{"uin":"NBHHLIP27058V102627","name":"Heartbeat","url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627","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":"Heartbeat is a Niva Bupa indemnity health insurance policy sold as Silver, Gold and Platinum plans on an individual, family floater or Family First (extended family) basis, with base sum insured from Rs 1 lac per person (Family First) or Rs 2 lacs up to Rs 1 Crore. It has a 30-day initial wait, a 24-month pre-existing disease wait (36 months on Silver), a re-fill of up to 100% of base sum insured outside Family First, and the Platinum plan adds OPD and emergency cover outside India excluding USA & Canada.","analysis":{"state":"extracted","analysed_at":"2026-10-16 07:11:59.045243+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":["Silver","Gold","Platinum"],"display":"Silver, Gold and Platinum plans, each as Individual / Family Floater or Family First","note":"Each plan is sold as Individual / Family Floater or as Family First (extended family, up to 19 relationships, with a base sum insured per person plus a floater sum insured). Individual and Family Floater Silver is for renewals only.","quote":"Individual and Family Floater - Silver Plan (Renewal only) ... Individual and Family Floater - Gold Plan ... Individual and Family Floater - Platinum Plan ... Family First - Silver Plan ... Family First - Gold Plan ... Family First - Platinum Plan","sources":[{"clause":null,"heading":"Individual and Family Floater - Silver Plan (Renewal only)","page":58,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-individual-and-family-floater-silver-plan-renewa"},{"clause":null,"heading":"Individual and Family Floater - Gold Plan","page":59,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-individual-and-family-floater-gold-plan"},{"clause":null,"heading":"Individual and Family Floater - Platinum Plan","page":61,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-individual-and-family-floater-platinum-plan"},{"clause":null,"heading":"Family First - Silver Plan","page":63,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-family-first-silver-plan"},{"clause":null,"heading":"Family First - Gold Plan","page":64,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-family-first-gold-plan"},{"clause":null,"heading":"Family First - Platinum Plan","page":66,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-family-first-platinum-plan"}],"law":[]},{"key":"policy_term","label":"Policy term","section":"Eligibility","meaning":"How long one policy runs before it ends or must be renewed.","status":"cross-checked","value":"One year by default; a two-year policy term is also available.","display":"1 year (2-year option)","note":"2-year term gets a 12.5% discount on the premium for the second policy year.","quote":"The default policy term for all plans is one year. Two year policy term option is also available under the product. ... 2 year term: 12.5% on the premium for second policy year","sources":[{"clause":"1","heading":"Policy Design","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/205#c-1"}],"law":[]},{"key":"claim_intimation","label":"Claim intimation deadline","section":"Claims","meaning":"How soon you must tell the insurer about a claim or hospitalisation.","status":"cross-checked","value":"Planned cashless treatment: at least 72 hours before. Emergency cashless: within 48 hours of hospitalisation or before discharge, whichever is earlier. Reimbursement: written notice within 48 hours of admission or before discharge, whichever is earlier.","display":"72 hours before planned treatment; within 48 hours of admission (or before discharge, if earlier) in emergencies and for reimbursement","note":"Delays are condoned on merits where proved to be for reasons beyond the claimant's control (Section 6.2.16.5). Critical Illness optional cover: written notice within 7 days.","quote":"We must be contacted to pre-authorize Cashless Facility for planned treatment at least 72 hours prior to the proposed treatment. ... If the Insured Person has been Hospitalized in an Emergency, We must be contacted to pre-authorize Cashless Facility within 48 hours of the Insured Person’s Hospitalization or before discharge from the Hospital, whichever is earlier. ... We shall be given written notice of the claim along with the following details within 48 hours of admission to the Hospital or before discharge from the Hospital, whichever is earlier: ... We will condone such delay on merits where the delay has been proved to be for reasons beyond the claimant’s control. ... We shall be given written notice immediately and in any event within 7 days of the aforesaid Illness/ condition/ Surgical Procedure.","sources":[{"clause":"6.2.16.2(a)(i)","heading":null,"page":47,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-6-2-16-2-a-i"},{"clause":"6.2.16.2(XI)","heading":null,"page":47,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-6-2-16-2-xi"},{"clause":"6.2.16.5","heading":"Delay in Claim Intimation or Claim Documentation","page":50,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-6-2-16-5"},{"clause":"4.2(II)(f)(i)","heading":"Bacterial meningitis","page":30,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-4-2-ii-f-i"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 20, 21","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_documents","label":"Claim documents","section":"Claims","meaning":"Documents the insurer asks for when you claim.","status":"cross-checked","value":["Claim form duly completed and signed by the claimant","Details of past medical history record, first and subsequent consultation","Age / Identity proof document","Cancelled cheque/ bank statement / copy of passbook","Original discharge summary","Bar code sticker and invoice for implants and prosthesis","Original final bill from Hospital with detailed break-up and paid receipt","Room tariff of the entitled room category (Non-Network provider)","Original bills of pharmacy/medicines purchased","MLC/ Panchnama / First Information Report (FIR) copy (accident cases)","Original laboratory investigation, diagnostic, radiological & pathological reports with supporting prescriptions"],"display":"Claim form, medical history, ID proof, bank details, discharge summary, final bill, pharmacy bills, investigation reports (FIR/MLC for accidents)","note":"For cashless claims the Network Provider submits these documents. Extra documents apply to Personal Accident, Critical Illness and claims outside India.","quote":"a) Claim form duly completed and signed by the claimant. ... b) Details of past medical history record, first and subsequent consultation. ... c) Age / Identity proof document of Insured Person ... d) Cancelled cheque/ bank statement / copy of passbook ... e) Original discharge summary. ... f) Bar code sticker and invoice for implants and prosthesis ... g) Original final bill from Hospital with detailed break-up and paid receipt. ... h) Room tariff of the entitled room category (in case of a Non-Network provider ... i) Original bills of pharmacy/medicines purchased ... j) For Medico-legal cases (MLC) or in case of Accident ... i) MLC/ Panchnama / First Information Report (FIR) copy ... k) Original laboratory investigation, diagnostic, radiological & pathological reports with supporting prescriptions.","sources":[{"clause":"6.2.16.3","heading":"Claims Documentation","page":49,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-6-2-16-3"}],"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; if payment is delayed it pays interest at 2% above the bank rate from receipt of claim intimation.","display":"Within 15 days of claim submission","note":"Cashless final discharge authorisation is processed within three hours of the final documents; CIS states a 1 hour TAT for cashless pre-authorisation.","quote":"I) The Company shall settle or reject a claim, as the case may be, within 15 days from the claim submission date ... the Company shall be liable to pay interest to the policyholder from the date of receipt of claim intimation till the date of payment of claim at a rate of 2% above the bank rate. ... 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 Hours","sources":[{"clause":"6.1.9(I)","heading":null,"page":41,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-6-1-9-i"},{"clause":"6.2.16.2(a)(i)","heading":null,"page":47,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-6-2-16-2-a-i"},{"clause":"Excl10(c)(iii)","heading":null,"page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/206#c-excl10-c-iii"}],"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)","30-day Waiting Period (Code-Excl03)","Specified disease/procedure waiting period (Code- Excl02)","Investigation & Evaluation (Code-Excl04)","Obesity/ Weight Control (Code-Excl06)","Cosmetic or plastic Surgery (Code-Excl08)","Hazardous or Adventure sports (Code-Excl09)","Breach of law (Code-Excl10)","Alcoholism, drug or substance abuse (Excl12)","Sterility and Infertility (Code-Excl17)","Maternity (Code-Excl18)","Conflict & Disaster","Dental/oral treatment","Hormone Replacement Therapy","Any treatment or medical services received outside the geographical limits of India"],"display":"Waiting periods (pre-existing diseases, first 30 days, listed illnesses), standard exclusions such as investigation-only admissions, obesity, cosmetic surgery, hazardous sports, alcohol and drug abuse, infertility and maternity, plus war, dental, hormone therapy and treatment outside India","note":"Maternity is covered under the Maternity Benefit (Family First, or Family Floater with spouse); treatment outside India is covered under the Platinum plan's international benefits. Full list in permanent exclusions.","quote":"5.1.1.1 Pre-existing Diseases (Code-Excl01) ... 5.1.1.2 30-day Waiting Period (Code-Excl03) ... 5.1.1.3 Specified disease/procedure waiting period (Code- Excl02) ... 