Health Insurance Plans

Buy/Renew your health insurance policy with Niva Bupa, and discover the enticing realm of medical insurance in India by safeguarding your well-being, enjoying tax benefits, a network of 10,000+ cashless hospitalisation, no claim bonus, co-payment and financial shelter.

Start your health cover with Niva Bupa today!

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Our Most Popular Health Insurance Plans

Here are our most popular health insurance plans which provide you comprehensive hospitalization coverage.

Aspire

A plan that rewards you for starting young

Starts From

₹ 6,655

For 1 year

₹ 500,000

Sum Insured
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Maternity coverage

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Up to 30% discount on renewals

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Jump start on waiting period for future spouse

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Accumulate cashback on every claim free year

Know More
ImgThis plan offers full covid 19 cover

Reassure 2.0

Our feature packed, best selling, comprehensive health insurance plan.

Starts From

₹ 10,431

For 1 year

₹ 1,000,000

Sum Insured
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Pay premium as per your entry age (till a claim is paid)

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Carry forward unused base sum insured up to 10 times of base cover

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Use and get back your base coverage, unlimited times

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Up to 30% discount on renewals

Know More
ImgThis plan offers full covid 19 cover

Health Companion

A plan with smart features to give you everything you need in a health cover.

Starts From

₹ 5,116

For 1 year

₹ 300,000

Sum Insured
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Cover Up To 1 Cr.

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Annual Health Check-up

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No room rent cap

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No Claim Bonus

Know More
ImgThis plan offers full covid 19 cover

What is a Health Insurance Policy ?

A health insurance policy offers vital financial security against unforeseen medical expenses. It serves as an agreement between you and your insurance provider, assuring that the latter will provide financial assistance in case of a medical emergency. Like any wise investment, a health plan safeguards your hard-earned resources and requires ongoing contributions to maintain coverage. Recognising your unique needs, insurance companies offer a diverse range of health programmes in India, ensuring personalised solutions to your specific requirements.

As a wise customer:

  • Free yourself from exorbitant medical expenses by selecting the finest health plan for you and your family.
  • You will not only cover your medical bills with a health insurance policy but also enjoy the convenience of cashless treatment at our extensive hospital network.
  • Embrace a future without worrying about medical costs by investing wisely in a health insurance policy for yourself and your loved ones.
What is health insurance policy?

Key Benefits of Health Insurance Plans in India

There are several benefits one can enjoy while purchasing the best health insurance in India.

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Cashless Medical Treatment

In the sector of best health insurance in India, each insurer hospitals nationwide. So, if you find yourself admitted to any of these esteemed partnerships with a vast network of empanelled hospitals,you can bid farewell to worries about payment. Simply present your policy number, and your insurer and the hospital will shoulder all your expenses. Cashless claims reign supreme in health insurance policies, owing to their seamless process that eliminates hassles related to claim disbursement and tedious documentation.

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Post and Pre-Hospitalisation Coverage

Best health insurance in India goes beyond merely covering hospitalisation expenses, providing clients with comprehensive coverage. Today, traditional health plans extend their reach to include pre and post-hospitalisation expenses, ensuring a holistic approach to healthcare. Moreover, these plans offer benefits like medication costs, doctor consultations, ambulance charges, and much more, ensuring that individuals are safeguarded against various healthcare expenses.

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No Claim Bonus

Best health insurance in India gives policyholders an enticing perk known as a "no-claim bonus." This bonus rewards individuals who haven't made any claims during the previous year by offering them a discount on their premiums or an increase in their coverage. Upon renewing the policy, policyholders can take advantage of this appealing no-claim bonus, ensuring they are recognised and rewarded for their healthy track record.

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Medical Checkup Facility

Choosing the best health insurance in India that aligns with your needs not only grants you coverage when required but also opens the door to regular medical check-ups. In addition, as a valuable inclusion within your health plan, insurers understand the significance of proactive healthcare and provide this facility to ensure your well-being remains a top priority.

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Co-Payment

Co-payment is a valuable benefit offered by health insurance plans that helps individuals manage their medical expenses. With co-payment, policyholders must pay a fixed, predetermined amount out of pocket for specific healthcare services while the insurance company covers the remaining costs. This feature of the best health insurance plans in India ensures that individuals have affordable access to necessary medical treatments, consultations, or prescription drugs, promoting timely healthcare utilisation and reducing financial burden.

Family Health Insurance Plans

Discover our family health insurance plans that offer all-encompassing coverage for hospitalisation.

