{"uin":"NBHHLIP27056V042627","name":"Arogya Sanjeevani, Niva Bupa Health Insurance","url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627","insurer":{"slug":"niva-bupa-health-insurance","name":"Niva Bupa Health Insurance Co Ltd.","url":"https://indiainsurances.com/insurer/niva-bupa-health-insurance"},"line":"health","category":"health-indemnity","category_name":"Health insurance (hospitalisation)","irdai_type":null,"kind":"product","status":"active","approved_on":null,"withdrawn_on":null,"summary":"Arogya Sanjeevani is Niva Bupa's one-year hospitalisation indemnity policy for individuals or families, with sum insured from INR 50,000 to 10 lakh. Every claim carries a 5% co-payment, room rent is capped at 2% of sum insured up to Rs. 5,000 per day, and pre-existing diseases wait 36 months.","analysis":{"state":"extracted","analysed_at":"2026-10-16 07:11:58.78223+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 on an individual or floater basis only.","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":null,"quote":"Policy Period | 1 year","sources":[{"clause":"12","heading":"TABLE OF BENEFITS","page":19,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-12"}],"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":"Within 24 hours of emergency hospitalisation or before discharge, whichever is earlier; at least 48 hours before admission for planned hospitalisation.","display":"Emergency: within 24 hours or before discharge, whichever is earlier; planned: at least 48 hours before admission","note":"Delay may be condoned on merit where it is proved to be for reasons beyond the Insured Person's control.","quote":"i) Within 24hours from the date of emergency hospitalization required or before the Insured Person’s discharge from Hospital, whichever is earlier. ii) At least 48 hours prior to admission in Hospital in case of a planned Hospitalization. ... Any delay in notification or submission may be condoned on merit where delay is proved to be for reasons beyond the control of the Insured Person.","sources":[{"clause":"9.3","heading":"Notification of Claim","page":12,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-9-3"},{"clause":"9.4","heading":"Documents to be submitted","page":12,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-9-4"}],"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":["Duly Completed claim form","Photo Identity proof of the patient","Medical practitioner’s prescription advising admission","Original bills with itemized break-up","Details of past medical history record, first and subsequent consultation","Payment receipts","Discharge summary (original)","Investigation/ Diagnostic test reports","OT notes or Surgeon’s certificate (for surgical cases)","Sticker/ Invoice of the Implants (original), wherever applicable","NEFT Details and cancelled cheque","KYC of the proposer, where claim liability is above Rs 1 Lakh","Legal heir/succession certificate, wherever applicable","Age / Identity proof document","MLC/ Panchnama / FIR copy for medico-legal or accident cases"],"display":"Claim form, ID proof, prescription, original itemised bills, discharge summary, test reports, payment receipts, NEFT details and others","note":"Any other relevant document required by the Company/ TPA may also be asked for.","quote":"i) Duly Completed claim form ii) Photo Identity proof of the patient iii) Medical practitioner’s prescription advising admission iv) Original bills with itemized break-up v) Details of past medical history record, first and subsequent consultation vi) Payment receipts vii) Discharge summary (original) ... viii) Investigation/ Diagnostic test reports ... ix) OT notes or Surgeon’s certificate giving details of the operation performed (for surgical cases). x) Sticker/ Invoice of the Implants (original), wherever applicable. xi) NEFT Details (to enable direct credit of claim amount in bank account) and cancelled cheque xii) KYC (Identity proof with Address) of the proposer, where claim liability is above Rs 1 Lakh as per AML Guidelines. xiii) Legal heir/succession certificate, wherever applicable. xiv) Any other relevant document required by Company/ TPA for assessment of the claim. xv) Age / Identity proof document ... xvi. For Medico-legal cases (MLC) or in case of Accident: a) MLC/ Panchnama / First Information Report (FIR) copy","sources":[{"clause":"9.4","heading":"Documents to be submitted","page":12,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-9-4"}],"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 from receipt of intimation.","display":"Within 15 days from the claim submission date","note":"Cashless final authorisation at discharge is processed within three hours of the final documents (clause 9.1(vi)). CIS gives a pre-authorisation TAT of 1 hour.","quote":"i) 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 from the date of receipt of claim intimation till the date of payment of claim at a rate of 2% above the bank rate. ... Once the final authorization request is received for discharge, the same will be processed within three hours from the final documents received. ... TAT for pre-authorization of cashless facility- 1 Hour","sources":[{"clause":"9.6(i)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-9-6-i"},{"clause":"9.6(ii)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-9-6-ii"},{"clause":"9.1(vi)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-9-1-vi"},{"clause":"19","heading":"Treatment taken outside the geographical limits of","page":2,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/203#c-19"}],"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","Listed conditions, surgeries/treatments until 24/36 months of continuous coverage","Any illness within 30 days from the first policy commencement, except accidents","Investigation & Evaluation","Rest Cure, rehabilitation and respite care","Cosmetic or plastic Surgery","Hazardous or Adventure sports","Breach of law","Alcoholism, drug or substance abuse or any addictive condition","Unproven Treatments","Sterility and Infertility","Maternity Expenses","War and nuclear, chemical or biological attack","Domiciliary Hospitalization and OPD treatment","Treatment taken outside the geographical limits of India"],"display":"Pre-existing diseases (36 months), listed conditions (24/36 months), first 30 days, plus standard and product exclusions","note":"Items in List I of Annexure A (non-medical items) are also not covered.","quote":"Pre-Existing Diseases (Code- Excl 01) ... until the expiry of 36 months of continuous coverage ... shall be excluded until the expiry of 24/36 months of continuous coverage ... 