5.1.2.1 Investigation & Evaluation (Code-Excl04) ... 5.1.2.3 Obesity/ Weight Control (Code-Excl06) ... 5.1.2.5 Cosmetic or plastic Surgery (Code-Excl08) ... 5.1.2.6 Hazardous or Adventure sports (Code-Excl09) ... 5.1.2.7 Breach of law (Code-Excl10) ... Treatment for, alcoholism, drug or substance abuse or any addictive condition and consequences thereof. ... Excl12 ... 5.1.2.14 Sterility and Infertility (Code-Excl17) ... 5.1.2.15 Maternity (Code-Excl18) ... 5.2.3 Conflict & Disaster ... 5.2.5 Dental/oral treatment ... 5.2.6 Hormone Replacement Therapy ... Any treatment or medical services received outside the geographical limits of India.","sources":[{"clause":"5.1.1.1","heading":"Pre-existing Diseases (Code-Excl01)","page":33,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-1-1-1"},{"clause":"5.1.1.2","heading":"30-day Waiting Period (Code-Excl03)","page":33,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-1-1-2"},{"clause":"5.1.1.3","heading":"Specified disease/procedure waiting period (Code- Excl02)","page":33,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-1-1-3"},{"clause":"5.1.2.1","heading":"Investigation & Evaluation (Code-Excl04)","page":34,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-1-2-1"},{"clause":"5.1.2.3","heading":"Obesity/ Weight Control (Code-Excl06)","page":35,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-1-2-3"},{"clause":"5.1.2.5","heading":"Cosmetic or plastic Surgery (Code-Excl08)","page":35,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-1-2-5"},{"clause":"5.1.2.6","heading":"Hazardous or Adventure sports (Code-Excl09)","page":35,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-1-2-6"},{"clause":"5.1.2.7","heading":"Breach of law (Code-Excl10)","page":35,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-1-2-7"},{"clause":"5.1.2.9","heading":null,"page":36,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-1-2-9"},{"clause":"Excl12","heading":null,"page":36,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-excl12"},{"clause":"5.1.2.14","heading":"Sterility and Infertility (Code-Excl17)","page":36,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-1-2-14"},{"clause":"5.1.2.15","heading":"Maternity (Code-Excl18)","page":36,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-1-2-15"},{"clause":"5.2.3","heading":"Conflict & Disaster","page":36,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-2-3"},{"clause":"5.2.5","heading":"Dental/oral treatment","page":36,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-2-5"},{"clause":"5.2.6","heading":"Hormone Replacement Therapy","page":37,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-2-6"},{"clause":"5.2.9","heading":null,"page":37,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-2-9"}],"law":[{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 11","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grievance","label":"Grievance route","section":"Claims","meaning":"Who to complain to first, as stated in the policy, before going to the Insurance Ombudsman.","status":"cross-checked","value":"Contact Niva Bupa customer services first (website www.nivabupa.com, toll free 1860-500-8888, service platform, or any branch grievance cell); if not satisfied, the grievance officer (Head - Customer Services) and then GRO@nivabupa.com; then the Insurance Ombudsman.","display":"Niva Bupa customer services (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":"In case of any grievance the insured person may contact the company through: ... Website: www.nivabupa.com Toll free: 1860-500-8888 ... lnsured person may also approach the grievance cell at any of the company’s branches with the details of grievance. 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 ... (Senior citizens may write to us at: seniorcitizensupport@nivabupa.com) ... Grievance may also be lodged at IRDAI lntegrated Grievance Management System – www.bimabharosa.irdai.gov.in","sources":[{"clause":"6.1.8","heading":"Redressal of Grievances","page":41,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-6-1-8"}],"law":[{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 3","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 4","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 5","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(11)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(42)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 34","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 69","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Insurance Act, 1938","section":"Section 38","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 12","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 19","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 20","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 13","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 2","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(5), 5(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(9)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 25","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 26","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 11","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 3","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 13","url":"https://indiainsurances.com/law/ombudsman-rules-2017"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 14","url":"https://indiainsurances.com/law/ombudsman-rules-2017"}]},{"key":"sum_insured_options","label":"Sum insured options","section":"Cover","meaning":"The cover amounts you can choose from.","status":"cross-checked","value":"Individual / Family Floater: Silver Rs 2 or 3 lacs (renewal only); Gold Rs 5, 7.5, 10, 15, 20, 30 or 50 lacs; Platinum Rs 15, 20, 50 lacs or 1 Cr. Family First: base sum insured per person (Silver 1 to 5 lacs, Gold 1 to 15 lacs, Platinum 5, 10 or 15 lacs) plus a floater sum insured (Silver 3 to 15 lacs, Gold 3 to 50 lacs, Platinum 15 to 50 lacs).","display":"Individual / Family Floater: Rs 2 lacs to Rs 1 Crore by plan (Rs 5 lacs minimum for new policies); Family First: Rs 1 to 15 lacs per person plus a floater of Rs 3 to 50 lacs","note":"Sum insured each year also includes Loyalty Additions and, outside Family First, the re-fill amount.","quote":"Individual and Family Floater - Silver Plan (Renewal only) Base Sum Insured (in Rs) | 2 lacs | 3 lacs ... Base Sum Insured (in Rs) | 5 lacs | 7.5 lacs | 10 lacs | 15 lacs | 20 lacs | 30 lacs | 50 lacs ... Base Sum Insured (in Rs) | 15 lacs | 20 lacs | 50 lacs | 1 Cr ... Base Sum Insured: 1Lacs, 2Lacs, 3Lacs, 4Lacs & 5Lacs per Insured Person Floater Sum Insured – (available on a floating basis over Base Sum Insured): 3Lacs, 4Lacs, 5Lacs, 10Lacs &15Lacs. ... Base Sum Insured: 1Lacs, 2Lacs, 3Lacs, 4Lacs, 5Lacs, 10Lacs & 15Lacs per Insured Person Floater Sum Insured – (available on a floating basis over Base Sum Insured): 3Lacs, 4Lacs, 5Lacs, 10Lacs, 15Lacs, 20Lacs, 30Lacs & 50Lacs ... Base Sum Insured: 5Lacs, 10 Lacs & 15 Lacs per Insured Person Floater Sum Insured: (available on a floating basis over Base Sum Insured): 15Lacs, 20 Lacs, 30 Lacs & 50 Lacs. ... In case of Individual or Family Floater - range from Rs. 2 lacs ( for renewal policy) / Rs. 5 lacs (for new policy) to Rs. 1 Crore depending on the plan you choose.","sources":[{"clause":null,"heading":"Individual and Family Floater - Silver Plan (Renewal only)","page":58,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-individual-and-family-floater-silver-plan-renewa"},{"clause":null,"heading":"Individual and Family Floater - Gold Plan","page":59,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-individual-and-family-floater-gold-plan"},{"clause":null,"heading":"Individual and Family Floater - Platinum Plan","page":61,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-individual-and-family-floater-platinum-plan"},{"clause":null,"heading":"Family First - Silver Plan","page":63,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-family-first-silver-plan"},{"clause":null,"heading":"Family First - Gold Plan","page":64,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-family-first-gold-plan"},{"clause":null,"heading":"Family First - Platinum Plan","page":66,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-family-first-platinum-plan"},{"clause":"2","heading":"Coverage Options","page":3,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/205#c-2"}],"law":[]},{"key":"initial_waiting","label":"Initial waiting period","section":"Waiting periods","meaning":"Days from the start of the first policy during which illness claims are not paid (accidents usually are).","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days","note":"Accidents are covered from day one. The optional Critical Illness cover has its own 90-day waiting period.","quote":"a) Expenses related to the treatment of any Illness within 30 days from the first Policy commencement date shall be excluded except claims arising due to an Accident, provided the same are covered. ... b) This exclusion shall not, however, apply if the Insured Person has continuous coverage for more than twelve months ... 