{"uin":"NBHHLIP27053V022627","name":"Senior First","url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627","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-senior","category_name":"Senior citizen health","irdai_type":"New","kind":"product","status":"active","approved_on":"2021-03-26","withdrawn_on":null,"summary":"Senior First is a Niva Bupa health insurance policy for people aged 61 to 75 at entry, sold on individual or family floater basis in Gold and Platinum variants with sum insured from Rs.5 Lac to Rs.25 Lac. Every claim carries a default 50% co-payment (reducible to 40%, 30% or 20% at first purchase), pre-existing diseases and listed conditions wait 24 months, and the Platinum variant adds ReAssure, Loyalty Additions and an annual health check-up.","analysis":{"state":"extracted","analysed_at":"2026-10-16 04:48:12.909597+00","note":"Every stated fact carries a verbatim quote found in the cited clause."},"facts":[{"key":"plan_variants","label":"Plans and variants","section":"Overview","meaning":"The named plans inside this product (not cover types or payout options). Facts can differ between them.","status":"cross-checked","value":["Gold","Platinum"],"display":"Gold and Platinum","note":"Each variant can be bought on individual or family floater basis. Optional benefits: Annual Aggregate Deductible and modification in co-payment. Loyalty Additions, ReAssure and Health Check-up are Platinum only.","quote":"There are two variants under the policy – Gold and Platinum.","sources":[{"clause":null,"heading":"Coverage Options","page":2,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/8#c-coverage-options"}],"law":[]},{"key":"policy_term","label":"Policy term","section":"Eligibility","meaning":"How long one policy runs before it ends or must be renewed.","status":"cross-checked","value":"The default policy term is one year; two year and three year terms are also available.","display":"1 year (default); 2 or 3 years also available","note":"Term discount: 7.5% on the second year premium for a 2 year term; 15% on the third year plus 7.5% on the second year for a 3 year term. For 2 or 3 year terms the sum insured applies separately for each policy year.","quote":"The default policy term is one year. Two year and three year policy term options are also available under the product.","sources":[{"clause":null,"heading":"Policy Design","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/8#c-policy-design"}],"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 time limit for intimating a claim is printed; documents must be submitted at the earliest possible time, with delays 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","Claim form"],"display":"Claim form, discharge summary, final hospital bill, lab reports, FIR/MLC (accidents), KYC, cancelled cheque","note":"Policyholder documents are from the nominee in case of death of the policyholder. Documents for expenses within the deductible must also be submitted if the deductible applies.","quote":"Documents required with claim form: ... Original Discharge summary with first and subsequent consultation papers. ... Original Final Hospital bill with detailed break-up and payment receipt (including pharmacy bills). ... Laboratory investigation reports with supporting prescriptions. ... MLC/First Information Report (FIR) (in accident cases). ... KYC documents ... Cancelled cheque","sources":[{"clause":"6.2(X)(b)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-6-2-x-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 the bank rate.","display":"15 days from the claim submission date","note":"Cashless final bill authorization within three hours of the final documents; the CIS states 1 hour 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. ... claim within 15 days (from the claim ... at a rate of 2% above the bank rate","sources":[{"clause":"6.1(ii)","heading":null,"page":15,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-6-1-ii-3"}],"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 (Code-Excl01) until the waiting period ends","Specified disease/procedure waiting period (Code-Excl02)","30-day waiting period (Code-Excl03)","Investigation & Evaluation (Code-Excl04)","Rest Cure, rehabilitation and respite care (Code-Excl05)","Cosmetic or plastic Surgery (Code-Excl08)","Hazardous or Adventure sports (Code-Excl09)","Treatment for alcoholism, drug or substance abuse or any addictive condition (Code-Excl12)","Maternity Expenses (Code-Excl18)","Charges related to a Hospital stay not expressly mentioned as being covered","Dental/oral treatment, except if required while Hospitalized due to an Accident","Any treatment or medical services received outside the geographical limits of India","Any expenses incurred on OPD treatment","Treatment related to intentional self inflicted Injury or attempted suicide","Conflict & Disaster"],"display":"Waiting-period exclusions, standard exclusions Excl04 to Excl18, OPD, treatment outside India and other specific exclusions","note":"Full lists are in section 5.1 (standard exclusions) and 5.2 (specific exclusions) of the wording, and Annexure I lists non-payable items.","quote":"Pre-existing Diseases (Code–Excl01) ... Specified disease/procedure waiting period (Code- Excl02) ... 30-day waiting period (Code- Excl03) ... Investigation & Evaluation (Code-Excl04) ... Rest Cure, rehabilitation and respite care (Code-Excl05) ... 