Aspire

A plan that rewards you for starting young

Starts From

₹ 6,655

For 1 year

₹ 500,000

Sum Insured
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Maternity coverage

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Up to 30% discount on renewals

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Jump start on waiting period for future spouse

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Accumulate cashback on every claim free year

Know More
ImgThis plan offers full covid 19 cover

Reassure 2.0

Our feature packed, best selling, comprehensive health insurance plan.

Starts From

₹ 10,431

For 1 year

₹ 1,000,000

Sum Insured
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Pay premium as per your entry age (till a claim is paid)

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Carry forward unused base sum insured up to 10 times of base cover

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Use and get back your base coverage, unlimited times

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Up to 30% discount on renewals

Know More
ImgThis plan offers full covid 19 cover

Health Companion

A plan with smart features to give you everything you need in a health cover.

Starts From

₹ 5,116

For 1 year

₹ 300,000

Sum Insured
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Cover Up To 1 Cr.

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Annual Health Check-up

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No room rent cap

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No Claim Bonus

Know More
ImgThis plan offers full covid 19 cover

Reasons For Buying Health Insurance Plan

The top reasons to consider buying a health insurance plan:

Beating Medical Inflation:

Medical costs are rising due to technological advancements and treatment quality. However, health insurance provides coverage that ensures affordable healthcare without worrying about increasing medical expenses.

Safeguarding Your Wealth with a Health Insurance Policy:

Paying for hospitalisation out of your savings can leave a significant financial burden. Health insurance protects your money and assets, requiring only a small premium per policy period.

Protecting Your Family:

Ensure the well-being of your entire household by purchasing health insurance that covers every family member. Use the benefits to fulfil the medical needs of each individual.

Tax Benefits:

Medical insurance or health insurance policy premiums are tax-deductible under Section 80D, reducing your overall tax liability.

Individual Health Insurance Plans

Explore our range of individual health insurance plans that offer comprehensive coverage for hospitalisation.

Aspire

A plan that rewards you for starting young

Starts From

₹ 6,655

For 1 year

₹ 500,000

Sum Insured
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Maternity coverage

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Up to 30% discount on renewals

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Jump start on waiting period for future spouse

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Accumulate cashback on every claim free year

Know More
ImgThis plan offers full covid 19 cover

Reassure 2.0

Our feature packed, best selling, comprehensive health insurance plan.

Starts From

₹ 10,431

For 1 year

₹ 1,000,000

Sum Insured
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Pay premium as per your entry age (till a claim is paid)

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Carry forward unused base sum insured up to 10 times of base cover

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Use and get back your base coverage, unlimited times

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Up to 30% discount on renewals

Know More
ImgThis plan offers full covid 19 cover

Health Companion

A plan with smart features to give you everything you need in a health cover.

Starts From

₹ 5,116

For 1 year

₹ 300,000

Sum Insured
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Cover Up To 1 Cr.

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Annual Health Check-up

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No room rent cap

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No Claim Bonus

Know More
ImgThis plan offers full covid 19 cover

How to Buy Health/ Medical Insurance Policy Online?

You can buy health policies online with Niva Bupa. Compare medical policies and get access to benefits like cashless hospitalisation, medical expense cover & more. Prior to now, health insurance businesses in India had to invest in infrastructure and enlist the aid of several brokers, agents, and financial advisers in order to offer health insurance plans. The process was laborious, time-consuming, and involved mountains of paperwork.


But in the current digital era, obtaining a health insurance plan is virtually as simple as ordering a pizza. The internet can offer you a plethora of knowledge about different health insurance plans, their features, and advantages, as well as quick and easy instructions on how to purchase a health insurance plan online.


With very little paperwork and middlemen, the process has developed into one that is incredibly transparent, efficient, and cost-effective. The only remaining query is how to submit an application for an Indian health insurance plan?

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Discover a World of Insurance Options

Uncover a treasure trove of valuable insights about various health insurance policy providers right at your fingertips. Explore and compare all the available choices on multiple comparison portals tailored to your preferences, including premiums, coverage types, and more.

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Delve into Plan Details

After narrowing your options to a few promising health insurance plans, dive into the details by visiting the respective insurance provider's website. Arm yourself with the knowledge and understanding to make an informed decision. Access brochures and policy wordings for all Niva Bupa health insurance plans directly on our website.

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Securely Provide KYC Details

When applying for health insurance policy online, provide your identity details and documents through the insurance provider's website. Avoid third-party websites to maintain security and peace of mind.

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Uncover the Fine Print

Read the terms and conditions meticulously, paying close attention to exclusions and riders. Note vital factors such as premiums, sum insured, waiting periods, claim settlement processes, inclusions and exclusions, flexibility, renewal clauses, and additional benefits.

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🛒

Seal the Deal

Once you've selected your ideal plan and determined the desired sum insured, take the next step and effortlessly pay through the secure payment gateways on the insurer's website.

