delhi NCR, Kolkata & Gujarat State.","display":"None in Zone 1; 20% in Mumbai, Delhi NCR, Kolkata & Gujarat State under Zone 2","note":"Zone-wise co-payment does not apply to OPD Consultation, Emergency Ambulance, Health Checkup / Diagnostic Tests, Second Medical Opinion, Behavioral Assistance Program and Personal Accident Cover.","quote":"Co-payment (if applicable) as specified in the Policy Schedule shall be applicable on the amount payable by Us. ... If You select Zone 2 (as described under Section 7.2.XI), then 20% Co-payment will apply for treatment in Mumbai, Delhi NCR, Kolkata & Gujarat State. ... Zone 1: All India coverage","sources":[{"clause":"5.2","heading":"Co-payment","page":21,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-5-2"},{"clause":"7.2(XI)","heading":null,"page":32,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-7-2-xi"}],"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 Rs. 25,000, 50,000, 1 lac, 2 lacs, 3 lacs, 5 lacs or 10 lacs per Policy Year; it does not apply to health check-up, second opinion, OPD, Behavioral Assistance or Personal Accident Cover.","quote":"shall apply to all Insured Persons only if such options are selected by You ... Annual Aggregate Deductible ... Deductible | 25,000 / 50,000 / 1 lac / 2 lacs / 3 lacs / 5 lacs / 10 lacs","sources":[{"clause":"5","heading":"Claim Cost Sharing Options / Conditions","page":20,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-5"},{"clause":"5.1","heading":"Annual Aggregate Deductible","page":20,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-5-1"},{"clause":null,"heading":"Operation theatre charges","page":48,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-operation-theatre-charges"}],"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":["Robotic surgeries: maximum INR 1 Lac, except robotic total radical prostatectomy, robotic cardiac surgeries, robotic partial nephrectomy and robotic surgeries for malignancies"],"display":"INR 1 Lac on robotic surgeries (with exceptions)","note":"No other disease-wise sub-limits are printed. Emergency Ambulance is limited to Rs. 3,000 per hospitalization.","quote":"A limit of maximum INR 1 Lac will apply to all robotic surgeries, except the following: ... a) Robotic total radical prostatectomy ... b) Robotic cardiac surgeries ... c) Robotic partial nephrectomy ... d) Robotic surgeries for malignancies","sources":[{"clause":"3.16","heading":"Modern Treatments","page":14,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-3-16"}],"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":90},"display":"90 days","note":"Reimbursement basis only; covered up to Sum Insured.","quote":"We will not be liable to pay Pre-hospitalization Medical Expenses for more than 90 days immediately preceding the Insured Person's admission","sources":[{"clause":"3.2(b)","heading":null,"page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-3-2-b"}],"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":"Reimbursement basis only; covered up to Sum Insured.","quote":"We will not be liable to pay Post-hospitalization Medical Expenses for more than 180 days immediately following the Insured Person's discharge","sources":[{"clause":"3.3(b)","heading":null,"page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-3-3-b"}],"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":"Day Care Treatments listed in Annexure VI are covered up to Sum Insured.","display":"Listed day care treatments covered up to Sum Insured","note":"OPD treatment and diagnostic services are not covered under this benefit.","quote":"d) List of Day Care Treatments which are covered under the Policy are provided in Annexure VI. ... Day Care Treatment | Covered up to Sum Insured","sources":[{"clause":"3.4","heading":"Day Care Treatment","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-3-4"},{"clause":null,"heading":"Operation theatre charges","page":48,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-operation-theatre-charges"}],"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. Domiciliary Hospitalization is covered up to Sum Insured on reimbursement if it lasts at least 3 consecutive days and the patient could not be moved to hospital or no bed was available; Home Health Care Services after a hospitalisation are covered cashless through empanelled providers in selected cities.","display":"Covered up to Sum Insured (at least 3 consecutive days)","note":null,"quote":"We will indemnify on a Reimbursement basis the Medical Expenses incurred for Domiciliary Hospitalization ... The Domiciliary Hospitalization continues for at least 3 consecutive days ... the treating Medical Practitioner confirms in writing that the Insured Person's condition was such that the Insured Person could not be transferred to a Hospital OR the Insured Person satisfies Us that a Hospital bed was unavailable. ... The Home Health Care Services are covered only if We have accepted a claim under Section 3.1 (Inpatient Care) above and Home Health Care Services are availed immediately after that Hospitalization. The Home Health Care Services are provided through empanelled Service Provider in selected cities