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) ... Maternity Expenses (Code-Excl18) ... Charges related to a Hospital stay not expressly mentioned as being covered. ... Dental/oral treatment: ... except if required by an Insured Person while Hospitalized due to an Accident. ... XI) Any treatment or medical services received outside the geographical limits of India. XII) Any expenses incurred on OPD treatment. ... Treatment related to intentional self inflicted Injury or attempted suicide by any means. ... IV) Conflict & Disaster:","sources":[{"clause":"5.1","heading":"Standard Exclusions","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-5-1"},{"clause":"5.1(II)(d)(ii)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-5-1-ii-d-ii"},{"clause":"Excl14","heading":null,"page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-excl14"},{"clause":"5.2","heading":"Specific Exclusions","page":12,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-5-2"}],"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":"First contact Niva Bupa customer service (website, toll free 1860-500-8888, e-mail, fax, courier, or the grievance cell at any branch); if not satisfied, the grievance officer (Head, Customer Services); then the Insurance Ombudsman or IRDAI's Bima Bharosa portal.","display":"Niva Bupa customer service (toll free 1860-500-8888), then the grievance officer, then the Insurance Ombudsman","note":"Senior citizens may write to seniorcitizensupport@nivabupa.com. The prospectus adds an escalation step to GRO@nivabupa.com before the Ombudsman.","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 ... the insured person may also approach the office of lnsurance Ombudsman of the respective area/region","sources":[{"clause":"6.1(ii)","heading":null,"page":15,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-6-1-ii-3"}],"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":"Gold: Rs.5 Lac or Rs.10 Lac. Platinum: Rs.5 Lac to Rs.25 Lac in multiples of Rs.5 Lac.","display":"Rs.5 Lac to Rs.25 Lac (Gold: Rs.5 Lac or Rs.10 Lac)","note":"Stated in the prospectus; the wording refers to the Policy Schedule.","quote":"Gold variant has sum insured options of Rs.5 Lac and Rs.10 Lac. Platinum variant has sum insured options from Rs.5Lac to Rs.25 Lac (in multiples of Rs.5 Lac).","sources":[{"clause":null,"heading":"Coverage Options","page":2,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/8#c-coverage-options"}],"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 to accidents, or if the insured has continuous coverage for more than twelve months; applies afresh to enhanced sum insured.","quote":"Expenses related to the treatment of any Illness within 30 days from the first Policy commencement date shall be excluded except claims arising due to an Accident, provided the same are covered.","sources":[{"clause":"5.1","heading":"Standard Exclusions","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-5-1"}],"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":24},"display":"24 months","note":"Reduced by prior continuous coverage under portability; applies afresh to enhanced sum insured; PED must be declared and accepted.","quote":"Expenses related to the treatment of a Pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 24 months of continuous coverage after the date of inception of the first Policy.","sources":[{"clause":"5.1","heading":"Standard Exclusions","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-5-1"}],"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 for accidents. Personal waiting periods named in the schedule are also 24 months.","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.","sources":[{"clause":"5.1","heading":"Standard Exclusions","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-5-1"}],"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 and cervix, endometriosis, Fibroids, PCOD, hysterectomy (unless necessitated by Malignancy)","Hemorrhoids, fissure or fistula or abscess of anal and rectal region","Hernia of all sites","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 or neoplasms/ tumours, cyst, sinus, polyp, nodules, mass or lump","Ulcer, erosion and 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":"eleven groups of conditions and procedures","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 and cervix, endometriosis, Fibroids, PCOD, hysterectomy (unless necessitated by Malignancy) ... v) Hemorrhoids, fissure or fistula or abscess of anal and rectal region ... vi) Hernia of all sites, ... 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 or neoplasms/ tumours, cyst, sinus, polyp, nodules, mass or lump ... x) Ulcer, erosion and 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":"5.1","heading":"Standard Exclusions","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-5-1"}],"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":"years","amount":5},"display":"sixty continuous months (5 years)","note":"Counts ported and migrated coverage; contestable after that only for established fraud. Runs afresh on enhanced sum insured from the date of enhancement.","quote":"After 5 years, no health insurance claim ... The period of sixty continuous months is called as moratorium period.","sources":[{"clause":"6.1(ii)","heading":null,"page":15,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-6-1-ii-3"}],"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 