Health Insurance Policies for Large Family

Here are our health plans which provide comprehensive hospitalisation coverage to extended and large families.

Aspire

A plan that rewards you for starting young

Starts From

₹ 6,655

For 1 year

₹ 500,000

Sum Insured
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Maternity coverage

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Up to 30% discount on renewals

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Jump start on waiting period for future spouse

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Accumulate cashback on every claim free year

Know More
ImgThis plan offers full covid 19 cover

Reassure 2.0

A health insurance plan that keeps giving you more!

Starts From

₹ 10,244

For 1 year

₹ 1,000,000

Sum Insured
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Pay premium as per your entry age (till a claim is paid)

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Carry forward unused base sum insured up to 10 times of base cover

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Use and get back your base coverage, unlimited times

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Up to 30% discount on renewals

Know More
ImgThis plan offers full covid 19 cover

Health Companion

A plan that makes insuring your family's health painless

Starts From

₹ 18,281

For 1 year

₹ 500,000

Sum Insured
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No room rent cap

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Alternative Treatment

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All Day Care Treatment

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No Claim Bonus

Know More
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Get a Health Insurance plan today!


Things to Consider Before Buying Health Insurance Policy in India

Choosing the right health insurance policy requires careful consideration in the vast landscape of best health insurance in India. Here are some major points to keep in mind:

  • Sufficient Coverage: Ensure the policy you choose provides adequate coverage for yourself and your entire family.
  • Individual Plans Matter: While employer-provided group health insurance is common, reviewing individual plans and their terms is beneficial to make an informed decision.
  • Seek Additional Compensation: Add supplementary coverage such as hospital cash and critical illness benefits to compensate for non-payable losses.
  • Update Existing Conditions: Keep your health insurer informed about any existing medical conditions to ensure seamless coverage.
  • Understand Terms and Conditions: Familiarise yourself with the details of your health insurance, including deductibles, waiting periods, cumulative incentives, and pre-existing sickness provisions.
  • Opt for High Sum Coverage: Given the rising medical costs, selecting a policy with a high sum coverage is advisable.
  • Timely Renewal: Avoid gaps in coverage by renewing your health insurance policy promptly to maintain its benefits.
  • Early Purchase Advantage: Secure health insurance early to enjoy a higher level of coverage while keeping your premiums affordable.

With these factors in mind, you can make an informed decision when choosing the best health insurance plan for your needs.

Things to consider before buying health insurance policy

Features You Should Know About

The below-mentioned features ensure that health insurance policies provide comprehensive coverage for various medical needs while considering factors like waiting periods, co-payments, and additional riders.

  • Comprehensive Hospitalization Coverage: Medical expenses for in-patient care and hospitalisation are covered.
  • Pre and Post-Hospitalization Coverage: Expenses incurred before and after hospitalisation for a specified number of days are included.
  • Room Rent and ICU Charges: Coverage for hospital room rent and ICU charges, with or without sub-limits.
  • Home Medical Treatment: Coverage for medical treatment at home when hospital beds are unavailable.
  • Day Care Treatment: Coverage for outpatient department treatments, ENT, dental procedures, and other specified procedures.
  • Cashless Health Check-ups and Diagnostic Tests: Convenience of cashless transactions for health check-ups and diagnostic tests.
  • Emergency Ambulance Coverage: Coverage for emergency ambulance costs.
  • Organ Donor Treatment: In-patient treatment related to organ harvesting for organ donors.
  • Permanent Exclusions: Pre-specified list of diseases and medical conditions not covered by the policy.
  • Waiting Periods: Waiting periods vary, with accident treatments typically having no waiting period and other treatments having a 30-day waiting period. Pre-existing conditions may have a longer waiting period of 2-6 years.
  • Co-payment and Deductibles: Insurers offer options for co-payment percentages and deductible amounts, which can lower the premium. However, the deductible or co-payment must be paid out of pocket when making a claim.
  • Additional Riders: Additional riders for special medical needs, such as critical illness coverage and hospital cash, can be purchased with an extra premium.

