Niva Bupa “Senior First” Health Insurance Plan

This is an independent review of Senior First Health Insurance plan by Niva Bupa. In this post, we will cover various features of this health insurance policy, compare the various options, look for comparison of prices and also try to find which option may be better for you.

About the Senior First Plan

Niva Bupa’s Senior First Health Insurance plan is a specialised plan curated for Senior Citizens aged between 61 to 75 years.

Under this plan, health insurance can be taken either on Individual or on Floater basis. In case of floater, 2 adults (Self & Spouse) can be covered under a simple plan.

About Niva Bupa

Niva Bupa Health Insurance is a joint venture between Fettle Tone LLP and Bupa Singapore Holdings Pte. Niva Bupa Health Insurance was previously known as Max Bupa Health Insurance.

Niva Bupa offers a wide range of health insurance plans to suit every need. The company provides cashless claim processing, with all claims processed directly and no third party involved. Niva Bupa has a strong network of hospitals, with over 10,000 hospitals in its network.

Plan Options

Senior First Plan comes in 2 different variants –

  • Gold
  • Platinum

Gold variant has 2 sub options underneath it where the Base Sum assured can be 5 Lacs or 10 Lacs. We can also call the Gold variant as the base variant.

Platinum variant has 5 sub options where Base Sum assured can be 5 Lacs / 10 Lacs / 15 Lacs / 20 Lacs or 25 Lacs. The platinum plan is an enhanced version which has additional benefits over the base plan like Health Checkup, ReAssure etc.

Features Explained

The Senior First Plan by Niva Bupa comes with the following features –

  • No sub-limits on common health conditions – Like cataract, joint replacements, cancer or any other common health conditions
  • No mandatory pre-issuance medical tests – While this is not mandatory it is always advisable to declare your pre-existing diseases at the time of issuance of policy to avoid any hassles during the claim later on.
  • No Loading – If you have any existing health condition, then there is no extra loading applicable under this plan.
  • Co-Payment and Deductible – You can opt for co-payment (between 0% to 50%) or deductible which can help you lower the cost of health insurance premium. This has been explained in detail in the later secion.

Benefit Illustration

The below table summarizes the various benefits available under Niva Bupa Senior First Health Insurance Plan.

As you can see from above there are 4 features that make the Platinum plan stand above the base Gold Plan.

Let’s explore these features in detail now.

Features Difference

The Senior First Health Plan of Niva Bupa has the following 4 extra features as part of its Platinum option:

Room Category

In case of Gold Plan, you can only opt for Shared Room during hospitalization whereas in Platinum Plan, you opt for Single Private Room as well. However, in case of Gold Plan, if you opt for a room category higher than your eligibility, then there is a mandatory additional 10% co-payment applicable.

As an example, let’s say that during hospitalization you opted for a Single Room instead of a share room. Let’s assume that at the time of discharge your total bill comes out to be ₹2 Lakh. Since you opted for a room above your category, you will be liable for copayment of 10% and thus cost of ₹20 thousand will have to be borne by you.

No Claim Bonus

Like is the case of NCB in vehicle insurance, if you do not make a claim against your Niva Bupa Health Insurance – Platinum option during a policy year, then your base sum assured will get increased by 10% each year. This can go up to a maximum of 100% of your Base Sum assured.

Let’s understand this with the help of an example.

Assume you bought the Senior Citizen policy with Base Sum Assured as ₹10 Lac. In case you do not take a claim for this policy, you will get an NCB of ₹1 Lac per year. So, after 5 claim free years, your total NCB will be ₹5 Lac (means your total sum assured now is ₹15 Lac).

Now, in case during 6th year you plan to buy the policy with a reduced Base Sum Assured, your NCB will also be revised accordingly. As shown below, if you choose to reduce your Base Sum Assured from ₹10 Lac to ₹5 Lac, your accumulated NCB will also be reduced correspondingly to ₹2.5 Lac.

ReAssure Benefit

This by far is the biggest difference between the 2 plans and probably a deal breaker. Let’s see how this works.

Assume that you have taken the Niva Bupa Senior Citizen Platinum Plan with base sum assured of ₹10 Lac. Due to an unforeseen scenario, you get hospitalized and your bill comes out to be ₹7 Lac. Now while you are relaxed that your current health expenses have been taken care of, you soon become worried that what if you are faced with another such unforeseen event or what if something happens to your spouse (in case of a floater policy).

Under the Platinum variant, the ReAssure benefit kicks in with first claim. Now, let’s assume that your next claim amount comes to be ₹12 Lac. Now, ₹3 Lac will be paid from base policy and ₹9 Lac will be paid from ReAssure.

In case there is a 3rd claim as well, a maximum of ₹10 Lac will be paid from the ReAssure benefit.

Health Checkup

Available once every Policy Year, from day 1 of the policy, up to the amount as specified in your policy schedule. You can choose any test(s) from the list specified below:

Waiting Period

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.

Exclusion will not be applicable if the Insured Person has continuous coverage for more than twelve months.

Co-Payment and Deductible Explained

Co-Pay and Deductible are 2 options available to the users who wish to bring their Health Insurance premium down. Let us try to understand how these options work?

  1. Co-Pay – Co-Pay or Co-Payment means a cost sharing requirement under a health insurance policy that provides that the Policyholder/insured will bear a specified percentage of the admissible claim amount. A Co-payment does not reduce the Sum Insured.
  2. Deductible – Deductible means a cost-sharing requirement under a health insurance policy that provides that the Insurer will not be liable for a specified rupee amount in case of indemnity policies and for a specified number of days/hours in case of hospital cash policies which will apply before any benefits are payable by the insurer. A deductible does not reduce the Sum Insured.

How does Co-Pay work?

In simple terms, a health insurance co-pay is a set percentage of the total claim amount that you, as the policyholder, are responsible for paying. The insurance company covers the rest based on the terms and conditions of the policy.

For instance, let’s say you have a claim of ₹4 lakhs, and your policy includes a 10% co-pay requirement. This means the insurance company will pay ₹3.6 Lac after deducting any non-covered expenses, while you will need to cover the remaining amount yourself.

It’s worth noting that while some health insurance policies make co-payment mandatory, others give you the choice to decide if you want to include it in your policy. In case of Niva Bupa First Citizen Plan, you can choose to Co-Pay between 0% to 50%. The most preferred options are generally 10% or 20%.

How does Deductible work?

A health insurance deductible is like a threshold or a starting point in your insurance plan. It’s the amount of money you have to pay from your own pocket before your insurance kicks in to cover the rest.

For example, let’s say you have a health insurance policy with a coverage of ₹5 Lac and a deductible of ₹1 Lac. If you have a medical procedure that costs ₹4 Lac, you would need to pay the first ₹1 Lac yourself, and then your insurance would cover the remaining ₹3 Lac.

However, if your medical expenses are lower, let’s say ₹80,000 , it’s less than your deductible of ₹1 Lac. In this case, you’d have to pay the entire ₹80,000 yourself because it’s less than your deductible, and your insurance won’t cover it.

So, think of the deductible as a threshold you need to cross before your insurance starts to help with the bills.

Senior First Health Insurance Premium

For a 70 year old healthy male, following are the premiums you have to pay for a family floater health insurance policy taken along with spouse for a Base sum assured of ₹5 Lac.

0% Co-PaySenior First Gold vs Platinum

20% Co-PaySenior First Gold vs Platinum

1 Lac Deductible Senior First Gold vs Platinum

Leave a comment