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One of the most well-known health insurance company, Niva Bupa, offers exclusive health insurance coverage. Niva Bupa offers affordable health insurance plans that cover every aspect of healthcare. The healthcare needs of senior citizens are substantial, so it is necessary for them to have health insurance. There are many benefits offered by Niva Bupa Health Insurance's Senior Citizens plan. A wide network of over 4,500 hospitals and over 2,000 doctors are available to Niva Bupa Health Insurance customers for cashless treatment. Furthermore, it provides a delivery service for medicines and diagnostic samples at home. As people reach retirement age, they are usually exposed to a variety of health risks that make them vulnerable medically. To ease your problem, Niva Bupa Health Insurance has developed a Senior First plan that not only helps you stay fit and healthy but also offers unique benefits such as the Reassure benefit, an annual aggregate deductible, direct claim settlement facilities, etc.
1. Treatment for daycare - Insured Person's Medical Expenses incurred under a Day Care Treatment during the Policy Period following an illness or injury will be reimbursed Injuries. In order to be covered, the following conditions must be met:
a. Medical Practitioners recommend Day Care Treatment in writing as Medically Necessary.
b. The Day Care Treatment would be covered if the Insured Person was admitted for more than 2 hours and if treatment was taken for more than 2 hours Treatment for cancer may include angiography, dialysis, radiotherapy, or chemotherapy.
c. The Insured Person will also be indemnified for their pre-hospitalization and post-hospitalization medical expenses if their claim has been accepted under this benefit.
2. Hospitalisation at home - An Insured Person's Domiciliary Hospitalisation incurred during the Policy Period will be reimbursed on a reimbursement basis only. In order to be covered, the following conditions must be met:
a. As long as the domiciliary hospitalization continues for at least 3 consecutive days, we will pay the medical expenses under this benefit Hospitalisation costs incurred from the first day of domiciliary care
b. In writing, the treating Medical Practitioner confirms that the Insured Person cannot be transferred to another facility due to their medical condition. Neither a Hospital nor the Insured Person is able to find a bed in a Hospital.
3. Medical expenses prior to hospitalization - Insured Person's Pre-hospitalization Medical Expenses incurred as a result of an illness or injury will be reimbursed on a reimbursement basis only. In order to be covered, the following conditions must be met:
a. The claim was accepted under the headings of (Day Care Treatment), (Alternative Treatments), or (Modern Treatments).
b. Inpatient Care and Day Care Treatment are accepted for the same health conditions as pre-hospitalization medical expenses Claim of Alternative Treatments or Modern Treatments.
c. The expenses are incurred after the First Policy with Us is issued. No matter how long the initial waiting period is, it will only be responsible for expenses incurred after the commencement date of the First Policy, regardless of whether any expenses were incurred before then.
d. Physiotherapy expenses incurred prior to hospitalization will also be payable if prescribed in writing by the physician. Treating Medical Practitioners as Medically Necessary Treatment is directly related to the condition that led to hospitalization.
e. Inpatient Care or Day Care Treatment and Alternative Care may reduce the Sum Insured in the Policy Year during which the claim is admitted. Treatments or Modern Treatments claim has been incurred.
4. Medical expenses incurred after hospitalization - The Insured Person will be reimbursed for post-hospitalization medical expenses incurred following an illness or injury on a reimbursement basis only. In order to be covered, the following conditions must be met:
a. An inpatient care claim has been accepted. An outpatient care claim has been accepted.
b. Inpatient or Day Care Medical Expenses are incurred for the same condition for which we accepted inpatient care or daycare services. The claim of Alternative Treatments or Modern Treatments.
c. Expenses will be incurred according to the treating Medical Practitioner's instructions in writing.
d. Medical expenses incurred after hospitalization for physiotherapy will also be reimbursed provided that the treating physician prescribes such physiotherapy in writing as a medically necessary treatment and that it is directly related to the hospitalization.
e. Inpatient Care or Day Care Treatment and Alternative Care may reduce the Sum Insured in the Policy Year during which the claim is admitted. Treatments or Modern Treatments claim has been incurred.
1. Treatment of mental disorders - You are covered for the expenses incurred by the Insured Person for Inpatient treatment for Mental Illness up to the limit specified in your policy schedule. The conditions are:
a. The treatment of mental disorders is only covered when a qualified psychiatrist or a professional registered with the relevant State Authority diagnoses the patient or if the professional has a postgraduate degree (Ayurveda) in Mano Vigyan Avum Manas Roga or a postgraduate degree (Homoeopathy) in Psychiatry or a postgraduate degree (Unani) in Moalijat (Nafasiyatt) or a postgraduate degree (Siddha) in Sirappu Maruthuvam.
b. Medically necessary treatment is the reason for the hospitalization.
c. The treatment should be taken in Mental Health Establishment, including Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homoeopathy establishment, by whatever name called, either wholly or partially, meant for the care of persons with mental illness, established, owned, controlled or In which persons with mental illness are admitted, live, or are kept for care, treatment, convalescence, and rehabilitation, either temporarily or permanently, by the appropriate government, local authority, trust, corporation, co-operative society, organization, or any other person or entity; Generally, a general hospital or nursing home established or maintained by the appropriate government, local authority, trust, corporation, cooperative society, organization, or any other entity or person is included; however, a family residential place where a person with mental illness lives with family or friends is not included.