90 day Waiting Period:","sources":[{"clause":"5.1.1.2","heading":"30-day Waiting Period (Code-Excl03)","page":33,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-1-1-2"},{"clause":"4.2(II)(f)(i)","heading":"Bacterial meningitis","page":30,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-4-2-ii-f-i"}],"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 (Gold & Platinum); 36 months (Silver)","note":"36 months under Silver plans. The optional Critical Illness cover has a 36-month PED waiting period.","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 (under gold & platinum Plans)/ 36 months (under Silver Plans) of continuous coverage after the date of inception of the first Policy.","sources":[{"clause":"5.1.1.1","heading":"Pre-existing Diseases (Code-Excl01)","page":33,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-1-1-1"}],"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 (only for those above 45 at entry)","note":"Applies only to Insured Persons above 45 years of Age at inception of the First Policy. Not applicable to accidents (covered from day 1) or cancer (covered after the 30-day waiting period). The CIS prints a different list of conditions (see specific_waiting_list).","quote":"For all Insured Persons who are above 45 years of Age as on the date of inception of the First Policy with Us, the following specifies disease/procedure waiting period will be applicable. ... a) Expenses related to the treatment of the listed conditions, surgeries/treatments shall be excluded until the expiry of 24 months of continuous coverage after the date of inception of the first Policy. ... This exclusion shall not be applicable for claims arising due to an Accident (covered from day 1 or Cancer (covered after 30-day waiting period).","sources":[{"clause":"5.1.1.3","heading":"Specified disease/procedure waiting period (Code- Excl02)","page":33,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-1-1-3"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting_list","label":"Illnesses with a specific waiting period","section":"Waiting periods","meaning":"The named illnesses and procedures that carry the specific waiting period.","status":"conflicting","value":["Pancreatitis and Stones in Biliary and Urinary System","Cataract, Glaucoma and Retinal detachment","Hyperplasia of Prostate, Hydrocele and spermatocele","Prolapse uterus or cervix, endometriosis, Fibroids, Polycystic ovarian disease (PCOD), hysterectomy (unless necessitated by Malignancy)","Hemorrhoids, Fissure or Fistula or Abscess of anal and rectal region","Hernia of any site or type","Osteoarthritis, joint replacement, osteoporosis, systemic connective tissue disorders, inflammatory polyarthropathies, Rheumatoid Arthritis, gout, intervertebral disc disorders, arthroscopic surgeries for ligament repair","Varicose veins of lower extremities","All internal or external benign neoplasms/ tumours, cyst, sinus, polyps, nodules, mass or lump","Ulcer, erosion or varices of gastro intestinal tract","Surgical treatment for diseases of middle ear and mastoid (including otitis media, cholesteatoma, perforation of tympanic membrane), Tonsils and adenoids, nasal septum and nasal sinuses"],"display":"Wording list of named conditions (cataract, hernia, joint replacement, piles, stones, benign growths and others); CIS list differs","note":"Policy wording (and prospectus) list shown. The CIS prints a different list that adds 'Chronic kidney disease and failure' and 'Internal Congenital Anomaly' and words other items differently (e.g. 'Cataract, Glaucoma and other disorders of lens, disorders of Retina', 'Abnormal Utero-vaginal bleeding', 'Dorsopathies, Spondylopathies'), and omits joint replacement and arthroscopic ligament surgery.","quote":"i) Pancreatitis and Stones in Biliary and Urinary System, ... ii) Cataract, Glaucoma and Retinal detachment, ... iii) Hyperplasia of Prostate, Hydrocele and spermatocele, ... iv) Prolapse uterus or cervix, endometriosis, Fibroids, Polycystic ovarian disease (PCOD), hysterectomy (unless necessitated by Malignancy) ... v) Hemorrhoids, Fissure or Fistula or Abscess of anal and rectal region, ... vi) Hernia of any site or type, ... vii) Osteoarthritis, joint replacement, osteoporosis, systemic connective tissue disorders, inflammatory polyarthropathies, Rheumatoid Arthritis, gout, intervertebral disc disorders, arthroscopic surgeries for ligament repair ... viii) Varicose veins of lower extremities ... ix) All internal or external benign neoplasms/ tumours, cyst, sinus, polyps, nodules, mass or lump ... x) Ulcer, erosion or varices of gastro intestinal tract ... xi) Surgical treatment for diseases of middle ear and mastoid (including otitis media, cholesteatoma, perforation of tympanic membrane), Tonsils and adenoids, nasal septum and nasal sinuses ... viii. Chronic kidney disease and failure ... xiv. Internal Congenital Anomaly ... ii. Cataract, Glaucoma and other disorders of lens, disorders of Retina","sources":[{"clause":"5.1.1.3","heading":"Specified disease/procedure waiting period (Code- Excl02)","page":33,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-1-1-3"},{"clause":"Excl10(c)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/206#c-excl10-c"}],"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 amount only.","quote":"After completion of sixty continuous months of coverage (including portability and migration) in health insurance policy, no policy and claim shall be contestable by the insurer on the grounds of non-disclosure, misrepresentation, except on grounds of established fraud.","sources":[{"clause":"6.1.10","heading":"Moratorium Period","page":42,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-6-1-10"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 13","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 8","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"portability","label":"Portability","section":"Renewal and rights","meaning":"Whether you can move this policy to another insurer and keep waiting-period credit.","status":"cross-checked","value":"Yes. The policyholder can port the policy to another insurer and carry over credits for sum insured, no claim bonus, specific waiting periods, pre-existing disease waiting period and moratorium period, subject to the new insurer's underwriting.","display":"Yes, with waiting-period credit","note":"Migration to another Niva Bupa policy carries the same credits (Section 6.1.15).","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 the previous policy.","sources":[{"clause":"6.1.14","heading":"Portability","page":42,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-6-1-14"}],"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","note":"Lifetime renewability wording is from the prospectus; a child who completes Age 22 must move to a separate policy.","quote":"A health insurance policy shall be renewable except on grounds of established fraud or non-disclosure or misrepresentation by the insured. ... We assure you renewability of your policy for lifetime, if you pay renewal premium within the grace period of 30 days of expiry of your previous policy.","sources":[{"clause":"6.1.3","heading":"Renewal of Policy","page":39,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-6-1-3"},{"clause":null,"heading":"Heartbeat – Prospectus cum Sales Literature","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/205#c-heartbeat-prospectus-cum-sales-literature"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II D.II","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"claim_loading","label":"Premium loading after claims","section":"Renewal and rights","meaning":"Whether the premium can go up at renewal because you made a claim.","status":"cross-checked","value":"No loading on renewal based on individual claims experience. However the renewal discount depends on claims: the favourable claim experience discount (up to 42%) falls by 1 to 3 levels after claims above Rs 40,000.","display":"No claim-based loading; renewal discount can reduce after claims","note":"Favourable claim experience discount does not apply to insureds aged 60 years and above. A claim up to INR 40,000 keeps the same level.","quote":"III) No loading shall apply on renewals based on individual claims experience. However, discount in premium may be provided by insurers to individual policyholders for good claims experience. ... You will get a discount on your policy of up to 42% on the renewal premium basis the value of the claims paid in a policy year. ... More than INR 40,000- and up to INR 75,000 | Moves down the grid 1 level ... More than INR 1,50,000 | Moves down the gird by 3 levels ... Claim up to INR 40,000 | Stays in the same level ... Favourable claim experience discount will not apply to insureds aged 60 years and above","sources":[{"clause":"6.1.3","heading":"Renewal of Policy","page":39,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-6-1-3"},{"clause":"1","heading":"Policy Design","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/205#c-1"},{"clause":null,"heading":"Level Grid","page":2,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/205#c-level-grid"}],"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 (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 (Excl12)","Treatments received in heath hydros, nature cure clinics, spas (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 (Code-Excl18)","Ancillary Hospital Charges","Circumcision","Conflict & Disaster","External Congenital Anomaly","Dental/oral treatment","Hormone Replacement Therapy","Sexually transmitted Infections & diseases (other than HIV / AIDS)","Sleep disorders","Any treatment or medical services received outside the geographical limits of India","Unrecognized Physician or Hospital","Artificial life maintenance for the Insured Person who has been declared brain dead or in vegetative state","AYUSH Treatment (except Section 3.6)"],"display":"IRDAI standard exclusions Excl04 to Excl18 plus the product's own specific exclusions (war, dental, sleep disorders, treatment abroad and others)","note":"Maternity exclusion is superseded to the extent of the Maternity Benefit; treatment outside India is covered under the Platinum plan's international benefits. Personal Accident and Critical Illness optional covers have their own exclusion lists (Sections 5.2.13, 5.2.14).","quote":"5.1.2.1 Investigation & Evaluation (Code-Excl04) ... 5.1.2.2 Rest Cure, rehabilitation and respite care (Code-Excl05) ... 5.1.2.3 Obesity/ Weight Control (Code-Excl06) ... 5.1.2.4 Change-of-Gender treatments (Code-Excl07) ... 5.1.2.5 Cosmetic or plastic Surgery (Code-Excl08) ... 5.1.2.6 Hazardous or Adventure sports (Code-Excl09) ... 