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) ... Cosmetic or plastic Surgery (Code- Excl08) ... Hazardous or Adventure sports (Code- Excl09) ... Breach of law (Code- Excl10) ... Treatment for, Alcoholism, drug or substance abuse or any addictive condition ... Unproven Treatments (Code- Excl16) ... Sterility and Infertility (Code- Excl17) ... Maternity Expenses (Code- Excl18) ... War (whether declared or not) ... Nuclear, chemical or biological attack or weapons ... Any expenses incurred on Domiciliary Hospitalization and OPD treatment ... Treatment taken outside the geographical limits of India.","sources":[{"clause":"6.1","heading":"Pre-Existing Diseases (Code- Excl 01)","page":8,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-6-1"},{"clause":"6.3(a)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-6-3-a"},{"clause":"6.2","heading":"30 Day Waiting Period","page":8,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-6-2"},{"clause":"7.1","heading":"Investigation & Evaluation (Code- Excl04)","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-1"},{"clause":"7.2","heading":"Rest Cure, rehabilitation and respite care (Code- Excl05)","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-2"},{"clause":"7.5","heading":"Cosmetic or plastic Surgery (Code- Excl08)","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-5"},{"clause":"7.6","heading":"Hazardous or Adventure sports (Code- Excl09)","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-6"},{"clause":"7.7","heading":"Breach of law (Code- Excl10)","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-7"},{"clause":"7.9","heading":"Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-9"},{"clause":"7.13","heading":"Unproven Treatments (Code- Excl16)","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-13"},{"clause":"7.14","heading":"Sterility and Infertility (Code- Excl17)","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-14"},{"clause":"7.15","heading":"Maternity Expenses (Code- Excl18)","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-15"},{"clause":"7.16","heading":null,"page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-16"},{"clause":"7.17","heading":null,"page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-17"},{"clause":"7.18","heading":"Any expenses incurred on Domiciliary Hospitalization and OPD treatment","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-18"},{"clause":"7.19","heading":null,"page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-19"}],"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 first through its website, toll free 1860-500-8888, e-mail service platform or any branch grievance cell; if not satisfied, the grievance officer (Head, Customer Services) and then GRO@nivabupa.com, before the Insurance Ombudsman.","display":"Niva Bupa customer service (toll free 1860-500-8888), then the grievance officer and GRO@nivabupa.com, then the Ombudsman","note":"Senior citizens may write to seniorcitizensupport@nivabupa.com. Grievances can also be lodged at the IRDAI Bima Bharosa portal.","quote":"ln case of any grievance the insured person may contact the company through Website: www.nivabupa.com Toll free: 1860-500-8888 ... Email us through our service platform ... (Senior citizens may write to us at: seniorcitizensupport@nivabupa.com) ... 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. lf lnsured person is not satisfied with the redressal of grievance through above methods, the insured person may also approach the office of lnsurance Ombudsman ... Grievance may also be lodged at IRDAI integrated Grievance Management System – www.bimabharosa.irdai.gov.in","sources":[{"clause":"11(a)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-11-a"}],"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":"INR 50,000 to 10 lakh in multiples of INR 50,000, on individual or floater basis.","display":"INR 50,000 to 10 Lacs (in multiples of INR 50,000)","note":null,"quote":"Sum Insured | INR 50,000 to 10 Lacs (in multiples of INR 50,000) On Individual basis- SI shall apply to each individual family member On Floater basis- SI shall apply to the entire family","sources":[{"clause":"12","heading":"TABLE OF BENEFITS","page":19,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-12"}],"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 to persons with continuous coverage for more than twelve months; applies afresh to an 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. b) This exclusion shall not, however, apply if the Insured Person has Continuous Coverage for more than twelve months. c) The within referred waiting period is made applicable to the enhanced sum insured in the event of granting higher sum insured subsequently.","sources":[{"clause":"6.2","heading":"30 Day Waiting Period","page":8,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-6-2"}],"law":[]},{"key":"ped_waiting","label":"Pre-existing disease waiting period","section":"Waiting periods","meaning":"How long you wait before conditions you already had when you bought the policy are covered. The law caps it at 36 months.","status":"cross-checked","value":{"unit":"months","amount":36},"display":"36 months","note":"Only PEDs declared and accepted are covered after 36 months. Applies afresh to any sum insured increase; reduced by prior continuous cover under portability.","quote":"a) Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 36 months of continuous coverage after the date of inception of the first policy. b) In case of enhancement of sum insured the exclusion shall apply afresh to the extent of sum insured increase. c) If the Insured Person is