Plans For specific Needs

Niva Bupa (formerly known as Max Bupa) health insurance plans which takes away the financial pain of an accident or critical illness.

accidentcare

Protect you against accidental medical expenses

Starts From

₹ 6,444

For 1 year

₹ 4,500,000

Sum Insured
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Permanent total disability

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Permanent partial disability

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Child Education Benefit

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Accidental Death

Know More
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criticare

Protects you against 20 critical illness

Starts From

₹ 12,521

For 1 year

₹ 4,500,000

Sum Insured
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20 Critical illness Cover

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30 Min Cashless Claim Processing

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Renewal For Life

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Long Term Discounts

Know More
ImgThis plan offers full covid 19 cover

coronakavach

A plan designed to safeguard you and your family against Covid - 19 expenses

Starts From

₹ 625

For 1 year

₹ 500,000

Sum Insured
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Covid-19 Hospitalization Cover

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Covid-19 HomeCare Treatment Expenses

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AYUSH Cover

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Covers Comorbidities

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ImgThis plan offers full covid 19 cover


Choosing the Right Medical Insurance Plan

VariableConsideration
CoverageEvaluate the coverage provided by multiple plans and select or choose the one that reasonably meets your needs.
Sum AssuredTake into account medical expenses when choosing the sum assured. Choose a sensible amount that ensures you are neither overinsured nor underinsured. Consider affordability as well.
Hospital CoverageVerify the insurer's extensive network of hospitals that accept cashless hospitalisation.
Floater Over Individual PolicyIf you need health coverage for your family, choose a family plan instead of individual policies. It can be more cost-effective.
Lifetime RenewabilityOpt for a health insurance policy with lifetime renewability to ensure coverage as you age

Types of Health Insurance Plans in India

The below-mentioned features ensure that health insurance policies provide comprehensive coverage for various medical needs while considering factors like waiting periods, co-payments, and additional riders.


Compare plans

Get a Health Insurance plan today!

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What is Covered in Health Insurance Plans?

Eager to know what's covered under your health insurance? We've got all the answers! Here are the guaranteed inclusions and exclusions in a standard health insurance policy. While this list gives you an idea, it's essential to double-check with your provider and carefully read your policy documents for complete clarity.

  • Inpatient hospitalisation
  • Pre and post-hospitalisation care
  • Daycare procedures
  • Ambulance charges

Health Insurance Inclusions:

  • Inpatient hospitalization
  • Pre and post-hospitalization care
  • Day care procedures
  • Ambulance charges
  • Covid-19 coverage

Health Insurance Exclusions

  • Dental treatment (unless cancer/ acute trauma relate).
  • Purchase of external devices like spectacles, hearing aid, artificial limbs, crutches, artificial teeth, veneers, are all excluded.
  • Instances of self-inflicted injury are not covered by a health insurance policy.
  • Any type of cosmetic surgery such as plastic surgery or botox, are excluded. Exceptions include surgery for burns or accidental bodily injuries or surgeries for the treatment of cancer.
Know more about health insurance plans

Want to know more about buying health insurance online

Go to www.nivabupa.com or call 1860-500-1000 to find out more

Wellness Plans

Top Up Plans

reassure 2.0

Our feature packed, best selling, comprehensive health insurance plan.

Starts From

₹ 10,244

For 1 year

₹ 1,000,000

Sum Insured
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Pay premium as per your entry age (till a claim is paid)

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Carry forward unused base sum insured up to 10 times of base cover

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Use and get back your base coverage, unlimited times

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Up to 30% discount on renewals

Know More
ImgThis plan offers full covid 19 cover

GoactiveTM

A new-age health insurance that works for you everyday!

Starts From

₹ 13,352

For 1 year

₹ 500,000

Sum Insured
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No Room Rent Sub-Limit

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Early Age Advantage

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OPD And Diagnostic Cover

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Daily Health Coach

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ImgThis plan offers full covid 19 cover

Health Premia

Our top selling plan for networth individuals.

Starts From

₹ 12,488

For 1 year

₹ 500,000

Sum Insured
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Coverage up to Rs 3 cr

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Maternity & new born cover

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International coverage

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In-built travel insurance

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ImgThis plan offers full covid 19 cover

Understand Eligibility for Health Insurance

Eligibility for a medical insurance policy is determined based on the following criteria:

Age:

Typically, the entry age for the insured ranges from 18 to 65 years, but it can extend to 70 years in some cases. Children aged 16 days to 18 years can also be covered, and there may be provisions for newborn and post-natal care.

Tests:

Some insurers may require favourable medical test results, including routine blood and urine tests, as well as tests related to major organs. Applicants below the age of 45 generally do not need to undergo medical tests.

Medical Condition:

Pre-existing health conditions must be disclosed during the application process. This disclosure may trigger a waiting period and can affect the calculation of the premium.


Ensure you meet the eligibility criteria specified above to avail the benefits of a medical insurance policy.

Save Tax with a Medical Insurance Policy

Maximize your savings with the power of a health insurance policy. In accordance with section 80D of the Income Tax Act, individuals and HUFs can enjoy deductions on medical insurance premiums paid. Here's how it works:

  • For self, spouse, and dependent children, claim a deduction of ₹25,000.
  • For parents who are not senior citizens, claim an additional deduction of ₹25,000.
  • For senior citizen parents, boost your deduction to ₹50,000.
  • If both you and your spouse are senior citizens, enjoy a combined deduction of ₹50,000.

