REASSURE 3.0

Eligibility Criteria of Niva Bupa Reassure 3.0

Before you decide to go with the ReAssure 3.0 plan, it's important to know if you qualify to buy it. Understanding the eligibility requirements helps you figure out if the plan is the best fit for you and your family. Here are the eligibility criteria:

• Policy Type: This plan is available for both individual and family floater policies.
• Adult Entry Age: Adults can join the plan from the age of 18.
• Child Entry Age: Children can be included from as early as 91 days old.
• Maximum Entry Age: The plan is available up to the age of 99, so even older adults can join.
• Family Composition: A family floater plan can cover up to 5 dependent children, and the total number of people covered under one policy can be up to 6.
• Relationship Coverage: You can include yourself, your spouse, children, parents, parents-in-law, and other eligible relatives as allowed by the policy terms.
• Plan Variants: ReAssure 3.0 comes in four different versions: Classic, Select, Elite, and Black.
• Premium Structure: The plan has 8 different tiers, and your premium amount may vary depending on where you live.

Eligibility criteria are often overlooked, but they play a crucial role in deciding who can be covered, the age at which you can enroll, whether your family members qualify, and how your premium is calculated.

Carefully reviewing these details before purchasing a health insurance policy helps you select the most appropriate plan for your needs.

Features of Niva Bupa Reassure 3.0

1. Unlimited Base Sum Insured - One of the main attractions of Niva Bupa ReAssure 3.0 is that it has unlimited base sum insured. It means that you can get sufficient coverage for all your treatment expenses in case of a number of hospitalizations or if the amount is substantial.

2. Flexibility in Room Rent - Room rent is generally one of the most expensive components of the hospitalization bill, so the ability to choose what kind of room you will occupy is a significant aspect of any health insurance plan. Niva Bupa ReAssure 3.0 offers its policyholders several options depending on the variant they choose:

• Classic – covers the expenses for accommodation in a General Room;
• Select – covers the expenses for accommodation in Twin Sharing rooms;
• Elite – covers all types of wards, except for Deluxe & Suite;
• Black – offers full flexibility and covers all types of rooms available in the hospital.

Thus, the higher the variant of the policy, the more options for choosing accommodation for the insured person there are.

3. Ambulance Expenses Covered - Many people are often surprised that their hospitalization costs could include ambulance expenses, especially in cases when their condition does not allow them to reach the hospital on their own. Fortunately, Niva Bupa 3.0 covers transportation to the nearest healthcare facility by road ambulance, which allows policyholders to avoid additional expenses. The Classic and Select variants reimburse the policyholder up to ₹2,000 for road ambulance services per hospitalization. Additionally, the Elite and Black variants cover road ambulance services, with no capping amount, and provide reimbursement for air ambulance services up to ₹5 lakhs per hospitalization.

4. Coverage of AYUSH Treatments - Niva Bupa ReAssure 3.0 covers all expenses of the AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy) treatments if the insured person is hospitalized for a minimum of 24 hours. Expenses of eligible treatment are claimed based on the terms and conditions of the policy.

5. Modern Treatment Included - Niva Bupa ReAssure 3.0 includes a coverage for modern treatment. This type of procedures may be classified as leading-edge, innovative, advanced, and futuristic and is mostly available only in the country’s top hospitals. Classic and Select variants provide a coverage of up to ₹1 lakh for such procedures. This coverage is unlimited for the higher variants of the policy.

6. Pre & Post-Hospitalization Expenses Covered - When a person is hospitalizing, they often have to bear numerous expenses for diagnostic tests, consultations, and medications even before the actual treatment begins and after it finishes. In Niva Bupa ReAssure 3.0, the pre-hospitalization expenses are covered for 60 days and post-hospitalization expenses are covered for 180 days, till the sum insured on the policy is exhausted.

7. Home Care and Domiciliary Treatment Covered - Sometimes, sick people cannot take care of themselves and require assistance of healthcare providers even at home. With Niva Bupa ReAssure 3.0, the policyholder has an option to get reimbursed for expenses related to home care or domiciliary hospitalization. The coverage is unlimited.