5.1.2.7 Breach of law (Code-Excl10) ... 5.1.2.8 Excluded Providers (Code-Excl11) ... Treatment for, alcoholism, drug or substance abuse or any addictive condition and consequences thereof. ... 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) ... 5.1.2.12 Refractive Error (Code-Excl15) ... 5.1.2.13 Unproven Treatments (Code-Excl16) ... 5.1.2.14 Sterility and Infertility (Code-Excl17) ... 5.1.2.15 Maternity (Code-Excl18) ... 5.2.1 Ancillary Hospital Charges ... 5.2.2 Circumcision ... 5.2.3 Conflict & Disaster ... 5.2.4 External Congenital Anomaly ... 5.2.5 Dental/oral treatment ... 5.2.6 Hormone Replacement Therapy ... 5.2.7 Sexually transmitted Infections & diseases (other than HIV / AIDS) ... 5.2.8 Sleep disorders ... Any treatment or medical services received outside the geographical limits of India. ... 5.2.10 Unrecognized Physician or Hospital ... Artificial life maintenance for the Insured Person who has been declared brain dead or in vegetative state ... 5.2.12 AYUSH Treatment ... except as mentioned under Section 3.6","sources":[{"clause":"5.1.2.1","heading":"Investigation & Evaluation (Code-Excl04)","page":34,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-1-2-1"},{"clause":"5.1.2.2","heading":"Rest Cure, rehabilitation and respite care (Code-Excl05)","page":35,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-1-2-2"},{"clause":"5.1.2.3","heading":"Obesity/ Weight Control (Code-Excl06)","page":35,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-1-2-3"},{"clause":"5.1.2.4","heading":"Change-of-Gender treatments (Code-Excl07)","page":35,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-1-2-4"},{"clause":"5.1.2.5","heading":"Cosmetic or plastic Surgery (Code-Excl08)","page":35,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-1-2-5"},{"clause":"5.1.2.6","heading":"Hazardous or Adventure sports (Code-Excl09)","page":35,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-1-2-6"},{"clause":"5.1.2.7","heading":"Breach of law (Code-Excl10)","page":35,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-1-2-7"},{"clause":"5.1.2.8","heading":"Excluded Providers (Code-Excl11)","page":35,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-1-2-8"},{"clause":"5.1.2.9","heading":null,"page":36,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-1-2-9"},{"clause":"Excl12","heading":null,"page":36,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-excl12"},{"clause":"5.1.2.10","heading":null,"page":36,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-1-2-10"},{"clause":"5.1.2.11","heading":null,"page":36,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-1-2-11"},{"clause":"5.1.2.12","heading":"Refractive Error (Code-Excl15)","page":36,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-1-2-12"},{"clause":"5.1.2.13","heading":"Unproven Treatments (Code-Excl16)","page":36,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-1-2-13"},{"clause":"5.1.2.14","heading":"Sterility and Infertility (Code-Excl17)","page":36,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-1-2-14"},{"clause":"5.1.2.15","heading":"Maternity (Code-Excl18)","page":36,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-1-2-15"},{"clause":"5.2.1","heading":"Ancillary Hospital Charges","page":36,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-2-1"},{"clause":"5.2.2","heading":"Circumcision","page":36,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-2-2"},{"clause":"5.2.3","heading":"Conflict & Disaster","page":36,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-2-3"},{"clause":"5.2.4","heading":"External Congenital Anomaly","page":36,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-2-4"},{"clause":"5.2.5","heading":"Dental/oral treatment","page":36,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-2-5"},{"clause":"5.2.6","heading":"Hormone Replacement Therapy","page":37,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-2-6"},{"clause":"5.2.7","heading":"Sexually transmitted Infections & diseases (other than HIV / AIDS)","page":37,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-2-7"},{"clause":"5.2.8","heading":"Sleep disorders","page":37,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-2-8"},{"clause":"5.2.9","heading":null,"page":37,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-2-9"},{"clause":"5.2.10","heading":"Unrecognized Physician or Hospital","page":37,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-2-10"},{"clause":"5.2.11","heading":null,"page":37,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-2-11"},{"clause":"5.2.12","heading":"AYUSH Treatment","page":37,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-5-2-12"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"cancellation_refund","label":"Cancellation by you","section":"Renewal and rights","meaning":"What you get back if you cancel during the year.","status":"cross-checked","value":"You can cancel at any time with 7 days' written notice. For a policy term up to one year, the insurer refunds proportionate premium for the unexpired period if no claim has been made; for longer terms, premium for policy years not yet started is refunded.","display":"Proportionate refund for the unexpired period if no claim made","note":"The wording does not say what is refunded if a claim has been made.","quote":"The policy holder may cancel his/her policy at any time during the term, by giving 7 days’ notice in writing. ... 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.","sources":[{"clause":"6.1.2","heading":"Cancellation","page":39,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-6-1-2"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64VB","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 8","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 6","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 17","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, IV.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"territory","label":"Where it covers","section":"Overview","meaning":"Geographic area of cover: India only, worldwide, or listed countries. 'As stated in the schedule' is not an answer.","status":"cross-checked","value":"India only, except under the Platinum plan, which covers Specified Illness treatment, Emergency Medical Evacuation and Emergency Hospitalization outside India worldwide excluding USA & Canada.","display":"India (Platinum: some benefits worldwide excluding USA & Canada)","note":"USA & Canada can be added under Platinum with the optional 'Enhanced Geographical Scope for International Coverage'.","quote":"All benefits are available in India only and all claims shall be payable in India in Indian Rupees only except for benefits and claims under Section 3.20 (Specified Illness cover), Section 3.22 (Emergency Medical Evacuation – outside the geographical boundaries of India) and Section 3.23 (Emergency Hospitalization – outside the geographical boundaries of India). ... Emergency Medical Evacuation (outside the geographical boundaries of India) | Covered up to Sum Insured ( for worldwide excluding USA & Canada) ... without limitation to the geographical coverage in USA & Canada unlike specified under Section 3.20, Section 3.22 and Section 3.23","sources":[{"clause":"6.2.8","heading":"Territorial Jurisdiction","page":44,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-6-2-8"},{"clause":null,"heading":"Individual and Family Floater - Platinum Plan","page":62,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-individual-and-family-floater-platinum-plan-2"},{"clause":"4.6","heading":"Enhanced Geographical Scope for International Coverage","page":32,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-4-6"}],"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":"Applies to individual policies, not renewals. Refund is less proportionate risk premium, medical examination costs 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.. ... The Free Look Period shall be applicable on individual health insurance policies and not on renewals. ... 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":"6.1.1","heading":"Free Look Period","page":39,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-6-1-1"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 5","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(1), 20(2)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, II.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grace_period","label":"Grace period","section":"Renewal and rights","meaning":"Days you get after the due date to pay without losing cover or continuity.","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days","note":"The general definition gives fifteen days where premium payment mode is monthly; the documents do not say monthly payment is offered.","quote":"can be renewed within the Grace Period of 30 days (annual installment) to maintain continuity of benefits without break in policy.","sources":[{"clause":"6.1.3","heading":"Renewal of Policy","page":39,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-6-1-3"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 50","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 9","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 8","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule I, Para 1.2","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.3","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"eligibility_entry_age","label":"Entry age","section":"Eligibility","meaning":"The youngest and oldest age at which you can buy this policy.","status":"cross-checked","value":"Adults: 18 to 65 years (last birthday). Dependent children under a family floater: 91 days to 21 years.","display":"Adults 18 to 65 years; children 91 days to 21 years","note":"From the prospectus. A child who completes 22 years at renewal must take a separate policy. Entry ages for Family First members are not stated separately.","quote":"The range of entry ages for Adults under the policy is from 18 years (last birthday) to 65 years (last birthday). The range of entry ages for dependent children is from 91 days to 21 years under a family floater policy.","sources":[{"clause":"1","heading":"Policy Design","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/205#c-1"}],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"not-stated","value":null,"display":null,"note":"The documents do not list payment frequencies; the renewal clause mentions only the grace period for an annual installment, and a 2-year policy term option exists.","quote":null,"sources":[],"law":[]},{"key":"optional_covers","label":"Optional covers","section":"Cover","meaning":"Covers you can add for an extra premium. They change the answers above only if you buy them.","status":"cross-checked","value":["Personal Accident Cover","Critical Illness Cover","e-Consultation","Premium Waiver","Hospital Cash","Enhanced Geographical Scope for International Coverage (Platinum only)"],"display":"Personal Accident, Critical Illness, e-Consultation, Premium Waiver, Hospital Cash, Enhanced Geographical Scope (Platinum)","note":"Enhanced Geographical Scope (USA & Canada) is listed only in the Platinum plan charts; Premium Waiver is not available under an Individual Policy. Voluntary co-payment (10% or 20%) and annual aggregate deductible are cost-sharing options with a premium discount.","quote":"4 Optional Benefits ... 