continuously covered without any break as defined under the portability norms of the extant IRDAI (Insurance Products) Regulations 2024, then waiting period for the same would be reduced to the extent of prior coverage. d) Coverage under the policy after the expiry of 36 months for any pre-existing disease is subject to the same being declared at the time of application and accepted by us.","sources":[{"clause":"6.1","heading":"Pre-Existing Diseases (Code- Excl 01)","page":8,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#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 (36 months for some)","note":"36 months for joint replacement and age-related osteoarthritis and osteoporosis. Not applicable to claims arising from an accident.","quote":"excluded until the expiry of 24/36 months of continuous coverage, as may be the case after the date of inception of the first policy with the insurer. This exclusion shall not be applicable for claims arising due to an accident. ... i) 24 Months waiting period ... ii) 36 Months waiting period A) Treatment for joint replacement unless arising from accident B) Age-related Osteoarthritis & Osteoporosis","sources":[{"clause":"6.3(a)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-6-3-a"},{"clause":"6.3(e)(i)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-6-3-e-i"},{"clause":"6.3(I)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-6-3-i"}],"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":["Benign ENT disorders","Tonsillectomy","Adenoidectomy","Mastoidectomy","Tympanoplasty","Hysterectomy","All internal and external benign tumours, cysts, polyps of any kind, including benign breast lumps","Benign prostate hypertrophy","Cataract and age related eye ailments","Gastric/ Duodenal Ulcer","Gout and Rheumatism","Hernia of all types","Hydrocele","Non Infective Arthritis","Piles, Fissures and Fistula in anus","Pilonidal sinus, Sinusitis and related disorders","Prolapse inter Vertebral Disc and Spinal Diseases unless arising from accident","Calculi in urinary system, Gall Bladder and Bile duct, excluding malignancy","Varicose Veins and Varicose Ulcers","Internal Congenital Anomalies","Treatment for joint replacement unless arising from accident (36 months)","Age-related Osteoarthritis & Osteoporosis (36 months)"],"display":"ENT disorders, tonsillectomy, hysterectomy, benign tumours, cataract, hernia, piles, calculi, varicose veins and others (24 months); joint replacement and osteoarthritis (36 months)","note":"The CIS 24-month list stops at 'Varicose Veins and Varicose Ulcers' and omits Internal Congenital Anomalies.","quote":"i) 24 Months waiting period A) Benign ENT disorders B) Tonsillectomy C) Adenoidectomy D) Mastoidectomy E) Tympanoplasty F) Hysterectomy G) All internal and external benign tumours, cysts, polyps of any kind, including benign breast lumps H) Benign prostate hypertrophy ... I) Cataract and age related eye ailments J) Gastric/ Duodenal Ulcer K) Gout and Rheumatism L) Hernia of all types M) Hydrocele N) Non Infective Arthritis O) Piles, Fissures and Fistula in anus P) Pilonidal sinus, Sinusitis and related disorders Q) Prolapse inter Vertebral Disc and Spinal Diseases unless arising from accident R) Calculi in urinary system, Gall Bladder and Bile duct, excluding malignancy. S) Varicose Veins and Varicose Ulcers T) Internal Congenital Anomalies ii) 36 Months waiting period A) Treatment for joint replacement unless arising from accident B) Age-related Osteoarthritis & Osteoporosis ... S. Varicose Veins and Varicose Ulcers ii. 36Months waiting period (List II)","sources":[{"clause":"6.3(e)(i)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-6-3-e-i"},{"clause":"6.3(I)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-6-3-i"},{"clause":"19","heading":"Treatment taken outside the geographical limits of","page":2,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/203#c-19"}],"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 sixty months run from the date of enhancement on the enhanced limits 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. ... Wherever, the sum insured is enhanced, completion of sixty continuous months would applicable from the date of enhancement of sums insured only on the enhanced limits.","sources":[{"clause":"8","heading":"MORATORIUM PERIOD","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-8"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 13","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 8","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"portability","label":"Portability","section":"Renewal and rights","meaning":"Whether you can move this policy to another insurer and keep waiting-period credit.","status":"cross-checked","value":"Yes. The policy can be ported to another insurer, transferring credits for the sum insured, no claim bonus, specific and pre-existing disease waiting periods and moratorium, subject to the new insurer's underwriting.","display":"Yes, with credit for waiting periods","note":"Migration to another Niva Bupa policy with credit is also allowed (clause 10.14).","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. from the Existing Insurer to the Acquiring Insurer ... In case of migration of one policy to another with the same Insurer, the policyholder (including all members under family cover and group insurance policies) can transfer the credits gained","sources":[{"clause":"10.15","heading":"Portability","page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-10-15"},{"clause":"10.14","heading":"Migration","page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-10-14"}],"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 renewability","note":"From the prospectus; the policy wording says renewal is denied only for established fraud, non-disclosure or misrepresentation.","quote":"We assure you renewability of your policy for lifetime, if you pay renewal premium within the grace period ... A health insurance policy shall be renewable except on grounds of established fraud or non-disclosure or misrepresentation by the insured.","sources":[{"clause":null,"heading":"Arogya