2. AIDS and HIV - Expenses incurred by the insured person as a result of a condition caused by or associated with HIV/AIDS will be reimbursed. The conditions are:
a. Hospitalisation or daycare treatment is medically necessary, and the illness is the result of HIV/AIDS. A written prescription is required for this. Licensed by a medical practitioner.
b. AIDS-related opportunistic infections caused by low immunity status are covered under this benefit Bacterial, viral, fungal, or parasitic infections.
c. HIV positivity should be declared by the patient.
d. Medical Expenses incurred for up to 60 days prior to the Insured Person's admission, if occurring within the Policy Period, and for up to 90 days following admission.
3. Maintenance of artificial life - Up to the limit specified in Your Policy Schedule, the policy will indemnify the Insured Person for artificial life maintenance expenses, including life support machines used to sustain the Insured Person who is not brain dead. The conditions are:
a. The treating physician prescribes artificial life maintenance as a medical necessity.
4. Treatments that are modern - Depending on your policy schedule, the following procedures/treatments are covered either as inpatient care or as daycare treatment in a hospital.
a. HIFU (High intensity focused ultrasound) and uterine arterial embolization
b. Sinuplasty of balloons
c. Stimulation of the deep brain
d. Chemotherapy administered orally
e. Injection of monoclonal antibodies
f. Injections into the vitreous
g. The use of robotic surgery
h. Radiosurgery using stereotactic techniques
i. Thoracic Thermoplasty
j. Prostate vaporization (Green laser treatment or Holmium laser treatment)
k. Intraoperative Neuromonitoring (IONM)
l. Hematopoietic stem cells for bone marrow transplantation for hematological conditions to be covered.
5. A second opinion from a medical professional - During the Policy Period, if the Insured Person is diagnosed with a Specified Illness or plans to undergo surgery for any Illness or Injury, the Insured Person may obtain a Second Medical Opinion at his/her discretion. The following conditions must be met in order to receive the coverage described above:
a. A Second Medical Opinion is requested from our Service Provider.
b. Our Service Provider will arrange the Second Medical Opinion, and it will be based solely on the information and documentation provided by the Insured Person.
c. Insured Persons can only avail themselves of this benefit once during a Policy Year for the same Specified Illness or planned Surgery.
d. In seeking a Second Medical Opinion under this Benefit, the Insured Person is not prohibited from consulting with another independent Medical Practitioner or commencing or continuing any treatment recommended by that Medical Practitioner.
e. If the Second Medical Opinion is obtained, the Insured Person can decide whether to act upon it in whole or in part.
f. Second Medical Opinions under this benefit shall be limited to defined criteria and shall not be valid for medico-legal purposes.
1. Waiting period of 30 days
a. Treatment expenses related to any illness within 30 days of the policy's start date are excluded, except for claims arising from illness Accidents are covered, provided they are covered.
b. A continuous 12-month coverage, however, will not cause the exclusion to apply.
c. If a higher Sum Insured is granted subsequently, the within-referred waiting period is applied to the enhanced Sum Insured.
2. Evaluation & Investigation
a. Admissions primarily for diagnostics and evaluation are excluded.
b. A diagnostic expense that is not related or not incidental to the current diagnosis and treatment is excluded.
3. Rehabilitation, rest, and respite care - The costs associated with any admission are primarily for bed rest and not for treatment. Additionally, this includes:
a. Personal care such as bathing, dressing, and moving assistance at home or in a nursing facility Nursing assistants and non-skilled individuals can assist nurses.
b. The provision of physical, social, emotional, and spiritual support to people who are terminally ill.
4. Weight loss/obesity - Costs associated with obesity surgery that does not meet all the conditions below:
a. On the doctor's advice, surgery will be performed.
b. Clinical protocols should support the surgery/procedure.
c. Members must be 18 years or older
d. A measure of body mass index (BMI)
i. Equal to or greater than 40
ii. After the failure of less invasive methods of weight loss, have a body mass index greater than 35, as well as any of the following severe comorbidities:
5. Surgery for cosmetic or plastic reasons - Treatments to change appearance except for reconstructive surgery following an accident, burn(s), or cancer or as part of the medically necessary treatment to remove a direct and immediate health risk. In order for this to be considered a medical necessity, the attending physician must certify it as such.
6. Sports that are hazardous or adventurous - As a professional, you may be required to pay for any treatment you require as a result of participating in hazardous or adventure sports, such as para jumping, rock climbing, mountaineering, rafting, motor racing, horse racing, or scuba diving, hand gliding, skydiving, and deep sea diving, among others.
Among the modern treatments covered by the Niva Bupa Senior First Plan are:
Co-payment options cannot be changed once they are selected at the time of policy purchase.
Health check-up benefits are not subject to deductibles under this policy.
In all of its indemnity plans, Niva Bupa Health Insurance offers Covid-19 coverage.
RMOs, surcharges, and hospital service charges, which are not specifically mentioned as being covered, will not be covered by the policy.
Your NCB will not be carried over to the next or new policy if you migrate or change policies.
To qualify for domiciliary hospitalization, you must meet the following criteria.
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