4.1 Personal Accident Cover ... 4.2 Critical Illness Cover ... 4.3 e-Consultation ... 4.4 Premium Waiver ... 4.5 Hospital Cash ... 4.6 Enhanced Geographical Scope for International Coverage ... Optional benefits can be selected by You only at the time of issuance of the First Policy or at Renewal on payment of the corresponding additional premium. ... a) This benefit is not available under Individual Policy. ... Addittional optional co-payment of 10% or 20% is allowed in the product. Insured can avail discount equivalent to the co-payment chosen. ... Enhanced Geographical Scope for International coverage | USA & Canada included","sources":[{"clause":"4","heading":"Optional Benefits","page":24,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-4"},{"clause":"4.1","heading":"Personal Accident Cover","page":24,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-4-1"},{"clause":"4.2","heading":"Critical Illness Cover","page":26,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-4-2"},{"clause":"4.3","heading":"e-Consultation","page":31,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-4-3"},{"clause":"4.4","heading":"Premium Waiver","page":32,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-4-4"},{"clause":"4.5","heading":"Hospital Cash","page":32,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-4-5"},{"clause":"4.6","heading":"Enhanced Geographical Scope for International Coverage","page":32,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-4-6"},{"clause":null,"heading":"Level Grid","page":2,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/205#c-level-grid"},{"clause":null,"heading":"Optional Benefits","page":62,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-optional-benefits-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":"cross-checked","value":"Yes. The prospectus states that coverage is available during the grace period.","display":"Yes, covered during the grace period","note":"From the prospectus; the policy wording's general definition says coverage need not be available for the period for which no premium is received.","quote":"c) Coverage is available during the grace period. ... Coverage need not be available during the period for which no premium is received.","sources":[{"clause":"11.5","heading":"Renewal of Policy","page":38,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/205#c-11-5"},{"clause":"2.52","heading":"Grace Period","page":6,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-2-52"}],"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":"Gold: any room except Suite or above. Platinum: covered up to sum insured. Silver: shared room or 1% of the Base Sum Insured per day (Family First Silver: Rs 3,000 per day or shared room).","display":"Silver: shared room or 1% of Base Sum Insured per day (Family First Silver: Rs 3,000 per day or shared room); Gold: any room except Suite or above; Platinum: up to sum insured","note":"Platinum row from the prospectus plan chart (the wording's Platinum chart rows are garbled). A costlier room leads to proportionate deduction of associated medical expenses.","quote":"Room rent | Shared Room or 1% of the Base Sum Insured per day ... Room rent | Covered up to Sum Insured (except for Suite or above room category) ... Room rent | Rs 3,000 per day or Shared Room ... Room rent | Covered up to Sum Insured","sources":[{"clause":null,"heading":"Benefits","page":58,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-benefits"},{"clause":null,"heading":"Benefits","page":59,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-benefits-2"},{"clause":null,"heading":"Benefits","page":63,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-benefits-4"},{"clause":null,"heading":"Benefits","page":53,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/205#c-benefits-3"}],"law":[]},{"key":"room_category","label":"Room category allowed","section":"Limits and co-pay","meaning":"Shared room, single private room or any room, by plan, when the limit is a room type rather than a rupee amount.","status":"cross-checked","value":"Silver: shared room (or 1% of Base Sum Insured per day). Gold: any room except Suite or above. Platinum: no room category limit; room rent covered up to sum insured.","display":"Silver: shared room; Gold: any room except Suite or above; Platinum: no room limit","note":"Family First Silver: Rs 3,000 per day or Shared Room. Platinum row from the prospectus plan chart.","quote":"Room rent | Shared Room or 1% of the Base Sum Insured per day ... Room rent | Covered up to Sum Insured (except for Suite or above room category) ... Room rent | Rs 3,000 per day or Shared Room ... Room rent | Covered up to Sum Insured","sources":[{"clause":null,"heading":"Benefits","page":58,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-benefits"},{"clause":null,"heading":"Benefits","page":59,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-benefits-2"},{"clause":null,"heading":"Benefits","page":63,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-benefits-4"},{"clause":null,"heading":"Benefits","page":53,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/205#c-benefits-3"}],"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":"No separate ICU limit: ICU charges are part of inpatient care, which is covered up to the sum insured.","display":"No separate limit; up to sum insured","note":"Not a stated cap; inferred from the inpatient care benefit and the plan chart, which print no ICU sub-limit.","quote":"h) Intensive Care Unit Charges. ... Inpatient care | Covered up to Sum Insured","sources":[{"clause":"3.1","heading":"Inpatient Care","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-3-1"},{"clause":null,"heading":"Benefits","page":58,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-benefits"}],"law":[]},{"key":"proportionate_deduction","label":"Proportionate deduction","section":"Limits and co-pay","meaning":"If you choose a room above your limit, whether the insurer reduces associated charges (doctor fees, tests, procedures) by the same proportion.","status":"cross-checked","value":"Yes. If the room category or room rent is above the eligibility, only a pro-rated share of the Associated Medical Expenses (room rent, nursing, doctors' fees, operation theatre) is paid.","display":"Yes, pro-rated on associated medical expenses","note":"Matters for Silver plans (room limit); Gold excludes only Suite or above.","quote":"If the Insured Person is admitted in a Hospital room where the room category opted or Room Rent incurred is higher than the eligibility as specified in the Policy Schedule, then We shall be liable to pay only a pro-rated portion of the total Associated Medical Expenses ... Associated Medical Expenses shall include Room Rent, nursing charges, Medical Practitioners’ fees and operation theatre charges.","sources":[{"clause":"3.1","heading":"Inpatient Care","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-3-1"}],"law":[]},{"key":"copay","label":"Co-payment","section":"Limits and co-pay","meaning":"The share of every admissible claim you pay yourself, and when it applies (age, zone, choice of hospital).","status":"cross-checked","value":"No co-payment by default. Under Silver and Gold, choosing Zone 2 pricing means a 20% co-payment for treatment in Mumbai (including Navi Mumbai & Thane), Delhi NCR, Kolkata & Gujarat State. An optional 10% or 20% co-payment can be chosen for a discount.","display":"None by default; 20% in listed cities if Zone 2 is chosen (Silver/Gold); optional 10% or 20%","note":"Co-payment does not apply to health check-up, OPD, second opinion, specified illness cover or the optional benefits.","quote":"If You select Zone 2, then 20% Co-payment will apply for treatment in Mumbai (including Navi Mumbai & Thane), Delhi NCR, Kolkata & Gujarat State. ... Note: Zone based Co-payment is not applicable for platinum plan. ... The following claim cost sharing options shall apply under the Policy as per the plan in the Product Benefits Table and as specified in the Policy Schedule and shall apply to all Insured Persons only if such options are selected by You ... Co-payment | Options of 10% and 20% co-payment ... Co-payment will not apply to any claim under Section 3.11 (Health Check-up) ... Section 3.21 (OPD Treatment and Diagnostic Services)","sources":[{"clause":"6.2.11","heading":"Zonal pricing","page":45,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-6-2-11"},{"clause":"6.2.13","heading":"Claim Cost Sharing