only. ... We will cover the Medical Expenses incurred for Home Health Care Services during the Policy Period and availed through empanelled Service Provider on Cashless Facility basis ... Home Health Care Services and Domiciliary Hospitalization | Covered up to Sum Insured","sources":[{"clause":"3.5","heading":"Home Health Care Services and Domiciliary Hospitalization","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-3-5"},{"clause":"3.5(a)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-3-5-a"},{"clause":"3.5(b)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-3-5-b"},{"clause":"3.5(b)(ii)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-3-5-b-ii"},{"clause":null,"heading":"Operation theatre charges","page":48,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-operation-theatre-charges"}],"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":"Yes. Inpatient treatment under Ayurveda, Unani, Sidha and Homeopathy in an AYUSH Hospital is covered up to Sum Insured, with 90 days pre and 180 days post hospitalisation expenses.","display":"Covered up to Sum Insured in an AYUSH Hospital","note":"Yoga is not covered (the AYUSH exclusion still applies to Yoga).","quote":"We will indemnify the Medical Expenses incurred on the Insured Person's Hospitalization for Inpatient Care during the Policy Period on treatment taken under Ayurveda, Unani, Sidha and Homeopathy. ... a) The treatment should be taken in a AYUSH Hospital: ... Pre-hospitalization Medical Expenses incurred for up to 90 days prior to the commencement of treatment and Post-hospitalization Medical Expenses incurred for up to 180 days following the conclusion of the treatment ... Alternative Treatment | Covered up to Sum Insured","sources":[{"clause":"3.15","heading":"Alternative Treatments","page":14,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-3-15"},{"clause":null,"heading":"Operation theatre charges","page":48,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-operation-theatre-charges"}],"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 Sum Insured as inpatient or day care, including robotic surgeries, oral chemotherapy, immunotherapy and stem cell therapy; robotic surgeries are limited to INR 1 Lac except four listed types.","display":"Covered up to Sum Insured; INR 1 Lac limit on most robotic surgeries","note":"No INR 1 Lac limit for robotic total radical prostatectomy, robotic cardiac surgeries, robotic partial nephrectomy and robotic surgeries for malignancies.","quote":"Modern Treatment | Covered up to Sum Insured with sub-limit of Rs. 1Lac on few robotic surgeries ... 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:","sources":[{"clause":null,"heading":"Operation theatre charges","page":48,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-operation-theatre-charges"},{"clause":"3.16","heading":"Modern Treatments","page":14,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-3-16"}],"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 organ donor's inpatient costs for harvesting the organ are covered up to Sum Insured, if the recipient's inpatient claim is accepted.","display":"Covered up to Sum Insured","note":"Donor's pre and post hospitalisation expenses, screening, organ transportation or preservation and donor complications are not paid.","quote":"We will indemnify the Medical Expenses incurred for a living organ donor's Inpatient treatment for the harvesting of the organ donated ... We have accepted the recipient Insured Person's claim under Section 3.1 (Inpatient Care). ... Living Organ Donor Transplant | Covered up to Sum Insured","sources":[{"clause":"3.6","heading":"Living Organ Donor Transplant","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-3-6"},{"clause":null,"heading":"Operation theatre charges","page":48,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-operation-theatre-charges"}],"law":[]},{"key":"ambulance","label":"Ambulance cover","section":"Cover","meaning":"Road (and air) ambulance cover and its limit.","status":"cross-checked","value":"Road ambulance in an emergency, up to Rs. 3,000 per hospitalization, one transfer per hospitalization.","display":"Up to Rs. 3,000 per hospitalization (road)","note":"Only if the inpatient claim is accepted; not for transfers for evaluation only. Air ambulance is not mentioned.","quote":"We will indemnify the Reasonable and Customary Charges for ambulance expenses incurred to transfer the Insured Person by surface transport following an Emergency ... b) This benefit is available for one transfer per Hospitalization. ... Emergency Ambulance | Up to Rs.3,000 per hospitalization","sources":[{"clause":"3.7","heading":"Emergency Ambulance","page":12,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-3-7"},{"clause":null,"heading":"Operation theatre charges","page":48,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-operation-theatre-charges"}],"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":"Yes. A Re-fill of up to 100% of Base Sum Insured is available in a Policy Year once the Base Sum Insured is partly or fully used; it is only for subsequent claims for a different illness, not carried