Sanjeevani","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/202#c-arogya-sanjeevani"},{"clause":"10.16","heading":"Renewal of Policy","page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-10-16"}],"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 renewal based on individual claims experience.","display":"No loading for claims","note":"Premium can change with a higher age band.","quote":"No loading shall apply on renewals based on individual claims experience. ... the renewal premium may vary from one policy period to another on account of Insured Person attaining a higher age band","sources":[{"clause":"10.16","heading":"Renewal of Policy","page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-10-16"},{"clause":"10.18","heading":"Possibility of Revision of Terms of the Policy Including the Premium Rates","page":17,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-10-18"}],"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 or similar establishments (Excl13)","Dietary supplements and substances that can be purchased without prescription (Excl14)","Refractive Error (Excl15)","Unproven Treatments (Excl16)","Sterility and Infertility (Excl17)","Maternity Expenses (Excl18)","War (whether declared or not) and war like occurrence","Nuclear, chemical or biological attack or weapons","Domiciliary Hospitalization and OPD treatment","Treatment taken outside the geographical limits of India","Specified ICD codes for existing diseases disclosed and mentioned in the policy schedule"],"display":"Standard exclusions Excl04 to Excl18, plus war, nuclear/chemical/biological attack, domiciliary and OPD treatment, treatment outside India and specified ICD codes","note":"Refractive error is excluded below 7.5 dioptres; obesity surgery is covered when the listed conditions are met; excluded providers are paid up to stabilisation in emergencies; ectopic pregnancy is not excluded under maternity.","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) ... Unproven Treatments (Code- Excl16) ... Sterility and Infertility (Code- Excl17) ... Maternity Expenses (Code- Excl18) ... War (whether declared or not) and war like occurrence ... Nuclear, chemical or biological attack or weapons ... Any expenses incurred on Domiciliary Hospitalization and OPD treatment ... Treatment taken outside the geographical limits of India. ... In respect of the existing diseases, disclosed by the insured and mentioned in the policy schedule (based on insured’s consent), policyholder is not entitled to get the coverage for specified ICD codes. ... Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions ... expenses up to the stage of stabilization are payable but not the complete claim ... correction of eye sight due to refractive error less than 7.5 dioptres ... except ectopic pregnancy","sources":[{"clause":"7.1","heading":"Investigation & Evaluation (Code- Excl04)","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-1"},{"clause":"7.2","heading":"Rest Cure, rehabilitation and respite care (Code- Excl05)","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-2"},{"clause":"7.3","heading":"Obesity/ Weight Control (Code- Excl06)","page":9,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-3"},{"clause":"7.4","heading":"Change-of-Gender treatments (Code- Excl07)","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-4"},{"clause":"7.5","heading":"Cosmetic or plastic Surgery (Code- Excl08)","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-5"},{"clause":"7.6","heading":"Hazardous or Adventure sports (Code- Excl09)","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-6"},{"clause":"7.7","heading":"Breach of law (Code- Excl10)","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-7"},{"clause":"7.8","heading":"Excluded Providers (Code-Excl11)","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-8"},{"clause":"7.9","heading":"Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-9"},{"clause":"7.10","heading":null,"page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-10"},{"clause":"7.11","heading":null,"page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-11"},{"clause":"Excl14","heading":null,"page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-excl14"},{"clause":"7.12","heading":"Refractive Error (Code- Excl15)","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-12"},{"clause":"7.13","heading":"Unproven Treatments (Code- Excl16)","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-13"},{"clause":"7.14","heading":"Sterility and Infertility (Code- Excl17)","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-14"},{"clause":"7.15","heading":"Maternity Expenses (Code- Excl18)","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-15"},{"clause":"7.16","heading":null,"page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-16"},{"clause":"7.17","heading":null,"page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-17"},{"clause":"7.18","heading":"Any expenses incurred on Domiciliary Hospitalization and OPD treatment","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-18"},{"clause":"7.19","heading":null,"page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-19"},{"clause":"7.20","heading":null,"page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-20"}],"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":"The policyholder may cancel any time with 7 days' written notice; the insurer refunds proportionate premium for the unexpired period if no claim has been made.","display":"Proportionate premium for the unexpired period, if no claim was made","note":"Prospectus: where the monthly premium mode is opted, there is no refund on cancellation (other than free-look).","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. ... In case of cancellation of the policy (other than free-look) where monthly premium payment mode is opted, there will be no refund of the premium.","sources":[{"clause":"10.10","heading":"Cancellation","page":15,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-10-10"},{"clause":"1","heading":"Policy Design","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/202#c-1"}],"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":null,"quote":"All medical treatment for the purpose of this insurance will have to be taken in India only.","sources":[{"clause":"10.7","heading":"Territorial Limit","page":14,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-10-7"}],"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":"Individual policies only, not renewals. Refund less proportionate risk premium, medical examination and stamp duty costs.","quote":"The Free Look Period shall be applicable on individual health insurance policies and not on renewals. 