Aspire Plan

Eligibility Criteria of Niva Bupa Aspire Plan

Before you decide to go with the Aspire plan, it's important to know the eligibility criteria that helps you figure out if the plan is the best fit for you and your family. Here are the eligibility criteria:

• Coverage Options – It offers a wide range of sum insured options, starting from ₹5 lakh and going up to ₹1 crore.
• Policy Type and Coverage – This plan can be purchased as an individual or as a family floater plan. Under the family floater option, the policy can cover a family with up to five dependent children. For an individual policy, up to six members can be included, with a maximum of four adults and five children within the overall member limit. The adult members may include the policyholder, spouse, parents and parents-in-law.
• Entry Age - The minimum entry age for an adult is 18 years, while the maximum entry age for adults and dependent children is 65 years.
• Zonal Pricing - The premium for the Niva Bupa Aspire Plan divided into four pricing zones based on the expected cost of medical treatment in different cities and regions.
• Plan Variants – Aspire plan comes with 4 variants which is – Gold+, Diamond+, Platinum+ and Titanium+

Features of Niva Bupa Aspire Plan

The Niva Bupa Aspire Health Insurance Plan offers several valuable features as part of its standard coverage. Since these benefits are built into the plan, you do not have to pay an additional premium to access them. Here are the key features of this Plan:

• In Patient Hospitalisation Expenses - It covers a minimum hospitalisation of 24 hours for long hospitalization treatment. And it covers the expenses of doctor charge, nurse charge, medicines, tests, room rent etc.
• 2 Hours Hospitalization - Niva Bupa Aspire covers medical expenses for hospitalisation lasting two hours or more and rest it depends on terms and conditions.
• Road and Air Ambulance Cover - The plan covers expenses incurred while transporting the insured person to a hospital through a road or air ambulance. These expenses are covered up to the available sum insured.
• Modern Treatment Coverage - The policy covers eligible expenses related to modern medical treatments up to the available sum insured.
• Pre and Post-Hospitalisation Expenses - The Niva Bupa Aspire Plan covers eligible medical expenses incurred up to 60 days before hospitalisation and up to 180 days after discharge. This may include prescribed consultations, diagnostic tests and medicines related to the covered hospitalisation.
• Home Care and Domiciliary Treatment - If an insured person needs to receive medical treatment at home, the policy provides coverage for home care and domiciliary treatment up to the available sum insured.
• Organ Donor Expenses - The Niva Bupa Aspire covers expenses related to an organ donor when the insured person undergoes a covered organ transplant. This benefit is available up to the sum insured.
• Annual Health Check-Up - Policyholders can access an annual health check-up on a cashless basis. The benefit covers a defined list of medical tests, helping insured members monitor their health regularly.
• ReAssure Forever - The ReAssure Forever benefit work as restore benefit, means if your base sum insured exhaust then this plan provides unlimited restoration of coverage during the policy period. Each subsequent claim can be covered up to the base sum insured.
• Lock the Clock Benefit – Under this benefit, the premium continues to be same as per the policyholder’s entry age until an eligible claim is paid.
• Booster Benefit – Under this benefit you can carry forward your unused base sum insured from one policy year to the next year. This can gradually increase the total coverage. The maximum accumulation under the Booster Benefit depends on the insured member’s entry age and the chosen plan variant.
• Miracle Benefit - The Miracle Benefit is basically offered to cover the expenses related to maternity after completing the applicable waiting period and expenses are covered up to the Miracle sum insured. Any unused Miracle sum insured may also be carried forward, subject to the maximum limits applicable under the Booster Benefit.
• The waiting period for the Miracle Benefit varies by plan variant. It is 48 months under Gold+, 24 months under Diamond+, and nine months under both Platinum+ and Titanium+.
• Second Medical Opinion - The plan allows policyholders to obtain a second medical opinion from specialists within the insurer’s network. This benefit can be used an unlimited number of times during a policy year.
• Unlimited E-Consultations - Niva Bupa Aspire also provides unlimited online consultations with doctors available within the insurer’s network.