That's not all! Eligible expenses for deductions include not only the premium but also preventive health check-ups, medical expenditure on uncovered senior citizen health insurance, and contributions to the government or notified health insurance schemes

Health Insurance Portability

Does Health Insurance Cover Covid-19?

Corona-kavach-Health-Insurance

Safeguard you and your family with Health Insurance Plan.

KNOW MORE

Health Insurance Claims

Health insurance claims

Discover the nearest network hospital through the Niva Bupa Health app for seamless cashless claims.

  • Get your health insurance forms from the hospital, complete them, and submit them back. Required documents may include your policy number, photo ID, and other proofs.
  • ● When we receive your documents, our internal claims committee will assess your claims based on treatment, documents, and coverage of the health insurance policy. In the rare event of rejection, you can appeal to our grievance team for a thorough review.
  • Once your claims are approved, enjoy medical treatment without any upfront payments to the hospital, except for consumables or specific items/procedures mentioned in the exclusions charter.
  • Upon discharge, we will carefully review your discharge summary and documents before processing the claim. Stay informed about your claim's progress at every stage through the Niva Bupa website. Rest assured, Niva Bupa aims to process cashless claims in 30 minutes or less, providing swift assistance.

Health Insurance Myths

Health insurance Myths

Let's bust these myths about best health insurance plans in India once and for all:

Myth 1: Health insurance is unnecessary for the young and healthy.

➔ Reality: Waiting until you're older to get health insurance can lead to higher costs and potential exclusions. Buying insurance while you're young ensures lower premiums and the opportunity to build up a substantial sum insured.

Myth 2: Health insurance covers all healthcare costs.

➔ Reality: While most insurance companies do cover a wide range of healthcare costs, there can still be exclusions and limitations. These may include war-related medical emergencies, self-inflicted injuries, and more. Understanding your policy's exclusions is vital to avoid surprises.

Myth 3: Group coverage eliminates the need for an individual health insurance plan.

➔ Reality: Group health insurance often provides limited coverage and a smaller sum insured compared to individual plans. Depending solely on a group policy can leave you and your family underinsured.

Health Insurance Terms

Health insurance Terms

Understanding insurance terms is vital before selecting a policy. Explore the language of health insurance to make informed decisions.

Insurance TermAbout the Term
Room Rent LimitsA cap on the amount a policyholder can claim per day for room rent linked to the Sum Insured.
Sub-limitsCoverage limits for specific conditions or costs, such as surgical fees or doctors' fees.
Co-PaymentThe percentage of the claim money that the policyholder pays while the insurer covers the rest.
DeductibleThe initial or primary amount the policyholder must pay before the insurer starts covering the claim.

How to Calculate Health Insurance Premiums?

Calculate health insurance premiums easily and accurately using a premium calculator, a convenient tool from top insurers and third-party websites.

Simply input your age, family size, respective ages, location, and desired sum assured into the calculator to obtain an estimated premium amount. Location is considered due to potential variations in premiums between metro and non-metro areas.

Alternatively, you can visit the insurance company's website and provide details such as the number of members, their ages, desired sum assured, and personal information to request an online quote. Some websites may also inquire about pre-existing conditions and lifestyle habits to ensure a more precise premium estimate.

● Note: While the premium amount is important, it should not be the sole criterion for selecting a policy. Instead, considering the extent of coverage, special features, and exclusions is equally crucial.

Factors Affecting Health Insurance Premiums in India

Factors Affecting Health Insurance Premiums in India

Below mentioned factors play a crucial role in determining health insurance premiums. By understanding their impact, you can make well-thought-of decisions regarding your coverage.

FactorsAll About the Factors
AgeOne's age is a significant factor influencing health insurance premiums, with costs increasing as you grow older.
Pre-existing illnessAny pre-existing health conditions can lead to higher premium costs. Opting for insurance before developing such illnesses helps avoid elevated premiums.
Family historyA family history of chronic illnesses like diabetes, cancer, or stroke may increase insurance premiums due to increased risk.
City of residenceThe city or tier of the residence can impact premium costs, with Tier 1 or metropolitan cities generally having higher medical expenses.
Body mass index (BMI)Individuals with a high BMI may have to pay higher premiums due to the increased risk of chronic illnesses associated with weight-related conditions.
Smoking and drinkingSmokers and chronic drinkers are considered a higher risk, leading to elevated insurance premiums. In addition, such habits increase the likelihood of severe respiratory and liver diseases.