forward, and on floater basis for family policies.","display":"Up to 100% of Base Sum Insured, for a different illness","note":"A single claim cannot exceed Base Sum Insured plus any I-Protect increase. The documents do not say how many times the re-fill can be used in a year.","quote":"We will provide a Re-fill amount of maximum up to 100% of the Base Sum Insured which may be utilized for claims arising in that Policy Year ... The re-fill amount may be used for only subsequent claims in respect of the Insured Person and shall not be for any Illness / Injury (including its complications or follow up) for which a claim has been paid or accepted as payable in the current Policy Year for the same Insured Person. ... For Family Floater Policies, the re-fill amount will be available on a floater basis to all Insured Persons in that Policy Year. ... it cannot be carried forward to any extent in any subsequent Policy Year.","sources":[{"clause":"3.9","heading":"Re-fill Benefit","page":12,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-3-9"}],"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":"No no-claim or cumulative bonus is described. The optional I-Protect cover increases Sum Insured by 10% of Base Sum Insured each renewal regardless of claims.","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":"Consumables are paid as part of inpatient care, but the items in Annexure II List I (such as gloves, masks, nebulisation kits) are not covered.","display":"Covered in hospital bills, except Annexure II items such as gloves and masks","note":"Annexure II also lists items subsumed into room, procedure and treatment charges.","quote":"vi) Intravenous fluids, blood transfusion, injection administration charges, consumables and/or enteral feedings; ... List I - Expenses not covered ... 56 | GLOVES ... 60 | MASK ... 57 | NEBULISATION KIT","sources":[{"clause":"3.1(b)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-3-1-b"},{"clause":null,"heading":"List I – Expenses not covered","page":42,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-list-i-expenses-not-covered"}],"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 expenses (including complicated deliveries and caesarean sections), miscarriage and lawful medical termination of pregnancy are excluded, except ectopic pregnancy.","display":"Not covered (except ectopic pregnancy)","note":null,"quote":"Maternity (Code-Excl18) ... a) Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during Hospitalization) except ectopic pregnancy; ... b) Expenses towards miscarriage (unless due to an Accident) and lawful medical termination of pregnancy during the Policy Period.","sources":[{"clause":"Excl14","heading":null,"page":23,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-excl14"}],"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. Dependent children can be insured from 91 days of age.","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 cover is not mentioned. The Behavioral Assistance Program offers telephonic counseling sessions on stress and other topics.","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":"A health check-up with a defined list of tests for adults every Policy Year, for Sum Insured 3 Lacs and above; diagnostic tests up to Rs. 1,000, 1,500 or 2,500 per adult can be taken instead. Not available for 1 Lac and 2 Lac Sum Insured.","display":"Annual check-up for adults (Sum Insured 3 Lacs and above)","note":"The insured must be above Age 18. The benefit table does not print which sum insured takes the Rs. 1,000, 1,500 or 2,500 diagnostic limit.","quote":"The Insured Person may avail a health check-up as specified in the Policy Schedule through empanelled Service Provider for this benefit on Cashless Facility basis ... Any unutilized Health check-up cannot be carry forwarded to the next Policy Year. ... (Not applicable for 1 Lac and 2 Lac Sum Insured) ... Tests / Sum Insured | 3 Lac | ... Health check-up benefit - Defined list of tests. Applicable for Adults only. ... (Limits mentioned are per adult member) (Diagnostic tests applicable in lieu of Health check-up through cashless and reimbursement facility) | Not available | 1,000 | 1,500 | 2,500","sources":[{"clause":"3.8","heading":"Health Checkup / Diagnostic Tests","page":12,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-3-8"},{"clause":null,"heading":"List of tests covered under health check-up","page":47,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-list-of-tests-covered-under-health-check-up"},{"clause":null,"heading":"Operation theatre charges","page":48,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-operation-theatre-charges"}],"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":"OPD consultations are covered for Sum Insured 3 Lacs and above: 2 to 6 consultations per policy per year for 1 adult policies and 4 to 10 for 2 adult policies, depending on Sum Insured; reimbursement up to Rs. 600 per consultation (Zone 1) or Rs. 500 (Zone 2).","display":"2 to 10 consultations per policy year (Sum Insured 3 Lacs and above)","note":"Consultations only; medicines and diagnostic services bought through the insurer's empanelled