8. Organ Donor Benefit - When a person transplants an organ, both the recipient and the donor are subject to substantial expenses. The policy covers all expenses associated with the donor procedure that are applicable to the insured person. With Niva Bupa ReAssure 3.0, organ donor benefit is covered unlimited times.

9. Lock the Clock Benefit- An attractive feature of Niva Bupa ReAssure 3.0, available for the Elite and Black variants, is that allows policyholders to lock their premium based on their entrance age till the time they file their first claim.

10. Live Healthy Advantage for Policyholders - Niva Bupa introduced the wellness initiative called Live Healthy that encourages active lifestyles and offers rewards to those who make healthier choices. When a policyholder reaches all targets set by this program, they can get discounts on their policy premium on a renewal basis, with a maximum discount of 30%.

11. Day 1 Pre-Existing Disease Coverage - One of the most compelling advantages of Niva Bupa ReAssure 3.0 is that it allows coverage of pre-existing disease on day 1. Policyholders can opt for the day 1 coverage of the declared medical condition by paying an additional premium (loading) for this benefit.

12. Second Medical Opinion Available - If a policyholder gets diagnosed with a critical illness and/or needs to undergo major treatments, they are advised to consult another doctor to make sure that the diagnosis is correct and the chosen treatment method is the most effective and cost-efficient one. To get help with this, Niva Bupa ReAssure 3.0 policyholder can use the Second Medical Opinion service, available by specialty from Niva Bupa’s provider network.

13. Unlimited E-Consultation - Niva Bupa ReAssure 3.0 provides the policyholders with the option of getting cashless consultation with qualified doctors over the Internet through an e-consultation.

Niva Bupa ReAssure 3.0 Health Insurance Plan offers its policyholders extensive coverage with numerous additional benefits, including the Day 1 pre-existing disease coverage, home healthcare, coverage for organ donor benefits, unlimited treatment reimbursement, and e-consultation.

Optional Benefits of Niva Bupa ReAssure 3.0

Niva Bupa ReAssure 3.0 presents a range of riders in order to provide maximum coverage under the policy. You can choose from the following riders in order to customise your health plan and enjoy greater benefits:

1. CashBag+ : CashBag+ is a reward-based benefit with which Niva Bupa enables its policyholders to claim cashback on every claim-free year of their policy. In addition to that, you can claim this cashback in order to offset the renewal premium, OPD expenses, deductibles, or co-pay.

You will receive a cash discount equivalent to 10% and 5% of the first renewal premium and every subsequent renewal premium respectively, for having 3 consecutive claim-free years.

2. Annual Health Check-up : This optional benefit helps you get a Day 1 annual health check-up done. This is especially good for detecting diseases at an early stage and ensuring that you get the right treatment.

3. Tiered Network : This optional benefit enables access to a tier list of hospitals across the country, wherein you can claim discounts of up to 15%, on all medical expenses, upon submitting a claim for treatment at any of the hospitals in the Tier I list. In the case of treatment at a non-listed hospital, a co-pay will have to be made as per the terms and conditions of the policy.

4. Pre-Existing Disease Waiting Period Modification : With this optional benefit, the waiting period for pre-existing diseases can be lowered to either 12 or 24 months, as per the chosen option.

5. Specific Disease Waiting Period Modification : With this optional benefit, the waiting period for specific diseases can be lowered to either 12 or 36 months, as per the chosen option.

6. Co-Payment Options : The various options for co-payment that the policy provides includes 0%, 10%, 20%, 30%, 40%, and 50%. This optional benefit enables the policyholder to choose the most convenient premium rate as per their financial capability.

7. Personal Accident Cover : By utilising this optional rider, the policyholder can avail of an additional personal accident cover, upon purchasing the Reassure 3.0 plan. The maximum sum insured for this includes:

• Classic - ₹10 Lakh
• Select - ₹20 Lakh
• Elite - ₹50 Lakh
• Black - ₹1 Crore

The limit of the cover can be chosen in accordance with the variant chosen by the policyholder, in multiples of ₹5 Lakh, as applicable.