Documentation Required

In cashless hospitalisation, the network hospital directly sends documents to the insurer. You must submit specific documents for reimbursement that the insurer will review before approving your claim. These include:

  • Completed and signed claim form
  • Discharge certificate from the hospital
  • Doctor's consultation notes and receipts
  • Hospital bills with proper stamps and signatures
  • Reports and diagnostics including X-ray films, blood tests, urine tests, etc.
  • Invoices for medications and any other relevant treatment documents.

Why Should One Buy a Health Plan at an Early Age?

The advantages of purchasing the best health insurance plans in India at a young age are:

  • Lower premiums due to the policyholder's younger age.
  • Early protection with health coverage ensures you are safeguarded from potential risks.
  • Reduced likelihood of pre-existing diseases as they tend to develop with age. If you have pre-existing conditions, the waiting period will be over while you are young.
  • Longer duration for claiming tax deductions on health insurance premiums.

Compare Health Insurance Plans Online

You can now easily compare top health insurance plans online:

  • Visit the official websites of specific insurers to compare their policies using the provided compare option. Alternatively, explore insurance aggregator websites and apps for comparing health insurance policies from multiple insurers.
  • After determining your desired sum assured, compare premiums from different insurers. Evaluate their features, coverage, exclusions, network hospitals, and terms and conditions. Additionally, research the insurer's reputation and claim settlement ratio before making a purchase.

Who are Third Party Administrators in Health Insurance?

When it comes to purchasing a health insurance policy, third-party administrators (TPA) hold significant influence over your experience. They are the crucial agencies you'll directly interact with when making claims. So, if you're planning to secure a health insurance policy soon, the TPAs will play a vital role in your journey.

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TPA

The third-party administrator, or the TPA, is not an employee of any health insurance company but an independent and separate entity that acts as the bridge between you and your insurance provider. The TPA is licensed by the IRDAI to execute this task for insurers across categories, and not just for players engaged in health insurance. It can be an individual, an agency or could be a company that is retained by the insurer to perform several administrative services such as managing customer services on its behalf. Typically, it receives a fee of 5.5% of the premium amount. However, for the customer, the services provided by the third-party administrator are for free – there is no hidden cost in the contract.

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Scope Of Work for a TPA

The tasks that make TPA a key cog in your relationship with your health insurance provider is primarily customer service. This includes claims processing which makes it necessary for you to interact with a TPA. Insurers across verticals, including health insurance companies, outsource their claims process (a portion of it or entirely) to a TPA of their choice. In the case of health insurance-related claims though, the third-party administrator also coordinates with the network hospital or any other hospital where the policyholder has undergone treatment before filing their claim. In India, many health insurance companies have their own dedicated departments for claims processing. For instance, NivaBupa health insurance processes your claims without any TPA, which significantly reduces the time taken to process your claims.

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Role/Importance Of TPA

While some of the functions of the third-party administrator have been touched upon earlier, let's get into further details for a better insight. Broadly, the TPA is supposed to- Promote cashless facilities Provide customer service Process claims

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Customer Service

The work of the third-party administrator – vis-à-vis you – begins the day the policy is sold to you,i.e. when you enter your health insurance provider’s database. Any service of your’s which is due, is now the responsibility of the TPA. Some of these services include- delivery of the health/identity card, attending to your grievances if any and of course, settling claims. The TPA streamlines costs and services and keeps you posted on network hospitals and addresses any concern that you may have. The TPA also makes payments to the hospital (in the case of non-cashless cases) and aids the reimbursement process with the help of your provider.

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Cashless Service

The TPA is also responsible for building the network of hospitals for the health insurance company. In the process, it brings the cashless facility to you as the insured. It takes the call on empanelling a hospital-based on its service track record, infrastructure and facilities, management background and IT infrastructure.

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Claims Processing

This is the role that the TPA is most known for. It coordinates with the hospitals for claim settlements, verifies bills for treatments, checks for false claims and even settles payments with hospitals in case of cashless facilities.

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IRDAI Amendments

Until recently, a policyholder had to accept any third-party administrator their health insurance provider chose. This changed on December 3, 2019, when the IRDAI announced amended regulations giving customers the right to choose a TPA from the list suggested by their health insurance provider. To be precise, “The policyholder can choose a TPA of their choice from amongst the TPAs engaged by the insurer” as stated in the notification on the website. Keep in mind though that as a policyholder, you can only choose the TPA from the list suggested at the time of buying or renewing the policy. If you do not choose any of the suggested TPAs, then the health insurance company can allot you a TPA of its own choice. IRDAI also allows the health insurance company to limit the TPA list based on the health insurance product and geographical location of the policyholder. Hence, if the insurer engages the services of only one TPA because of those factors, you will have no option but to go along with that particular TPA. The regulator also says that it is the insurer’s “prerogative” to engage or discontinue the services of a TPA for a particular health insurance product. Also, the only time you can choose (an alternate) TPA is if the services of the original TPA are terminated during the period of your health insurance coverage.