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. ... the policyholder shall be entitled to a refund of the premium paid subject only to a deduction of a proportionate risk premium for the period of cover and the expenses, if any, incurred by the insurer on medical examination of the proposer and stamp duty charges.","sources":[{"clause":"10.19","heading":"Free Look Period","page":17,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-10-19"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 5","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(1), 20(2)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, II.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grace_period","label":"Grace period","section":"Renewal and rights","meaning":"Days you get after the due date to pay without losing cover or continuity.","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days (15 days for monthly instalments)","note":"The wording contradicts itself: the definition (3.19) and instalment clause (10.17) give 15 days only for monthly mode, while its Table of Benefits (and the prospectus front page) give 15 days for every mode other than yearly, so half-yearly and quarterly payers may get 15 or 30 days.","quote":"Grace Period of 30 days in all types of policies, and a period of 15 days in case of monthly instalments. ... For Yearly payment of mode, a fixed period of 30 days is to be allowed as Grace Period and for all other modes of payment a fixed period of 15 days be allowed as grace period. ... within the grace period of 30 days of expiry of your previous policy (15 days in case of premium payment mode other than yearly payment)","sources":[{"clause":"10.17","heading":"Premium Payment in Instalments","page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-10-17"},{"clause":"12","heading":"TABLE OF BENEFITS","page":19,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-12"},{"clause":null,"heading":"Arogya Sanjeevani","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/202#c-arogya-sanjeevani"}],"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":"Proposer 18 to 65 years; dependent children 3 months to 25 years. A proposer older than 65 can buy for the family without covering self.","display":"18 to 65 years (proposer); children 3 months to 25 years","note":"No upper entry age is given for spouse or parents. Prospectus says a child who has completed 26 years at renewal needs a separate policy (the wording's bonus clause speaks of a split at 25 years).","quote":"Policy can be availed by persons between the age of 18 years to 65 years, as Proposer. Proposer with higher age can obtain policy for family, without covering self. ... Dependent Children (i.e. natural or legally adopted) between the age 3 months to 25 years. ... if any Insured Person who is a child and has completed 26 years at the time of Renewal, then such Insured Person will have to take a separate policy","sources":[{"clause":"12","heading":"TABLE OF BENEFITS","page":19,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-12"},{"clause":"1","heading":"Policy Design","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/202#c-1"}],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"cross-checked","value":["Yearly","Half Yearly","Quarterly","Monthly"],"display":"Yearly, half-yearly, quarterly or monthly","note":"Prospectus: ACH / SI mandate needed for modes other than yearly; mode can change only at the end of the policy year.","quote":"Payment of Premium on an instalment basis i.e. Half Yearly, Quarterly or Monthly ... For Yearly payment of mode ... The premium payment modes allowed under the policy are Yearly, Half-Yearly, Quarterly or Monthly. ... The premium payment mode once opted, can be changed only at the end of the policy term of one year. ... ACH / SI is mandatory for all premium payment modes other than Yearly mode.","sources":[{"clause":"10.17","heading":"Premium Payment in Instalments","page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-10-17"},{"clause":"12","heading":"TABLE OF BENEFITS","page":19,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-12"},{"clause":"1","heading":"Policy Design","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/202#c-1"}],"law":[]},{"key":"optional_covers","label":"Optional covers","section":"Cover","meaning":"Covers you can add for an extra premium. They change the answers above only if you buy them.","status":"not-stated","value":null,"display":null,"note":"No optional covers or add-ons are described in the documents.","quote":null,"sources":[],"law":[]},{"key":"grace_cover","label":"Cover during the grace period","section":"Renewal and rights","meaning":"Whether a claim during the grace period is paid.","status":"conflicting","value":"Only for instalment premium policies: the wording gives coverage during the grace period where premium is paid in instalments; otherwise coverage need not be available.","display":"Covered only for instalment-premium policies","note":"Prospectus clause 9.16(c) says: 'Coverage is available during the grace period.' without limiting it to instalment payers.","quote":"Coverage need not be available during the period for which no premium is received. ... For policies where premium is paid in instalments only, the coverage will be given during grace period. ... c) Coverage is available during the grace period.","sources":[{"clause":"3.19","heading":"Grace Period","page":3,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-3-19"},{"clause":"10.17","heading":"Premium Payment in Instalments","page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-10-17"},{"clause":"9.16","heading":"Renewal