for sum insured, no claim bonus, specific waiting periods, pre-existing disease waiting period and moratorium.","display":"Yes, with waiting-period credits transferred","note":"Subject to the acquiring insurer's Board approved underwriting policy. Migration within Niva Bupa is also allowed, but Loyalty Additions are not carried on migration.","quote":"A Policyholder has the choice to port his/ her policies from one Insurer to ... The policyholder is entitled to transfer the credits gained to the extent of the Sum Insured, No Claim Bonus, specific waiting periods, waiting period for pre-existing disease , Moratorium period etc. from the Existing Insurer to the Acquiring Insurer","sources":[{"clause":"6.1(VII)(a)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-6-1-vii-a-2"}],"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, renewable for lifetime","note":"Renewal can be refused only for established fraud, non-disclosure or misrepresentation.","quote":"Policy can be renewed for lifetime subject to timely payment of due premium","sources":[{"clause":null,"heading":"Policy Design","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/8#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 loading on renewals based on individual claims experience.","display":"No loading for claims at renewal","note":"Renewal premium changes with age; any risk loading applied at underwriting continues for all renewals.","quote":"No loading shall apply on renewals based on individual claims experience.","sources":[{"clause":"6.1(iii)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-6-1-iii-2"}],"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":"quote-verified","value":["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)","Alcoholism, drug or substance abuse or any addictive condition (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 (Code-Excl14)","Refractive Error (Code-Excl15)","Unproven Treatments (Code-Excl16)","Sterility and Infertility (Code-Excl17)","Maternity Expenses (Code-Excl18)","Charges related to a Hospital stay not expressly mentioned as being covered","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","Any expenses incurred on OPD treatment","Unrecognized Physician or Hospital","Intentional self inflicted Injury or attempted suicide","Costs which are not Reasonable and Customary and treatments which are not Medically Necessary","Artificial life maintenance for an Insured Person declared brain dead or in vegetative state"],"display":"Excl04 to Excl18 and the product's own specific exclusions","note":"Excl01 to Excl03 are waiting periods, not permanent exclusions. The prospectus lists these same items under 'Permanent Exclusions'. The Excl14 code is printed in the CIS list; the wording text of that item carries no code.","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 ... Day Care procedure (Code-Excl14) ... Refractive Error (Code-Excl15) ... Unproven Treatments (Code-Excl16) ... Sterility and Infertility (Code-Excl17) ... Maternity Expenses (Code-Excl18) ... Charges related to a Hospital stay not expressly mentioned as being covered. ... 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. ... Any expenses incurred on OPD treatment. ... Unrecognized Physician or Hospital: ... Treatment related to intentional self inflicted Injury or attempted suicide by any means. ... Costs which are not Reasonable and Customary and treatments which are not Medically Necessary. ... Artificial life maintenance for the Insured Person who has been declared brain dead or in vegetative state","sources":[{"clause":"5.1","heading":"Standard Exclusions","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-5-1"},{"clause":"5.1(II)(d)(ii)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-5-1-ii-d-ii"},{"clause":"Excl14","heading":null,"page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-excl14"},{"clause":"5.2","heading":"Specific Exclusions","page":12,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-5-2"},{"clause":"Row 6","heading":"Exclusions","page":2,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/9#c-row-6"}],"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":"With 7 days' written notice, proportionate premium for the unexpired period is refunded for terms up to one year 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 premium for the unexpired period, if no claim","note":"7 days' written notice required.","quote":"The policy holder may cancel his/her policy at any time during the term, by giving 7 days’ notice in writing. ... a) Refund proportionate premium for unexpired policy period, if the term of the policy upto one year and there is no claim(s) made during the policy period. ... b) Refund premium for the unexpired policy period, in respect of policies with term more than 1 year and risk coverage for such policy years are not commenced. ... NOTE: We will NOT refund any premium if we have paid a claim.","sources":[{"clause":"6.1(II)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-6-1-ii"},{"clause":null,"heading":"What it means?","page":13,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-what-it-means"}],"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. ... XI) Any treatment or medical services received outside the geographical limits of India.","sources":[{"clause":"1","heading":"Preamble","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-1"},{"clause":"5.2","heading":"Specific Exclusions","page":12,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-5-2"}],"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 on renewals; only if no claim made. 