Option / Conditions","page":45,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-6-2-13"},{"clause":null,"heading":"Claim cost sharing options","page":58,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-claim-cost-sharing-options"},{"clause":"6.2.14","heading":"Co-payment","page":46,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-6-2-14"}],"law":[]},{"key":"deductible","label":"Deductible","section":"Limits and co-pay","meaning":"An amount of each claim or each year that you bear before the policy pays.","status":"cross-checked","value":"None unless the optional annual aggregate deductible is chosen.","display":"None unless opted","note":"Optional annual aggregate deductible: INR 10,000 to 10 Lacs (Gold and Platinum Individual / Family Floater), INR 10,000 to 3 lacs (Silver). The CIS says it is 'not available for new business'. The Family First plan charts list no deductible option.","quote":"shall apply to all Insured Persons only if such options are selected by You ... Annual Aggregate Deductible | INR 10,000/ INR 20,000/ INR 30,000/ INR 50,000/ INR 1 lac/ INR 2 lacs / INR 3 lacs/ INR 4 lacs/ INR 5Lacs/ 10 Lacs ... Annual aggregate Deductible | INR 10,000/ INR 20,000/ INR 30,000/ INR 50,000/ INR 1 lac/ INR 2 lacs / INR 3 lacs ... iii) Annual Aggregate Deductible (not available for new business)","sources":[{"clause":"6.2.13","heading":"Claim Cost Sharing Option / Conditions","page":45,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-6-2-13"},{"clause":null,"heading":"Individual and Family Floater - Platinum Plan","page":63,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-individual-and-family-floater-platinum-plan-3"},{"clause":null,"heading":"Claim cost sharing options","page":58,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-claim-cost-sharing-options"},{"clause":"Excl10(c)(iii)","heading":null,"page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/206#c-excl10-c-iii"}],"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: only Mono focal lens for Sum Insured up to 10 lacs","HIV / AIDS: up to Rs. 50,000","Specified mental disorders (severe depression, schizophrenia, bipolar disorder and others): Rs 50,000 on cumulative basis"],"display":"Cataract (mono focal lens up to 10 lacs SI), HIV/AIDS Rs 50,000, listed mental disorders Rs 50,000","note":"Maternity has plan-wise limits (see maternity). Non-network road ambulance is limited to Rs. 2,000 per event.","quote":"e) Cataract: We will pay only for Mono focal lens for Sum Insured up to 10 lacs. ... a) This benefit is covered up to a limit of Rs. 50,000. ... Mental disorder treatment (waiting period of 3 years) | Covered up to Sum Insured (sub-limit of Rs 50,000 applicable on few conditions) ... This sub-limit shall apply for all the following disorders / conditions on cumulative basis. ... Severe Depression ... Schizophrenia ... Bipolar Disorder","sources":[{"clause":"3.1","heading":"Inpatient Care","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-3-1"},{"clause":"3.15","heading":"HIV / AIDS","page":17,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-3-15"},{"clause":null,"heading":"Vaccination of the new born baby","page":58,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-vaccination-of-the-new-born-baby"},{"clause":"3.17(a)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-3-17-a-3"}],"law":[]},{"key":"pre_hospitalisation","label":"Pre-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days before admission that are paid if related to the hospitalisation.","status":"cross-checked","value":{"unit":"days","amount":60},"display":"60 days","note":"Reimbursement basis only; covered up to sum insured.","quote":"a) We will pay above mentioned Pre-hospitalization Medical Expenses only for period up to 60 days immediately preceding the Insured Person’s admission","sources":[{"clause":"3.2(a)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-3-2-a-2"}],"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":90},"display":"90 days","note":"Reimbursement basis only; covered up to sum insured.","quote":"a) We will pay Post-hospitalization Medical Expenses only for up to 90 days immediately following the Insured Person’s discharge from Hospital","sources":[{"clause":"3.3","heading":"Post-hospitalization Medical Expenses","page":12,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-3-3"}],"law":[]},{"key":"day_care","label":"Day-care treatments","section":"Cover","meaning":"Treatments needing less than 24 hours in hospital (chemotherapy, dialysis, cataract) and whether all or only listed ones are covered.","status":"cross-checked","value":"Covered up to sum insured, but only the Day Care Treatments listed in Annexure III.","display":"Listed day care treatments (Annexure III), up to sum insured","note":"OPD treatment is not covered under this benefit.","quote":"b) Only those Day Care Treatments are covered that are mentioned under list of Day Care Treatments under Annexure III. ... Day Care Treatment | Covered up to Sum Insured","sources":[{"clause":null,"heading":"3.4 Day Care Treatment","page":12,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-3-4-day-care-treatment"},{"clause":null,"heading":"Benefits","page":50,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/205#c-benefits-2"}],"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":"Covered up to sum insured on reimbursement basis if it lasts at least 3 consecutive days and the patient could not be moved to hospital or no hospital bed was available.","display":"Covered up to sum insured (minimum 3 days)","note":null,"quote":"We will indemnify on Reimbursement basis only, the Medical Expenses incurred for the Insured Person’s Domiciliary Hospitalization ... a) The Domiciliary Hospitalization continues for at least 3 consecutive days ... b) The treating Medical Practitioner confirms in writing that the Insured Person’s condition was such that the Insured Person could not be transferred to a Hospital OR the Insured Person satisfies Us that a Hospital bed was unavailable. ... Domiciliary Hospitalization | Covered up to Sum Insured","sources":[{"clause":"3.5","heading":"Domiciliary Hospitalization","page":12,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-3-5"},{"clause":"3.5(a)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-3-5-a"},{"clause":"3.5(b)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-3-5-b"},{"clause":null,"heading":"Benefits","page":50,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/205#c-benefits-2"}],"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":"Inpatient treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy in an AYUSH Hospital is covered up to sum insured.","display":"Covered up to sum insured in an AYUSH Hospital","note":"Yoga and Naturopathy claims need prior approval. Pre (60 days) and post (90 days) hospitalisation covered for AYUSH-related expenses.","quote":"We will indemnify the Medical Expenses incurred on the Insured Person’s Hospitalization for Inpatient Care during the Policy Period on treatment taken under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy. ... The treatment should be taken in AYUSH Hospital. ... Alternative Treatment | Covered up to Sum Insured ... Pre-hospitalization Medical Expenses incurred for up to 60 days immediately preceding the Insured Person’s admission and Post-hospitalization Medical Expenses incurred for up to 90 days immediately following the Insured Person’s discharge will also be indemnified under this benefit ... c) Claims under Yoga and Naturopathy system of treatment will be payable subject to prior approval from the Insurance Company.","sources":[{"clause":"3.6","heading":"Alternative Treatments","page":13,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-3-6"},{"clause":null,"heading":"Benefits","page":50,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/205#c-benefits-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 sum insured, as inpatient or day care: e.g. robotic surgeries, oral chemotherapy, immunotherapy, stem cell therapy, deep brain stimulation, stereotactic radio surgeries.","display":"Covered up to sum insured","note":null,"quote":"a) The following procedures / treatments will be covered either as Inpatient Care or as part of Day Care Treatment ... iii) Deep Brain stimulation ... iv) Oral chemotherapy ... v) Immunotherapy- Monoclonal Antibody to be given as injection ... vii) Robotic surgeries ... viii) Stereotactic radio surgeries ... xii) Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions to be covered. ... Modern Treatments | Covered up to Sum Insured","sources":[{"clause":"3.24","heading":"Modern Treatments","page":23,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-3-24"},{"clause":null,"heading":"Vaccination of the new born baby","page":58,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-vaccination-of-the-new-born-baby"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 2","url":"https://indiainsurances.com/law/irdai-health-mc-2024"}]},{"key":"organ_donor","label":"Organ donor expenses","section":"Cover","meaning":"Whether the donor's hospital costs for an organ transplant are paid.","status":"cross-checked","value":"Yes. The living organ donor's inpatient expenses for harvesting the organ are covered up to sum insured when the recipient's claim is accepted.","display":"Covered up to sum insured","note":"Donor's pre and post hospitalisation expenses are not covered.","quote":"We will indemnify the Medical Expenses incurred for a living organ donor’s treatment as an Inpatient for the harvesting of the organ donated. ... Living Organ Donor Transplant | Covered up to Sum Insured","sources":[{"clause":"3.7","heading":"Living Organ Donor Transplant","page":13,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-3-7"},{"clause":null,"heading":"Vaccination of the new born baby","page":58,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-vaccination-of-the-new-born-baby"}],"law":[]},{"key":"ambulance","label":"Ambulance