Niva Bupa Health Insurance

Niva Bupa Health Companion

Plain-English breakdown of the plan — every field a shopper actually needs before clicking buy. Compiled from public Niva Bupa brochures and policy wordings. Always confirm against the official PDF below.

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Trust at a glance

Niva Bupa — IRDAI FY 2024-25

Verified

Claim Settlement Ratio: 92.39%
Incurred Claim Ratio: 61.22%
Complaints / 10,000 claims: 43
Network hospitals: 10,000

Source: IRDAI Annual Report FY 2024-25 · UIN 145PolicyPlain earns no commission · numbers shown verbatim

Plan details

Every field, in one place

Sum insured options: ₹3L · ₹4L · ₹5L · ₹7.5L · ₹10L · ₹15L · ₹20L · ₹50L · ₹1Cr
Pre-existing disease (PED) waiting: 36 months
Pre-existing covered: Covered after PED waiting period
Co-payment: No copay published
Room rent: Single private AC room
Restoration of sum insured: Once per policy year
No Claim Bonus (NCB): 20% per claim-free year
Cashless network: 10,000 hospitals (insurer disclosure)
Free-look cancellation window: 30 days
Premium grace days: 30 days
IRDAI UIN: Not confirmed — verify on irdai.gov.in
Last verified: 2026-06 · third party aggregator

Honesty note: Health Companion has three variants (1 / 2 / 3) with different SI bands and room categories; fields reflect Variant 2 as typical.

Indicative premium

Order-of-magnitude only — NOT a quote

Age	Sum insured	Approx annual premium
28	₹5L	~₹8,000/yr
35	₹10L	~₹13,000/yr

Indicative figures vary by city, family member count, medical loading and policy term. Always confirm on the insurer's premium calculator.

Known exclusions

What this plan typically does NOT cover

Cosmetic / aesthetic surgery
Maternity unless rider opted
Self-inflicted injury, substance abuse
Adventure sports
Treatment outside India

Known traps

The fine print that decides claim outcomes

Single private AC room category — Variant 1 (smaller SI) has tighter caps.
Restoration is once per policy year for unrelated illness only on some variants.
NCB 20% per claim-free year, capped at 100% of base SI.
Hospital definition requires minimum 15 in-patient beds in metro / 10 non-metro.
Day-care list capped at the annexure — anything else requires > 24h stay.

How to claim

Cashless vs reimbursement — the steps

1Notify insurer. Within 24 hours of emergency admission or 48-72 hours for planned hospitalisation. Use Niva Bupa's helpline or app — keep the reference number.
2Cashless: Pre-authorisation form filled by hospital, sent to Niva Bupavia the hospital's TPA desk. Approval typically 4-6 hours during business; longer overnight. If your hospital is OUT of network (or PPN-only), you'll be on reimbursement.
3Reimbursement:Pay hospital out-of-pocket, then submit claim form + original bills + discharge summary + investigation reports + KYC. Insurer's IRDAI-mandated turnaround is 30 working days from receipt of complete documents.
4Watch for deductions. Room rent above your eligible category triggers proportionate deduction across the WHOLE bill, not just room rent. Sub-limits on cataract / modern treatment apply even when total SI is far higher.
5If denied: Ask for a written denial citing the exact clause. Internal grievance redressal first, then IRDAI Bima Bharosa or the Insurance Ombudsman.

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