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. ... Free look is a 30 days period during which you can return back your policy","sources":[{"clause":"6.1(I)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-6-1-i"},{"clause":null,"heading":"What it means?","page":13,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-what-it-means"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 5","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(1), 20(2)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, II.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grace_period","label":"Grace period","section":"Renewal and rights","meaning":"Days you get after the due date to pay without losing cover or continuity.","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days","note":"The standard definition adds fifteen days where premium payment mode is monthly; coverage need not be available during the grace period.","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":"6.1(ii)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-6-1-ii-2"}],"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":"Entry age is from 61 years to 75 years (as on last birthday).","display":"61 years to 75 years","note":"In a family floater plan the second member (spouse) can enter from 18 years to 75 years. Stated in the prospectus; the wording is silent.","quote":"The entry age under this policy is from 61 years to 75 years (as on last birthday). ... In family floater plan, entry age of the second member is from 18 years to 75 years.","sources":[{"clause":null,"heading":"Policy Design","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/8#c-policy-design"}],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"not-stated","value":null,"display":null,"note":"No premium payment frequency is set out; only the generic grace-period definition mentions monthly and instalment modes.","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":"quote-verified","value":["Annual Aggregate Deductible","Modification in co-payment"],"display":"Annual Aggregate Deductible; modification in co-payment (to 40%, 30% or 20%)","note":"Deductible is 1/5th of the base sum insured (Rs 1 Lac to 5 Lac) and earns a premium discount instead of costing extra; if opted, co-payment does not apply except for a higher room category. Lower co-payment loads the base premium by 18.5%, 37.0% or 55.5% and can be chosen only at first purchase. Both cannot be changed once chosen.","quote":"Annual Aggregate Deductible (optional benefit) ... Optional Benefits\nAnnual Aggregate Deductible(2) | 1L / 2L / 3L / 4L / 5L\nModification in co-payment | 40% / 30% / 20% ... (2) Deductible will be 1/5th of the base sum insured chosen. If deductible is opted, then co-payment will NOT apply except as specified in point(1) for treatment taken in higher than eligible category of room ... 40% Copay | 18.5%\n30% Copay | 37.0%\n20% Copay | 55.5% ... Deductible | Sum insured | Premium discount factor","sources":[{"clause":"4.2","heading":"Annual Aggregate Deductible (optional benefit) This","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-4-2"},{"clause":null,"heading":"Optional Benefits","page":19,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/8#c-optional-benefits"},{"clause":"1","heading":"Modification in Co-payment","page":26,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/8#c-1-2"},{"clause":"2","heading":"Annual aggregate deductible","page":26,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/8#c-2-3"}],"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":"quote-verified","value":"Cover during the grace period is not assured: coverage need not be available for the period for which no premium is received, so the policy should be renewed on or before the renewal date to stay covered during the grace period.","display":"Not assured; renew on or before the renewal date to stay covered","note":"Renewal within the grace period keeps continuity benefits for waiting periods and pre-existing diseases. The definition adds that coverage is offered during the grace period when premium is paid in instalments.","quote":"Coverage need not be available during the period for which no premium is received. ... You should renew on or before the renewal date of the policy to ensure you have continued medical insurance cover even during the grace period. ... Provided the insurers shall offer coverage during the grace period, if the premium is paid in instalments during the policy period.","sources":[{"clause":"2.1(IX)","heading":"Grace Period","page":2,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-2-1-ix"},{"clause":null,"heading":null,"page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/8#c-s1"}],"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.","status":"cross-checked","value":"Gold: Shared Room. Platinum: Single Private Room.","display":"Shared room (Gold); Single Private Room (Platinum)","note":"No rupee cap; an additional 10% co-payment applies if a higher room category is taken. The wording refers to the eligible room category in the Policy Schedule.","quote":"Room Category(1) | Shared Room | Single Private Room ... (1) 