cover","section":"Cover","meaning":"Road (and air) ambulance cover and its limit.","status":"cross-checked","value":"Road ambulance in an emergency: up to sum insured at a network hospital; up to Rs. 2,000 per event at a non-network hospital. One transfer per hospitalisation.","display":"Network hospital: up to sum insured; non-network: up to Rs. 2,000 per event","note":"The CIS says Rs. 2,000 per hospitalization (wording chart: per event). Air ambulance only through pre-authorised Emergency Medical Evacuation (Section 3.16(b) in India; Platinum Section 3.22 outside India).","quote":"on transportation of the Insured Person by road Ambulance to a Hospital for treatment in an Emergency ... c) This benefit is available for only one transfer per Hospitalization. ... Emergency Ambulance | Network Hospital: Covered up to Sum Insured Non-network Hospital: Covered up to Rs. 2,000 per event ... Emergency Ambulance covered up to Rs. 2,000 per hospitalization (for hospitalization in non-network hospitals) ... Medical Evacuation of the Insured Person by means of Air Transportation through an air ambulance or commercial flight","sources":[{"clause":"3.8","heading":"Emergency Ambulance","page":13,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-3-8"},{"clause":null,"heading":"Benefits","page":50,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/205#c-benefits-2"},{"clause":"Row 5","heading":"Policy Coverage","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/206#c-row-5"},{"clause":"6.2.16.8(c)","heading":null,"page":51,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-6-2-16-8-c"}],"law":[]},{"key":"restoration","label":"Restoration of sum insured","section":"Cover","meaning":"Whether the sum insured is refilled after it is used up in a year, how much, how often, and whether it works for the same illness.","status":"cross-checked","value":"Re-fill benefit: once a policy year, up to 100% of the Base Sum Insured is restored after the sum insured is partly or fully used; it works for the same and different illnesses. Not available under Family First.","display":"Up to 100% of Base SI, once a year, same or different illness","note":"Unused re-fill amount is not carried forward.","quote":"then We will provide an additional re-fill amount of maximum up to 100% of the Base Sum Insured. ... b) We will provide a re-fill amount only once in a Policy Year. ... b) This benefit is not available under Family First Policy. ... Re-fill benefit | Reinstate up to base Sum Insured. Applicable for same & different illness as well ... a) If the re-fill amount is not utilized in whole or in part in a Policy Year, it cannot be carried forward to any extent in any subsequent Policy Year.","sources":[{"clause":"3.12","heading":"Re-fill Benefit","page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-3-12"},{"clause":null,"heading":"Benefits","page":50,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/205#c-benefits-2"}],"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: the sum insured rises by 10% of the expiring Base Sum Insured each year on renewal without a break, up to 100% of Base Sum Insured (50% under Silver), irrespective of claims.","display":"10% a year, up to 100% (Silver 50%), regardless of claims","note":"Requires renewal without a break. The 'irrespective of claims status' wording is from the CIS. Under Family First the addition does not apply to the Floater Sum Insured.","quote":"by increasing the Sum Insured applicable under the Policy by 10% of the Base Sum Insured of the immediately preceding Policy Year ... Loyalty Additions | Increase of 10% of expiring Base Sum Insured in a Policy Year; maximum up to 100% of Base Sum Insured ... Loyalty Additions | Increase of 10% of expiring Base Sum Insured in a Policy Year; maximum up to 50% of Base Sum Insured ... The increase shall not apply to the Floater Sum Insured stated in the Policy Schedule ... Loyalty additions through increase in Sum Insured by 10% ... of expiring Base Sum Insured in a Policy Year, maximum up ... to 100% (50% in case of silver plan) of Base Sum Insured, irrespective of claims status","sources":[{"clause":"3.14(a)","heading":null,"page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-3-14-a"},{"clause":null,"heading":"Individual and Family Floater - Gold Plan","page":60,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-individual-and-family-floater-gold-plan-2"},{"clause":null,"heading":"Vaccination of the new born baby","page":58,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-vaccination-of-the-new-born-baby"},{"clause":"3.14(b)","heading":null,"page":16,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-3-14-b"},{"clause":null,"heading":"Customer Information Sheet/ Know Your Policy","page":2,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/206#c-customer-information-sheet-know-your-policy-2"}],"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 as a separate benefit: only allowable consumables are paid under inpatient care; items in Annexure VI List I (such as gloves, masks, nebulisation kits) are not payable.","display":"Not covered (only allowable consumables)","note":null,"quote":"e) Intravenous fluids, blood transfusion, injection administration charges, allowable consumables, and/or enteral feedings; ... List I – Expenses not covered ... 56 | GLOVES ... 60 | MASK ... 57 | NEBULISATION KIT","sources":[{"clause":"3.1","heading":"Inpatient Care","page":10,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-3-1"},{"clause":null,"heading":"List I – Expenses not covered","page":85,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-list-i-expenses-not-covered"}],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Whether childbirth costs are covered, the limit and the waiting period.","status":"cross-checked","value":"Covered only under Family First (female aged 18 or above) or a Family Floater covering both spouses, after 24 months of continuous coverage, for up to 2 pregnancies or terminations. Limits by plan: Silver Rs 20,000 / 30,000; Gold Rs 40,000 to 1,00,000; Platinum Rs 120,000 to 200,000; Family First Silver Rs 35,000, Gold Rs 50,000, Platinum Rs 100,000.","display":"Covered after 24 months; Rs 20,000 to Rs 200,000 by plan and sum insured","note":"Pre and post hospitalisation and pre/post-natal expenses are not covered under maternity.","quote":"i) The female Insured Person of Age 18 years or above is covered under a Family First Policy; or ... ii) Both the Insured Person and his / her legally married spouse are covered under a Family Floater Policy. ... b) This Benefit cannot be availed under an Individual Policy. ... must have been covered as an Insured Person for a period of 24 months of continuous coverage since the inception of the First Policy ... up to maximum 2 pregnancies or terminations ... Maternity Benefit (covered for up to 2 pregnancies or terminations) (1) | Covered up to Rs 20,000 | Covered up to Rs 30,000 ... Maternity Benefit (covered for up to 2 pregnancies or terminations) (1) | Covered up to Rs 40,000 | Covered up to Rs 60,000 | Covered up to Rs 70,000 | Covered up to Rs 75,000 | Covered up to Rs 80,000 | Covered up to Rs 1,00,000 | Covered up to Rs 1,00,000 ... Maternity Benefit (covered for up to 2 pregnancies or terminations) (1) | Covered up to Rs 120,000 | Covered up to Rs 160,000 | Covered up to Rs 200,000 | Covered up to Rs 200,000 ... Covered up to Rs 35,000 per Policy Year ... Covered up to Rs 50,000 per Policy Year ... Covered up to Rs 100,000","sources":[{"clause":"3.9","heading":"Maternity Benefit","page":14,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-3-9"},{"clause":null,"heading":"Benefits","page":48,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/205#c-benefits"},{"clause":null,"heading":"Benefits","page":50,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/205#c-benefits-2"},{"clause":null,"heading":"Benefits","page":53,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/205#c-benefits-3"},{"clause":null,"heading":"Benefits","page":56,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/205#c-benefits-4"},{"clause":null,"heading":"Benefits","page":58,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/205#c-benefits-5"},{"clause":null,"heading":"Benefits","page":60,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/205#c-benefits-6"}],"law":[]},{"key":"newborn","label":"Newborn baby cover","section":"Cover","meaning":"Whether a newborn is covered from birth and for what.","status":"cross-checked","value":"Yes. The new born baby is covered from birth until the end of the policy year up to sum insured, plus first-year vaccinations, subject to the mother's 24 months of continuous maternity coverage; the baby must be added within 90 days.","display":"Covered up to sum insured until end of policy year (after 24 months maternity cover)","note":null,"quote":"We will cover the Medical Expenses incurred towards the medical treatment of the Insured Person’s New Born Baby from the date of delivery until the expiry of the Policy Year, subject to continuous coverage of 24 months ... b) The New Born Baby should be added as an endorsement within 90 days from date of delivery ... New Born Baby (covered uptill the end of Policy Year) (1) | Covered up to Sum Insured ... Vaccination of the new born baby | Covered until new born baby completes one year, vaccinations as per annexure","sources":[{"clause":"3.10","heading":"New Born Baby","page":15,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-3-10"},{"clause":"3.10(b)","heading":null,"page":15,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-3-10-b"},{"clause":null,"heading":"Benefits","page":48,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/205#c-benefits"}],"law":[]},{"key":"mental_illness","label":"Mental illness","section":"Cover","meaning":"Cover for in-patient treatment of