Niva Bupa Health Insurance

Niva Bupa Senior First

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: ₹5L · ₹10L · ₹15L · ₹25L
Pre-existing disease (PED) waiting: 24 months
Pre-existing covered: Covered after PED waiting period
Co-payment: 20% from entry age 60+
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: Premium escalation pattern observed across renewal threads; confirm renewal terms in current policy wording.

Indicative premium

Order-of-magnitude only — NOT a quote

Age	Sum insured	Approx annual premium
65	₹10L	~₹38,000/yr
70	₹10L	~₹52,000/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
Treatment for obesity below BMI threshold
Hazardous sports
Substance abuse / self-inflicted injury
Experimental treatments

Known traps

The fine print that decides claim outcomes

20% copay on all claims at entry age 60+.
PED waiting reducible to 12 months with optional add-on (extra premium).
Pre-policy medical mandatory; insurer may decline based on prior medical history.
Restoration triggers only once per policy year and only for full SI exhaustion.
Premium re-rates aggressively at policy year +3 — annual premium can jump 25-40%.

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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