of Policy","page":13,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/202#c-9-16"}],"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":"Room rent, boarding and nursing up to 2% of sum insured, maximum Rs. 5,000 per day.","display":"2% of sum insured, up to Rs. 5,000 per day","note":"A costlier room leads to proportionate deduction of associated medical expenses.","quote":"Room Rent, Boarding, Nursing Expenses as provided by the Hospital/ Nursing Home up to 2% of the sum insured subject to maximum of Rs.5000/- per day. ... If the Insured Person is admitted in a room / ICU / ICCU at rates exceeding the aforesaid limits, then We shall be liable to pay only a pro-rated portion of the total Associated Medical Expenses","sources":[{"clause":"4.1","heading":"Hospitalization","page":6,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-4-1"},{"clause":"4.1.1","heading":"Other expenses","page":6,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-4-1-1"}],"law":[]},{"key":"room_category","label":"Room category allowed","section":"Limits and co-pay","meaning":"Shared room, single private room or any room, by plan, when the limit is a room type rather than a rupee amount.","status":"not-stated","value":null,"display":null,"note":"No room category is named; the room limit is a rupee amount (2% of sum insured up to Rs. 5,000 per day).","quote":null,"sources":[],"law":[]},{"key":"icu_limit","label":"ICU limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for intensive care.","status":"cross-checked","value":"ICU / ICCU expenses up to 5% of sum insured, maximum Rs. 10,000 per day.","display":"5% of sum insured, up to Rs. 10,000 per day","note":null,"quote":"Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) expenses up to 5% of sum insured subject to maximum of Rs. 10,000/- per day.","sources":[{"clause":"4.1","heading":"Hospitalization","page":6,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-4-1"}],"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, ICU or ICCU rate exceeds the limit, only a pro-rated share of associated medical expenses (room rent, nursing, doctors' fees, operation theatre charges) is paid.","display":"Yes, associated medical expenses are pro-rated","note":null,"quote":"If the Insured Person is admitted in a room / ICU / ICCU at rates exceeding the aforesaid limits, 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":"4.1.1","heading":"Other expenses","page":6,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-4-1-1"}],"law":[]},{"key":"copay","label":"Co-payment","section":"Limits and co-pay","meaning":"The share of every admissible claim you pay yourself, and when it applies (age, zone, choice of hospital).","status":"cross-checked","value":"5% co-payment on each and every admissible claim.","display":"5% on every claim","note":null,"quote":"Each and every claim under the Policy shall be subject to a Copayment of 5% applicable to claim amount admissible and payable as per the terms and conditions of the Policy.","sources":[{"clause":"9.5","heading":"Co-payment","page":13,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-9-5"}],"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.","display":"None","note":"From the CIS.","quote":"iii. Annual Aggregate Deductible - NA","sources":[{"clause":"19","heading":"Treatment taken outside the geographical limits of","page":2,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/203#c-19"}],"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":["Cataract: 25% of Sum Insured or Rs. 40,000, whichever is lower, per eye per policy year","Listed modern treatment methods: up to 50% of Sum Insured"],"display":"Cataract 25% of SI or Rs. 40,000 per eye; modern treatments 50% of SI","note":"Room rent (2% of SI up to Rs. 5,000 a day) and ICU (5% of SI up to Rs. 10,000 a day) limits also apply.","quote":"The Company shall indemnify medical expenses incurred for treatment of Cataract, subject to a limit of 25% of Sum Insured or Rs. 40,000/-, whichever is lower, per each eye in one policy year. ... The following procedures will be covered (wherever medically indicated) either as inpatient or as part of day care treatment in a hospital up to 50% of Sum Insured","sources":[{"clause":"4.3","heading":"Cataract Treatment","page":6,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-4-3"},{"clause":"4.6","heading":null,"page":7,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-4-6"}],"law":[]},{"key":"pre_hospitalisation","label":"Pre-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days before admission that are paid if related to the hospitalisation.","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days","note":null,"quote":"for a fixed period of 30 days prior to the date of admissible hospitalization covered under the policy.","sources":[{"clause":"4.4","heading":"Pre Hospitalization","page":6,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-4-4"}],"law":[]},{"key":"post_hospitalisation","label":"Post-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days after discharge that are paid if related to the hospitalisation.","status":"cross-checked","value":{"unit":"days","amount":60},"display":"60 days","note":null,"quote":"for a fixed period of 60 days from the date of discharge from the hospital, following an admissible hospitalization covered under the policy.","sources":[{"clause":"4.5","heading":"Post Hospitalisation","page":7,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-4-5"}],"law":[]},{"key":"day_care","label":"Day-care treatments","section":"Cover","meaning":"Treatments needing less than 24 hours in hospital (chemotherapy, dialysis, cataract) and whether all or only listed ones are covered.","status":"cross-checked","value":"All day care treatments are covered.","display":"All day care treatments","note":null,"quote":"iv) All the day care treatments ... the time limit shall not apply in respect of Day Care Treatment.","sources":[{"clause":"4.1.1","heading":"Other expenses","page":6,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-4-1-1"}],"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":"Not