mental illness.","status":"cross-checked","value":"In-patient treatment for mental illness is covered up to sum insured after 36 months of continuous coverage; listed conditions (severe depression, schizophrenia, bipolar disorder and others) have a cumulative sub-limit of Rs 50,000.","display":"Covered up to sum insured after 36 months; Rs 50,000 sub-limit on listed conditions","note":null,"quote":"We will indemnify the expenses incurred by the Insured Person for Inpatient treatment for Mental Illness ... must have been covered as an Insured Person for a period of 36 months of continuous coverage since the inception of the First Policy, with Mental Illness as a benefit, with Us. ... Mental disorder treatment (waiting period of 3 years) | Covered up to Sum Insured (sub-limit of Rs 50,000 applicable on few conditions)","sources":[{"clause":"3.17","heading":"Mental Disorders Treatment","page":20,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-3-17"},{"clause":"3.17(d)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-3-17-d"},{"clause":null,"heading":"Vaccination of the new born baby","page":58,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-vaccination-of-the-new-born-baby"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 3","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch III I","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(4)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 2(1)(s)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(1)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"}]},{"key":"health_checkup","label":"Health check-up","section":"Cover","meaning":"Free preventive check-ups and how often.","status":"cross-checked","value":"From renewal (second policy year): Silver once in two years with a fixed test list; Gold annual, tests up to Rs 1,250 to Rs 2,500 per person; Platinum annual, up to Rs 3750 to Rs 5000 per person. Cashless at empanelled providers.","display":"Gold: annual, up to Rs 1,250 to 2,500; Platinum: annual, up to Rs 3750 to 5000; Silver: once in two years","note":"Unused amount is not carried forward. Family First Gold Rs 2,500; Family First Platinum Rs 5000.","quote":"Health Check-up (2) | Once in two years, tests as per annexure ... Health Check-up (2) | Annual, Tests covered up to worth Rs 1,250 per Insured Person ... Annual, Tests covered up to worth Rs 2,500 per Insured Person ... Health Check-up (3) | Annual, tests covered up to worth Rs 3750 per Insured Person | Annual, tests covered up to worth Rs 5000 per Insured Person ... (2) If the Policy is Renewed with Us without a break or if the Policy continues to be in force for the 2nd Policy Year","sources":[{"clause":null,"heading":"Vaccination of the new born baby","page":58,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-vaccination-of-the-new-born-baby"},{"clause":null,"heading":"Benefits","page":59,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-benefits-2"},{"clause":null,"heading":"Individual and Family Floater - Gold Plan","page":60,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-individual-and-family-floater-gold-plan-2"},{"clause":null,"heading":"Individual and Family Floater - Platinum Plan","page":62,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-individual-and-family-floater-platinum-plan-2"},{"clause":null,"heading":"Claim cost sharing options","page":58,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-claim-cost-sharing-options"}],"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":"Platinum plan only: OPD treatment, diagnostics and prescribed medicines up to Rs 15,000, 20,000, 35,000 or 50,000 by sum insured (Family First Platinum Rs 35,000); 80% of unused amount carried forward up to 2.5 times the entitlement. Not covered under Silver or Gold.","display":"Platinum only: Rs 15,000 to Rs 50,000 a year","note":"Only the Platinum plan charts list OPD; the CIS lists OPD under 'Additional coverage applicable only for Platinum Plan'.","quote":"We will indemnify the Reasonable and Customary Charges incurred for OPD Treatment and/or Diagnostic Services and/or prescribed medicines for the OPD Treatment taken during the Policy Period. ... We will carry forward 80% of this unutilized amount to the immediately succeeding Policy Year, provided that the total amount (including the unutilized amount available under this Benefit) shall at no time exceed 2.5 times ... OPD Treatment and Diagnostic Services | Covered up to Rs 15,000 | Covered up to Rs 20,000 | Covered up to Rs 35,000 | Covered up to Rs 50,000 ... Additional coverage applicable only for Platinum Plan:","sources":[{"clause":"3.21","heading":"OPD Treatment and Diagnostic Services","page":22,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-3-21"},{"clause":"3.21(e)","heading":"If the Policy is Renewed with Us without any break and there","page":22,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-3-21-e"},{"clause":null,"heading":"Individual and Family Floater - Platinum Plan","page":62,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-individual-and-family-floater-platinum-plan-2"},{"clause":null,"heading":"Customer Information Sheet/ Know Your Policy","page":2,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/206#c-customer-information-sheet-know-your-policy-2"}],"law":[]},{"key":"zone_pricing","label":"Zone or city-based premium","section":"Premium","meaning":"Whether premium or co-pay depends on the city you are treated in.","status":"cross-checked","value":"Yes. Silver and Gold: Zone 1 (all India) or Zone 2 (cheaper, with 20% co-payment for treatment in Mumbai, Delhi NCR, Kolkata & Gujarat). Platinum premium uses 3 zones by address with no zone co-payment.","display":"Yes, zone-based premium; 20% co-pay in listed cities under Zone 2","note":null,"quote":"For the purpose of calculating premium for silver and gold plan, following zones are available: ... If You select Zone 2, then 20% Co-payment will apply for treatment in Mumbai (including Navi Mumbai & Thane), Delhi NCR, Kolkata & Gujarat State. ... For the purpose of calculating premium for platinum plan, the country has been divided into the following 3 zones based on the address provided by You: ... Note: Zone based Co-payment is not applicable for platinum plan.","sources":[{"clause":"6.2.11","heading":"Zonal pricing","page":45,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-6-2-11"}],"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 after pre-authorisation; the insurer also offers 'Cashless Everywhere', including hospitals outside its network.","display":"Yes, at network hospitals and also non-network ('Cashless Everywhere')","note":"Pre-authorisation 72 hours before planned treatment; within 48 hours for emergencies. Overseas benefits (Platinum) are cashless only.","quote":"Cashless Facility can be availed only at Our Network Providers or Service Providers (as applicable). ... We offer Cashless Everywhere, even in hospitals which are not part of our network. ... during the Policy Period on Cashless Facility basis only.","sources":[{"clause":"6.2.16.2(a)","heading":"For Availing Cashless Facility","page":47,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-6-2-16-2-a"},{"clause":"6.2.16.2(XI)","heading":null,"page":47,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-6-2-16-2-xi"},{"clause":"3.22","heading":"Emergency Medical Evacuation (outside the geographical boundaries of India)","page":22,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204#c-3-22"}],"law":[]},{"key":"claims_handled_by","label":"Claims handled by","section":"Claims","meaning":"The insurer itself or a third-party administrator (TPA).","status":"cross-checked","value":"The insurer (Niva Bupa) handles claims directly, not through a third party.","display":"Niva Bupa directly (no TPA)","note":"From the prospectus introduction; emergency assistance and overseas services use the insurer's Service Provider.","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":"Heartbeat – Prospectus cum Sales Literature","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/205#c-heartbeat-prospectus-cum-sales-literature"}],"law":[]},{"key":"family_floater","label":"Family floater available","section":"Cover","meaning":"Whether one sum insured can be shared by the whole family.","status":"cross-checked","value":true,"display":"Yes","note":"Family Floater: up to 6 insured persons including up to 4 children. Family First adds a shared Floater Sum Insured on top of each person's Base Sum Insured.","quote":"‘Heartbeat’ product can be issued to an individual customer or to a family with up to 4 children (referred to as a ‘family floater’ policy) or extended family (referred to as a ‘family first’ policy).","sources":[{"clause":"1","heading":"Policy Design","page":1,"url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/205#c-1"}],"law":[]}],"documents":[{"kind":"wording","label":"Heartbeat Policy Wording","pages":90,"fetched_at":"2026-10-16 07:11:44.715554+00","source_url":"https://transactions.nivabupa.com/pages/doc/policy_wording/HBPolicy-Wording.pdf?v=1.7","url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/204"},{"kind":"prospectus","label":"Heartbeat Prospectus cum Sales Literature","pages":83,"fetched_at":"2026-10-16 07:11:44.715554+00","source_url":"https://transactions.nivabupa.com/pages/doc/prospectus/Heartbeat-Prospectus-cum-Sales-Literature_with-logo.pdf?v=1.1","url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/205"},{"kind":"cis","label":"Heartbeat","pages":14,"fetched_at":"2026-10-16 07:11:44.715554+00","source_url":"https://transactions.nivabupa.com/pages/doc/Customer-Information/CIS_HeartBeat.pdf","url":"https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627/document/206"}],"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":"Heartbeat (UIN NBHHLIP27058V102627), IndiaInsurances, https://indiainsurances.com/policy/niva-bupa-health-insurance/heartbeat-nbhhlip27058v102627"}