provider are paid by the insured (Section 3.13). Booked through the app or website; the number of consultations is shared by all insured persons and unused consultations lapse. Not available for 1 Lac and 2 Lac Sum Insured.","quote":"OPD Consultation(2) (For 1A, 1A+1C, 1A+2C: Consultations limits per policy, per policy year) | Not available | 2 | 3 | 4 | 4 | 6 | 6 | 6 ... OPD Consultation(2) (For 2A and more: Consultations limits per policy, per policy year) | Not available | 4 | 5 | 6 | 8 | 10 | 10 | 10 ... For Reimbursement, the maximum per consultation limit is Rs. 600 for Zone 1 coverage and Rs. 500 for Zone 2 coverage ... OPD Consultations - Number of consultations per policy per policy year are fixed basis Sum Insured (Ranges from 2 to 10 consultations for Sum Insured Rs. 3 Lacs & above)","sources":[{"clause":null,"heading":"Operation theatre charges","page":48,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-operation-theatre-charges"},{"clause":"Row 5","heading":"Policy Coverage","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/185#c-row-5"}],"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 zone chosen: Zone 1 (All India coverage) or Zone 2 (All India coverage with 20% co-payment for treatment in Mumbai, Delhi NCR, Kolkata & Gujarat State).","display":"Yes, Zone 1 or Zone 2 (20% co-pay in Mumbai, Delhi NCR, Kolkata & Gujarat under Zone 2)","note":"Renewal premium may also change if you move to a different zip code.","quote":"For the purpose of calculating premium, following zones are available: ... Zone 1: All India coverage ... Zone 2: All India coverage (Co-payment applicable for Mumbai, Delhi NCR, Kolkata & Gujarat State) If You select Zone 2, then 20% Co-payment will apply for Inpatient treatment in Mumbai, Delhi NCR, Kolkata & Gujarat State.","sources":[{"clause":"7.2(XI)","heading":null,"page":32,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-7-2-xi"}],"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 Facility at Network Providers with pre-authorization; the insurer also offers 'Cashless Everywhere', even in hospitals outside the network.","display":"Yes, at network hospitals; Cashless Everywhere also offered","note":"Pre and post hospitalisation expenses are reimbursement only.","quote":"Cashless Facility can be availed only at Our Network Providers or Service Providers. ... Note: We offer Cashless Everywhere, even in hospitals which are not part of our network.","sources":[{"clause":"7.2(XIII)","heading":null,"page":32,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-7-2-xiii"},{"clause":"7.2(XIII)(a)(ii)","heading":null,"page":34,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-7-2-xiii-a-ii"}],"law":[]},{"key":"claims_handled_by","label":"Claims handled by","section":"Claims","meaning":"The insurer itself or a third-party administrator (TPA).","status":"cross-checked","value":"The insurer itself; the prospectus says you deal with Niva Bupa directly, not through third parties.","display":"Niva Bupa in-house","note":"From the prospectus.","quote":"You talk to us directly, not through any third parties.","sources":[{"clause":null,"heading":"GoActive - Start a healthy relationship","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/184#c-goactive-start-a-healthy-relationship"}],"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":"Self, spouse and up to 4 children under 21 at commencement; combinations 1A+1C, 1A+2C, 2A, 2A+1C to 2A+4C.","quote":"Family Floater Policy means a Policy described as such in the Policy Schedule where the family members (two or more) named in the Policy Schedule are insured under this Policy. ... The family floater policy is available in any of the following combinations","sources":[{"clause":"2.2(IX)","heading":"Family Floater Policy","page":5,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183#c-2-2-ix"},{"clause":null,"heading":"Policy Design","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/184#c-policy-design"}],"law":[]}],"documents":[{"kind":"wording","label":"GoActive TM Policy Wording","pages":69,"fetched_at":"2026-10-16 07:11:42.542563+00","source_url":"https://transactions.nivabupa.com/pages/doc/policy_wording/goactive-policy-document.pdf?v=1.1","url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/183"},{"kind":"prospectus","label":"GoActive Prospectus","pages":62,"fetched_at":"2026-10-16 07:11:42.542563+00","source_url":"https://transactions.nivabupa.com/pages/doc/prospectus/GoActive-Prospectus.pdf?v=1.1","url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/184"},{"kind":"cis","label":"GoActive","pages":13,"fetched_at":"2026-10-16 07:11:42.542563+00","source_url":"https://transactions.nivabupa.com/pages/doc/Customer-Information/CIS_GoActive.pdf","url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526/document/185"}],"versions":[{"uin":"MAXHLIP21173V022021","version":null,"approved_on":null},{"uin":"NBHHLIP26046V032526","version":null,"approved_on":null}],"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":"GoActive (UIN NBHHLIP26046V032526), IndiaInsurances, https://indiainsurances.com/policy/niva-bupa-health-insurance/goactive-nbhhlip26046v032526"}