8. Hospital Daily Cash : During a hospitalisation due to an ailment, policyholders may have to incur expenses beyond the room and board, such as food, transport, and family accommodation, among others. Hospital Daily Cash provides additional cash support to compensate for these incidental expenses. The amount offered for this benefit differs as per the variant chosen by the policyholder:

• Classic - ₹1,000 Per day
• Select - ₹1,000 Per day
• Elite - ₹2,000 Per day
• Black - ₹4,000 Per day

9. Annual Aggregate Deductible : There are various deductible options to choose from, in accordance with the financial requirements of the policyholder. The various options for the deductible include between ₹10,000 and 5 Lakh, wherein a higher deductible will lead to a lower premium payment for the policy.

10. Claim Safeguard+ : One of the biggest expenditures that a typical health insurance plan may require a policyholder to bear during a hospitalisation is the amount for consumables and non-payable expenses. Claim Safeguard+ covers some of the payables under the policy which may not be covered by a standard health insurance plan.

11. WellConsult+ : WellConsult+ is an optional health cover that allows the policyholder to access a number of OPD benefits in addition to the OPD benefits that the base plan provides. The OPD can be claimed up to the multiple of the annual premium, as per the chosen option. Additionally, the policy covers expenses pertaining to doctor visits, diagnostic tests, medicines, gymkhana fees, and preventive health services, in accordance with the chosen option, wherein a co-pay may be applicable during reimbursement.

12 Borderless Benefit : Under this optional benefit, the policyholder can access treatment from any hospital across the world. This benefit is ideal for those who wish to travel abroad frequently or want to get treatment from overseas. The amount of coverage for this optional benefit includes:

• Select - Worldwide treatment up to ₹10 Lakh
• Elite - Worldwide treatment up to ₹50 Lakh
• Black - Worldwide treatment up to ₹5 Crore

Various options for co-payment are available wherein the percentage can range from 0% to 50%.

13. Borderless for Specified Illnesses : This optional benefit enables the policyholder to receive benefits for ailments listed under the policy, in accordance with the chosen variant. Therefore, the policyholder can access treatment for critical illnesses in overseas hospitals. The coverage for this rider includes:

• Select - Up to ₹10 Lakh
• Elite - Up to ₹50 Lakh
• Black - Up to ₹5 Crore

Like the Borderless Rider, various options for co-payment are available wherein the percentage can range from 0% to 50%. By choosing the most suitable option for co-payment, the policyholder can reduce the overall premium amount that they are required to pay under the ReAssure 3.0 Plan.

Exclusions under Niva Bupa ReAssure 3.0

Niva Bupa ReAssure 3.0 has a list of exclusions that are not covered by the plan. You need to read them before investing in the insurance scheme to avoid future claim rejections and understand your benefits. The following are Niva Bupa’s Reassure 3.0’s policy exclusions:

• Cosmetic surgery or plastic surgery: This includes those types of surgeries that are done solely for cosmetic reasons and are not related to accidents, burn, or cancer treatment.
• Hazardous and adventurous activities: Any treatment resulting from participating in professional races or other extreme sports such as skydiving, scuba diving, etc.
• Breach of law: Treatment due to breaking the law or attempting to do so is also excluded from coverage under this policy.
• Excluded hospitals, doctors, or providers: Policyholders will not be covered for any healthcare costs incurred at hospitals, doctors’ clinics, or other providers not included in the list approved by the insurance company, except for limited stabilization costs in specific cases.
• Alcohol, substance abuse, and treatment: Treatment for alcohol addiction, abuse of substances, and treatment of resulting conditions is excluded from coverage under this policy.
• Refractive error: The treatment of refractive errors below the defined threshold is excluded from coverage.
• Unproven treatments: Unrecognized treatments and therapies that have not been proven to work are excluded from coverage.
• Infertility, contraception, sterilization, and surrogacy: Any treatment for infertility, including IVF, contraception, sterilization, surrogacy, and fertility treatments, is excluded from coverage.
• Maternity: Expenses related to maternity such as caesarean section, miscarriage, pregnancy termination, and related treatments are excluded from coverage, with the exception of those specified above.
• Illnesses related to war or disaster: Any treatment of disease, injury, or damage related to war, rebellion, terrorism, nuclear, or radiological dangers is also excluded.
• Congenital malformation: Excludes screening, counseling, and treatment for birth defects.
• Dentist treatment: Excludes all types of treatments for teeth except those resulting from an accident or cancer.