10% additional co-payment applicable, if treatment is taken in higher room category than eligible room category","sources":[{"clause":null,"heading":"Benefits","page":19,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/8#c-benefits"},{"clause":null,"heading":"Optional Benefits","page":19,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/8#c-optional-benefits"}],"law":[]},{"key":"copay","label":"Co-payment","section":"Limits and co-pay","meaning":"The share of every admissible claim you pay yourself.","status":"cross-checked","value":"50% of every admissible claim by default; can be reduced to 40%, 30% or 20% at inception of the first policy for extra premium.","display":"50% (default)","note":"Can be reduced to 40%, 30% or 20% only at first purchase (premium loading 18.5%, 37.0%, 55.5%); cannot be changed later. Extra 10% for a higher room category. Not on ambulance or health check-up. If the optional deductible is chosen, co-payment does not apply except the room-category 10%.","quote":"The default co-payment in the product is 50% which You can modify to 40% or 30% or 20% at inception of the first policy. Note: a. Co-payment will NOT apply to Ambulance and Health Check-up benefits. b. You will have to bear additional 10% co-payment IF treatment is taken in higher room category than the eligible room category","sources":[{"clause":"4.1","heading":null,"page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-4-1"}],"law":[]},{"key":"disease_sublimits","label":"Disease or procedure sub-limits","section":"Limits and co-pay","meaning":"Caps on what is paid for named treatments even if the sum insured is higher.","status":"cross-checked","value":["Robotic surgeries: maximum Rs. 1,00,000 per claim (except total radical prostatectomy, cardiac surgeries, partial nephrectomy and surgeries for malignancies)"],"display":"Robotic surgeries capped at Rs. 1,00,000 per claim","note":"Ambulance is also capped (road Rs. 2,000, air Rs. 2,50,000 per hospitalization). Sub-limits do not increase with Loyalty Additions.","quote":"NOTE: A limit of maximum Rs. 1,00,000 per claim will apply to all robotic surgeries, except for total radical prostatectomy, cardiac surgeries, partial nephrectomy and surgeries for malignancies.","sources":[{"clause":"3.1","heading":null,"page":6,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-3-1"}],"law":[]},{"key":"pre_policy_checkup","label":"Medical tests before buying","section":"Eligibility","meaning":"Whether you need medical tests before the policy is issued.","status":"cross-checked","value":"No set pre-medical tests; tests may be required based on declarations, disclosure and past medical history.","display":"Not mandatory; tests may be asked for based on medical history","note":"Test cost is 100% borne by Niva Bupa if the proposal is accepted and 100% by the customer if declined.","quote":"The product envisages that there is no set pre-medical limit. However, appropriate tests may be required based on declarations, disclosure and past medical history of the proposed to be insured.","sources":[{"clause":"7","heading":"Pre-Policy Medical Check-up (PPMC)","page":18,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/8#c-7"}],"law":[]},{"key":"pre_hospitalisation","label":"Pre-hospitalisation cover","section":"Cover","meaning":"Medical costs before admission that are paid.","status":"cross-checked","value":{"unit":"days","amount":60},"display":"60 days","note":"Only if related to the condition for which the hospital admission or domiciliary claim is paid.","quote":"We will pay expenses incurred on consultations, medicines, diagnostic tests 60 days before date of admission and 180 days after date of discharge","sources":[{"clause":"3.3","heading":"Expenses before and after hospitalization (Pre & Post hospitalization)","page":7,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-3-3"}],"law":[]},{"key":"post_hospitalisation","label":"Post-hospitalisation cover","section":"Cover","meaning":"Medical costs after discharge that are paid.","status":"cross-checked","value":{"unit":"days","amount":180},"display":"180 days","note":"Only if related to the condition for which the hospital admission or domiciliary claim is paid.","quote":"We will pay expenses incurred on consultations, medicines, diagnostic tests 60 days before date of admission and 180 days after date of discharge","sources":[{"clause":"3.3","heading":"Expenses before and after hospitalization (Pre & Post hospitalization)","page":7,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-3-3"}],"law":[]},{"key":"day_care","label":"Day-care treatments","section":"Cover","meaning":"Treatments needing less than 24 hours in hospital.","status":"cross-checked","value":"Day care treatments are covered up to the sum insured; hospital admission of 2 hours or more is covered.","display":"Covered up to Sum Insured","note":"The wording pays for any hospital admission of 2 hours or more, and for Angiography, Dialysis, Radiotherapy or Chemotherapy for cancer; the prospectus benefit table shows Day Care Treatment covered up to Sum Insured for both variants.","quote":"Admitted for 2 hours or more ... Day Care Treatment | Covered up to Sum Insured","sources":[{"clause":"3.1","heading":null,"page":6,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-3-1"},{"clause":null,"heading":"Benefits","page":19,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/8#c-benefits"}],"law":[]},{"key":"restoration","label":"Restoration