What Makes Niva Bupa the Best Insurance Company in India?

Niva Bupa Health Insurance policy is a leading provider in India, serving customers since 2008. With a remarkable customer base of over 70 lakh individuals, it boasts an impressive claim settlement ratio of 92%, successfully settling claims totalling 1,141 crores since inception. What sets Niva Bupa apart is its direct claim settlement process, eliminating the need for third-party administrators (TPA). Moreover, Niva Bupa offers critical illness insurance coverage across a vast international network spanning 190 countries.

With an extensive network of 10,000+ hospitals nationwide, accessing cashless treatment through Niva Bupa is incredibly convenient. In addition, the company has embraced digital solutions for the seamless handling of medical needs and insurance processes, ensuring efficiency, shorter turnaround times, and an exceptional consumer experience.

Niva Bupa is a joint venture with Bupa Singapore Holdings, a well-established British healthcare services company, and Fettle Tone LLP, an experienced private equity firm with a successful track record of transforming over 50 Indian companies. Driven by a vision to become India's most admired and best health insurance company, coupled with customer-centric features, Niva Bupa emerges as an ideal choice in the Indian health insurance sector.

Why Choose Niva Bupa?

Niva Bupa Health Insurance policy is the top choice for health coverage, offering an extensive range of policies to cater to diverse needs. Niva Bupa has everything from individual plans to family floater options and senior citizen coverage to critical illness policies.

What sets Niva Bupa apart is the attractive benefits offered across their policies, making them among the best in India. For example, you can enjoy a generous 30% renewal premium discount, no restrictions on room rent, coverage for alternative treatments, access to a daily health coach, international coverage, travel insurance , refill benefits, no-claim bonuses, e-consultations, and coverage for various medical expenses beyond hospitalisation.

Senior citizens are well cared for with premium services that include coverage for road and air ambulances, organ donors, AYUSH therapy, daycare treatments, and ongoing treatments. In addition, accident plans offer comprehensive benefits such as permanent disability coverage, child education, and death benefits. Moreover, Niva Bupa covers 20 critical illnesses and provides long-term discounts and lifetime renewal options.

With all these advantages, it's no wonder that Niva Bupa is the go-to choice for health insurance seekers. Experience peace of mind and comprehensive coverage with Niva Bupa Health Insurance.

Frequently Asked Questions

Why Do You Need Health Insurance?

How can I buy this policy?

How to calculate health insurance premium?

How to renew your health insurance policy?

What documents do you require to buy health insurance?

What are the eligibility criteria for health insurance?

What are the benefits of comparing health insurance plans online?

Do health insurance plans cover Ayurveda and other alternative treatments?

Which medical insurance plan is best for you?

Save Tax in India with Health Insurance Plans

Why buy health insurance online?

How to buy health insurance online?

Can I buy a Health Insurance Plan for my whole family?

Is a Health Insurance Policy the Same as a Family Floater?

What is the waiting period for critical illnesses under a Health Insurance Plan?

Can I add a rider to a Health Insurance Plan?

Does the Health Insurance Plan offer maternity benefits?

Can I change my existing policy to Niva Bupa Health Insurance Policy?

Customer Testimonial

Hear what our customers have to say

Access our blog where you can read more about what our doctors and affiliated industry experts have to say on living healthy

26 August 2020

Customer

Niva Bupa

Covid-19 Survivor stories: Dr Rohit Mehta shares his journey of struggle, hope and his takeaway from the experience COVID-19 Survivor Stories: Dr Rohit Mehta shares his journey of struggle, hope and his takeaway from the experience.

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26 August 2020

Customer

Niva Bupa

Covid-19 Survivor stories: Dr Aarushi Gupta shares her story of battle with the Coronavirus and victory along with her take-way of strength inside out COVID-19 Survivor Stories: Dr Aarushi Gupta shares her story of battle with the Coronavirus and victory along with her take-way of strength inside out.

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26 August 2020

Customer

Niva Bupa

Covid-19 Survivor stories: Mr Rajesh Sawant recalls a tumultuous time fighting the dreaded Coronavirus and how he finally won his battle against it. All I want to convey is that don’t panic if you notice symptoms; take help of the medical staff. And most importantly, invest in your and your family's well-being. I strongly recommend Niva Bupa as a perfect health partner for their seamless and quick service.