covered.","display":"Not covered","note":null,"quote":"Any expenses incurred on Domiciliary Hospitalization and OPD treatment","sources":[{"clause":"7.18","heading":"Any expenses incurred on Domiciliary Hospitalization and OPD treatment","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-18"}],"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":"In-patient AYUSH treatment in an AYUSH Hospital is covered up to the sum insured.","display":"Covered up to the sum insured (in-patient, AYUSH Hospital)","note":null,"quote":"The Company shall indemnify medical expenses incurred for inpatient care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems of medicines during each Policy Year up to the Iimit of sum insured as specified in the policy schedule in any AYUSH Hospital.","sources":[{"clause":"4.2","heading":"AYUSH Treatment","page":6,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-4-2"}],"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 50% of the sum insured, in-patient or day care: Uterine Artery Embolization and HIFU, Balloon Sinuplasty, Deep Brain Stimulation, Oral Chemotherapy, Immunotherapy, Intra Vitreal Injections, Robotic Surgeries, Stereotactic Radio Surgeries, Bronchical Thermoplasty, Vaporisation of the Prostrate, IONM and Stem Cell Therapy.","display":"Covered up to 50% of sum insured","note":"Stem cell therapy limited to hematopoietic stem cells for bone marrow transplant for haematological conditions.","quote":"The following procedures will be covered (wherever medically indicated) either as inpatient or as part of day care treatment in a hospital up to 50% of Sum Insured, specified in the policy schedule, during the policy period: A. Uterine Artery Embolization and HIFU (High Intensity Focused Ultrasound) B. Balloon Sinuplasty C. Deep Brain Stimulation D. Oral Chemotherapy E. lmmunotherapy- Monoclonal Antibody to be given as injection F. Intra Vitreal Injections G. Robotic Surgeries H. Stereotactic Radio Surgeries ... I) Bronchical Thermoplasty J. Vaporisation of the Prostrate (Green Laser treatment or Holmium Laser Treatment) K. IONM (Intra Operative Neuro Monitoring) L. Stem Cell Therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions to be covered.","sources":[{"clause":"4.6","heading":null,"page":7,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-4-6"},{"clause":"4.6(I)","heading":null,"page":7,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-4-6-i"}],"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":"not-stated","value":null,"display":null,"note":"The documents do not mention organ donor expenses.","quote":null,"sources":[],"law":[]},{"key":"ambulance","label":"Ambulance cover","section":"Cover","meaning":"Road (and air) ambulance cover and its limit.","status":"cross-checked","value":"Road ambulance up to Rs. 2,000 per hospitalisation.","display":"Road ambulance up to Rs. 2000 per hospitalisation","note":"Air ambulance is not mentioned. The wording contradicts itself: Annexure A List I (items not covered) also lists 'AMBULANCE'.","quote":"Expenses incurred on road Ambulance subject to a maximum of Rs.2000/- per hospitalisation. ... List I- Items for which coverage is not available in the policy ... 67 | AMBULANCE","sources":[{"clause":"4.1.1","heading":"Other expenses","page":6,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-4-1-1"},{"clause":"Annexure A","heading":null,"page":20,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-annexure-a"}],"law":[]},{"key":"restoration","label":"Restoration of sum insured","section":"Cover","meaning":"Whether the sum insured is refilled after it is used up in a year, how much, how often, and whether it works for the same illness.","status":"not-stated","value":null,"display":null,"note":"The documents do not describe any restoration or recharge of the sum insured.","quote":null,"sources":[],"law":[]},{"key":"no_claim_bonus","label":"No-claim or cumulative bonus","section":"Cover","meaning":"How much the cover grows each year, the maximum, whether it depends on not claiming, and what happens after a claim.","status":"cross-checked","value":"Cumulative bonus of 5% of sum insured for each claim-free year, up to 50%; after a claim it is reduced at the same rate.","display":"5% per claim-free year, up to 50% of sum insured","note":"Prospectus: a flat INR 49 renewal discount is also given whenever cumulative bonus is offered.","quote":"Cumulative Bonus will be increased by 5% in respect of each claim free policy year (where no claims are reported), provided the policy is renewed with the company without a break subject to maximum of 50% of the sum insured under the current policy year. If a claim is made in any particular year, the cumulative bonus accrued shall be reduced at the same rate at which it has accrued. ... In case a consumer is receiving Cumulative Bonus at the time of renewal, as specified in the policy wordings, we will offer a flat discount of INR 49 to the policy.","sources":[{"clause":"5","heading":"CUMULATIVE BONUS (CB)","page":7,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-5"},{"clause":"1","heading":"Policy Design","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/202#c-1"}],"law":[]},{"key":"consumables","label":"Consumables and non-medical items","section":"Cover","meaning":"Gloves, PPE, syringes and other items hospitals bill that standard policies exclude; whether this policy pays them.","status":"cross-checked","value":"Not covered: items such as gloves, masks, nebulizer kits and other non-medical items in List I of Annexure A are not payable.","display":"Not covered (List I of Annexure A)","note":null,"quote":"List I- Items for which coverage is not available in the policy ... NEBULIZER KIT ... GLOVES ... MASK","sources":[{"clause":"Annexure A","heading":null,"page":20,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-annexure-a"}],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Whether childbirth costs are covered, the limit and the waiting period.","status":"cross-checked","value":"Not covered: childbirth, caesarean, miscarriage and termination expenses are excluded.","display":"Not