of sum insured","section":"Cover","meaning":"Whether the sum insured is refilled after it is used up.","status":"cross-checked","value":"ReAssure: the first paid claim triggers unlimited reinstatement, paying up to the base sum insured for any single claim (Platinum variant only).","display":"Yes, unlimited ReAssure up to base sum insured per claim (Platinum only)","note":"Platinum variant only (prospectus and CIS); not applicable to Gold. Applies to same and different illness.","quote":"The first paid claim triggers ReAssure, a benefit with unlimited sum insured. NOTE: Maximum amount ReAssure benefit pays for any single claim is up to base sum insured. ... ReAssure (Platinum variant only) – Unlimited reinstatement up to base Sum Insured (applicable for both same & different illness)","sources":[{"clause":"3.7","heading":"ReAssure","page":8,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-3-7"},{"clause":"Row 5","heading":"Policy Coverage","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/9#c-row-5"}],"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 Additions: 10% of the previous year's Base Sum Insured added at each policy anniversary, up to 100% of the Base Sum Insured (Platinum variant only).","display":"10% of Base Sum Insured per year, up to 100% (Platinum only)","note":"Platinum only. Not carried on migration to another product; reduced proportionately if base sum insured is reduced. The wording ties it to policy-year completion, not to claim-free years, though its example shows Loyalty Additions after 5 claim free years.","quote":"Upon every completion of policy year, at the policy anniversary, 10% of the previous year’s Base Sum insured will be provided as Loyalty Additions subject to a maximum of 100% of the Base Sum Insured. ... Loyalty Additions (Platinum variant only)","sources":[{"clause":"3.6","heading":"Loyalty Additions","page":7,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-3-6"},{"clause":"Row 5","heading":"Policy Coverage","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/9#c-row-5"}],"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":"Cashless claims are available at Niva Bupa network hospitals; the policy also notes a 'Cashless Everywhere' facility even in non-network hospitals. Final bill authorization within three hours.","display":"Yes, at network hospitals (plus 'Cashless Everywhere' noted for non-network hospitals)","note":"The wording says network hospitals ONLY in 6.2(X)(a) but its note to 6.2(X)(e) offers Cashless Everywhere in non-network hospitals; the process is on the insurer's website. Delay beyond three hours: extra hospital charges borne by the insurer.","quote":"Cashless claim facility is available at our network hospitals ONLY. ... Once the final authorization request is received for discharge, the same will be processed within three hours from the final documents received. ... Note: We offer Cashless Everywhere, even in hospitals which are not part of our network.","sources":[{"clause":"6.2(X)(a)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-6-2-x-a"},{"clause":"6.2(X)(e)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7#c-6-2-x-e"}],"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":"Niva Bupa itself; the prospectus says you deal with the insurer directly, not through third parties.","display":"The insurer (Niva Bupa) directly","note":"From the prospectus introduction; the wording's definitions mention TPAs only generically.","quote":"You talk to us directly, not through any third parties. We will be there for you when you need us. Because you should concentrate on getting healthier, not chasing your claims.","sources":[{"clause":null,"heading":null,"page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/8#c-s1"}],"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 (self and spouse)","note":"Floater covers self and spouse only; an individual policy can also cover up to 2 adults with a 10% discount.","quote":"The policy is also available on family floater basis (self & spouse).","sources":[{"clause":null,"heading":"Policy Design","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/8#c-policy-design"}],"law":[]}],"documents":[{"kind":"wording","label":"Senior First Policy Wording","pages":28,"fetched_at":"2026-10-16 04:47:24.617158+00","source_url":"https://transactions.nivabupa.com/pages/doc/policy_wording/Senior-First-Policy-Wording.pdf?v=1.1","url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/7"},{"kind":"prospectus","label":"Senior First Prospectus","pages":27,"fetched_at":"2026-10-16 04:47:26.31798+00","source_url":"https://transactions.nivabupa.com/pages/doc/prospectus/Senior-First-Prospectus.pdf?v=1.2","url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/8"},{"kind":"cis","label":"Senior First","pages":12,"fetched_at":"2026-10-16 04:47:26.837936+00","source_url":"https://transactions.nivabupa.com/pages/doc/Customer-Information/CIS_SeniorFirst.pdf","url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627/document/9"}],"versions":[{"uin":"MAXHLIP21575V012021","version":null,"approved_on":null},{"uin":"NBHHLIP27053V022627","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":"Senior First (UIN NBHHLIP27053V022627), IndiaInsurances, https://indiainsurances.com/policy/niva-bupa-health-insurance/senior-first-nbhhlip27053v022627"}