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Reviews and Rating

Here are some reviews we think you may like

The Niva Bupa doctors work to ensure that you receive a fair Insurance experience.

I trust niva bupa

⭐⭐⭐⭐⭐

Avtar Singh

21/12/2020

I have been a Niva Bupa customer for years, and now I trust them more than ever. Not just me, but I have been suggesting it even to my employees and near and dear ones to opt for Niva Bupa. Its hassles free, convenient, and most importantly, the team is proactive in their dealings. Great Job!

Everyone needs health insurance

⭐⭐⭐⭐⭐

Gajendar Sharma

23/08/2020

I had Niva Bupa as my health insurance partner, and I must say that they truly process claims in under 30 minutes. It really is true and not just one of those hoax promises by a brand. Their team has been supportive throughout. Thank You!

I recommend Niva Bupa

⭐⭐⭐⭐⭐

Kishan Sethi

11/07/2019

I strongly recommend Niva Bupa Health insurance to all my near and dear ones. it was truly a wise decision to have selected a healthcare partner that not only provided me with a hassle free experience during covid-19 hospitalisation, but all the convenience during a difficult time

What is the difference between health insurance and mediclaim policy?

When you decide to sign up for health insurance and begin researching the best plan for you, you may come across several phrases that confuse you. Most articles use the terms' health insurance 'and mediclaim' interchangeably. This is due to the widespread assumption that mediclaim is associated with health insurance. However, this is not the case. While they both serve the same aim of providing financial assistance during a medical emergency, their coverage is vastly different. Continue reading to compare the two:

Health Coverage:

Health insurance covers the majority of healthcare expenses, including pre-hospitalisation, post-hospitalisation, and critical illness. You have the option of filing cashless claims, in which the insurance company contacts your healthcare provider immediately and pays the money owed (if the healthcare provider is a part of the network hospitals of the insurance company). If that is not possible, you can pay your medical expenditures in advance and seek reimbursement from your insurer.

Niva Bupa health insurance policies include value-added advantages such as free medical exams, no-claim bonuses, health coaches, and so on. You can also tack on extra coverage such as personal accident and maternity insurance.

Mediclaim:

Mediclaim insurance is just for hospitalisation expenditures - they only cover your hospital/treatment costs after an accident or a certain condition. Other medical expenses are not covered as a result. However, similar to a health insurance plan, you can pick between reimbursement and cashless claim settlement methods.

When it comes to health insurance, it is vital to select a plan that meets your specific requirements. A comprehensive health insurance plan with pre-existing disease inclusions and add-ons may be your best bet if you have pre-existing diseases.A mediclaim policy, on the other hand, may be a possibility if you require basic and low-cost coverage.

Here are the fundamental distinctions between health insurance and mediclaim:

Health InsuranceMediclaim
CoverageComprehensive medical and surgical coverage, including hospitalisation, diagnostic tests, medicines, ambulance services, daycare treatments, AYUSH treatments, e-consultation, modern treatments, OPD etc.Limited to hospitalisation expenses and pre-existing diseases. Extends coverage for treatment due to accidents and specific diseases
Add-on coverageA range of additional covers available, including personal accident insurance, accidental disability coverage, maternity coverage etc.No add-on covers available
FlexibilityCustomers can opt to increase their sum insured. They can customise their plan by opting for additional benefits like health coach, hospital cash, enhanced geographical cover etc.No possibility of changing the premium amount or extending the term of the policy. And not much flexibility is offered in terms of benefits
CostCosts more than mediclaim as it provides comprehensive coverageCosts less than health insurance as it offers limited coverage
Plan featuresHealth insurance policy features are mostly similar across different health insurance providers. And they all offer comprehensive coverage with beneficial featuresFeatures can vary widely from provider to provider and plan to plan
ClaimsIn critical illness cover and personal accident cover, the sum insured is paid in lump sum, and claims can be made only once during a policy year. In other plans, claims can be made until the total sum insured is exhausted. Moreover, with Niva Bupa's ReAssure and Refill Benefits, a policyholder's sum insured is restored upon exhaustion during a policy year for treatment of the same or different diseasePolicyholders can file claims until the total sum assured is exhausted. Once exhausted, no more claims can be filed during the same year
Critical Illness CoverCovers a range of critical illnesses such as cancer, heart attacks, kidney failure, liver failure, lung diseases, multiple sclerosis, different types of organ transplants, etc.Critical illness coverage is not available
Sum InsuredHigh sum insured - up to Rs. 6 croresLow sum insured options - up to Rs. 5 lakhs
HospitalisationEverything from pre to post hospitalisation, including hospital cash, ambulance charges etc.Only the actual hospitalisation expense

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