Optional Riders Under Niva Bupa Aspire

Niva Bupa Aspire offers several optional riders that allow customers to customise their health insurance coverage according to their medical needs, lifestyle and budget. These riders are available at an additional premium and may vary depending on the selected plan variant. Check the Optional benefit available under this plan as follows:

• Fast Forward – Under this benefit it allows you to combine the sum insured of multiple policy years and use it whenever required. This option applies to both the Base Sum Insured and the M-iracle Sum Insured.
• Future Ready - The Future Ready benefit is designed for individuals who may want to add their spouse to the policy after marriage. It provides guaranteed policy issuance for the future spouse and gives continuity for the waiting periods already completed by the policyholder, subject to the applicable terms and conditions.
• Worldwide Treatment Cover - This optional benefit allows the insured person to receive eligible medical treatment anywhere in the world. Covered expenses are payable up to the available sum insured, making it useful for customers who want access to healthcare facilities outside India.
• Co-payment Options - Niva Bupa Aspire offers different co-payment options, including 0%, 20%, 30%, 40% and 50%. Here the policyholder pays the selected percentage of an admissible claim, while the insurer pays the remaining amount. Choosing a higher co-payment may reduce the policy premium, but it also increases your out-of-pocket expenses during a claim.
• Cash-Bag Benefit - The Cash-Bag benefit allows you to accumulate cashback for every claim-free policy year. The amount can be used to pay renewal premiums, deductibles, co-payments and OPD expenses.
• The Cash-Bag receives an amount equal to 10% of the first renewal premium and 5% of each subsequent renewal premium. This benefit rewards customers for staying healthy and continuing their policy.
• Safeguards Benefit -  Claim Safeguard covers specified one time usable items like PPE kit, gloves, sanitizer etc. listed under the policy, so that you don’t have to pay from your pocket
• Booster Safeguard protects the accumulated Booster benefit when the total claim during a policy year is less than ₹1 lakh. This means a smaller claim will not affect the accumulated Booster, subject to policy terms.
• Wellness Cover - This optional benefit provides OPD benefit and covers teleconsultations, physical doctor consultations, diagnostic tests and pharmacy expenses. It may also include gym membership and a range of wellness-related benefits, helping policyholders manage both preventive and routine healthcare requirements.
• Personal Accident Cover - The Personal Accident rider provides additional coverage equal to one, two, three, four or five times the Base Sum Insured, subject to a maximum cover of ₹1 crore.
• Hospital Daily Cash – Under this rider it provides a fixed daily amount during a hospitalisation. For a Base Sum Insured of up to ₹5 lakh, the daily cash benefit is ₹1,000. For a Base Sum Insured between ₹7.5 lakh and ₹15 lakh, the benefit is ₹2,000 per day. For a Base Sum Insured above ₹15 lakh, the benefit is ₹4,000 per day.
• Annual Aggregate Deductible - The Annual Aggregate Deductible option allows customers to select a fixed Available deductible options include ₹20,000, ₹30,000, ₹50,000 and ₹1 lakh. Choosing a deductible can help reduce the premium, but the selected amount must be paid by the policyholder before the coverage becomes payable.
• Tiered Network Option - Under this benefit, the policyholder can receive a 15% discount on the premium by choosing treatment within the insurer’s tiered network hospitals. If treatment is taken at a non-tiered network hospital, a 20% co-payment will apply to the admissible claim.

Exclusions Under Niva Bupa Aspire Plan

Like every health insurance policy, the Niva Bupa Aspire Plan has certain exclusions and waiting periods under which medical expenses are not covered. Understanding these exclusions are more important:

• Rest Cure and Rehabilitation: Admission primarily for bed rest, rehabilitation, respite care, custodial support or assistance with routine daily activities is not covered.
• Cosmetic and Plastic Surgery: Cosmetic treatments performed only to alter appearance are excluded unless medically necessary due to an accident, burns, cancer or an immediate health risk.
• Professional Adventure Sports: Treatment resulting from professional participation in hazardous activities such as mountaineering, motor racing, rafting, scuba diving, skydiving or similar sports is not covered.
• Breach of Law: Medical expenses arising directly from an intentional criminal act or an attempted violation of the law are excluded.
• Alcohol and Substance Abuse: Treatment for alcoholism, drug abuse, substance dependency or any resulting medical complications is excluded.
• Refractive Error: Expenses for correcting eyesight where the refractive error is below 7.5 dioptres are not covered.
• Unproven Treatments: Experimental or unproven treatments, procedures, services and medical supplies without sufficient evidence of effectiveness are excluded.
• War, Terrorism and Nuclear Risks: Treatment for injury or illness caused directly or indirectly by war, rebellion, terrorism, nuclear activity or radiological emissions is excluded.
• External Congenital Conditions: Screening, counselling and treatment related to external congenital anomalies are not covered.
• Dental Treatment: Dental procedures are excluded unless required because of an accident or cancer.