covered","note":"Ectopic pregnancy is not excluded.","quote":"Maternity Expenses (Code- Excl18) i) Medical treatment expenses traceable to child birth (including complicated deliveries and caesarean sections incurred during hospitalization) except ectopic pregnancy;","sources":[{"clause":"7.15","heading":"Maternity Expenses (Code- Excl18)","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-15"}],"law":[]},{"key":"newborn","label":"Newborn baby cover","section":"Cover","meaning":"Whether a newborn is covered from birth and for what.","status":"cross-checked","value":"No cover from birth: dependent children can be insured only from 3 months of age.","display":"Not from birth; children can be covered from 3 months of age","note":"Maternity and childbirth expenses are excluded (Excl18).","quote":"Dependent Children (i.e. natural or legally adopted) between the age 3 months to 25 years. ... i) Medical treatment expenses traceable to child birth (including complicated deliveries and caesarean sections incurred during hospitalization) except ectopic pregnancy;","sources":[{"clause":"12","heading":"TABLE OF BENEFITS","page":19,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-12"},{"clause":"7.15","heading":"Maternity Expenses (Code- Excl18)","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-15"}],"law":[]},{"key":"mental_illness","label":"Mental illness","section":"Cover","meaning":"Cover for in-patient treatment of mental illness.","status":"not-stated","value":null,"display":null,"note":"The documents do not mention mental illness cover.","quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 3","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch III I","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(4)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 2(1)(s)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(1)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"}]},{"key":"health_checkup","label":"Health check-up","section":"Cover","meaning":"Free preventive check-ups and how often.","status":"not-stated","value":null,"display":null,"note":"No preventive health check-up benefit is described (only pre-insurance medical tests for underwriting).","quote":null,"sources":[],"law":[]},{"key":"opd","label":"Out-patient (OPD) cover","section":"Cover","meaning":"Doctor consultations, tests and medicines without admission, and the limit.","status":"cross-checked","value":"Not covered.","display":"Not covered","note":null,"quote":"Any expenses incurred on Domiciliary Hospitalization and OPD treatment","sources":[{"clause":"7.18","heading":"Any expenses incurred on Domiciliary Hospitalization and OPD treatment","page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-7-18"}],"law":[]},{"key":"zone_pricing","label":"Zone or city-based premium","section":"Premium","meaning":"Whether premium or co-pay depends on the city you are treated in.","status":"not-stated","value":null,"display":null,"note":"The documents do not mention zone-based premium or co-pay.","quote":null,"sources":[],"law":[]},{"key":"cashless","label":"Cashless treatment","section":"Claims","meaning":"Whether and where the insurer pays the hospital directly instead of you paying and claiming back.","status":"cross-checked","value":"Yes, at network providers subject to pre-authorisation; the insurer also offers 'Cashless Everywhere', including hospitals outside its network.","display":"Yes, at network hospitals and also non-network hospitals (Cashless Everywhere)","note":null,"quote":"i) Treatment may be taken in a network provider and is subject to pre authorization by the Company or its authorized TPA. ... Note: We offer Cashless Everywhere, even in hospitals which are not part of our network.","sources":[{"clause":"9.1(i)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-9-1-i"},{"clause":"9.1(vi)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-9-1-vi"}],"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 or its authorised TPA.","display":"The insurer or its authorised TPA","note":"The prospectus front page says: 'You talk to us directly, not through any third parties.'","quote":"subject to pre authorization by the Company or its authorized TPA.","sources":[{"clause":"9.1(i)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-9-1-i"}],"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, individual or floater sum insured","note":null,"quote":"Product Type | Individual/Floater ... On Floater basis- SI shall apply to the entire family","sources":[{"clause":"12","heading":"TABLE OF BENEFITS","page":19,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201#c-12"}],"law":[]}],"documents":[{"kind":"wording","label":"Arogya Sanjeevani Policy Wording","pages":27,"fetched_at":"2026-10-16 07:11:44.415326+00","source_url":"https://transactions.nivabupa.com/pages/doc/policy_wording/ArogyaSanjeevani-PolicyDocument.pdf?v=1.3","url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/201"},{"kind":"prospectus","label":"Arogya Sanjeevani Prospectus","pages":26,"fetched_at":"2026-10-16 07:11:44.415326+00","source_url":"https://transactions.nivabupa.com/pages/doc/prospectus/Arogya_Sanjeevani_Prospectus.pdf?v=1.3","url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/202"},{"kind":"cis","label":"Arogya Sanjeevani, Niva Bupa Health Insurance","pages":9,"fetched_at":"2026-10-16 07:11:44.415326+00","source_url":"https://transactions.nivabupa.com/pages/doc/Customer-Information/Arogya-Sanjeevani-Customer-Information-Sheet.pdf?v=1.0","url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627/document/203"}],"versions":[],"where_to_buy":[],"claims_and_complaints":[],"notice":"Information, not advice. IndiaInsurances is not an insurer or an insurance intermediary, does not sell insurance and earns no commission. Policy terms change and your own policy schedule can differ: always confirm with the policy document and the insurer before you buy or claim.","cite_as":"Arogya Sanjeevani, Niva Bupa Health Insurance (UIN NBHHLIP27056V042627), IndiaInsurances, https://indiainsurances.com/policy/niva-bupa-health-insurance/arogya-sanjeevani-niva-bupa-health-insurance-nbhhlip27056v042627"}