Niva Bupa Aspire (Titanium+) with Disease Management Rider

Niva Bupa Aspire (Titanium+), along with the add-on Disease Management Rider, is a comprehensive health insurance policy provided by Niva Bupa Health Insurance Company Limited. 

This plan is a perfect choice if you're looking for unique features and benefits that are planned to suit your specific requirements. By selecting the add-on, you will be provided with coverage for diabetes and hypertension from day 1 of purchase of the policy. It offers extensive coverage beyond hospitalisation, such as overseas treatment, maternity and consumables expenditures. It further introduces a range of enticing incentives to motivate young individuals to join without delay, such as the opportunity to pay premiums based on entry age until the first claim, transferring completed waiting periods to your future spouse, and other additional benefits. 

On the other hand, this plan doesn't offer the option to pay the premiums monthly. Additionally, our research shows that the insurer has received a higher number of complaints related to claim settlements and policy purchases, suggesting a poor track record in terms of both purchase and claim services.

What are the benefits offered by the Niva Bupa Aspire (Titanium+) with Disease Management Rider?

• Inpatient hospitalisation coverage: Inpatient hospitalisation coverage generally arises when a patient is admitted to the hospital for more than 24 hours. The plan covers the expenses related to the cost of your hospital room, nursing care, consultations, prescription medications, ICU charges, and any other relevant expenses. The Niva Bupa Aspire (Titanium+) with Disease Management Rider plan provides coverage for the expenses related to inpatient hospitalisation. There is no limit for both ICU and room rent charges through inpatient coverage. However, expenses related to the use of an automation machine for peritoneal dialysis during hospitalisation for inpatient treatments will not be covered.
• Pre-hospitalisation coverage: Prior to your hospital admission, you might encounter various medical expenses known as pre-hospitalization costs. These expenses encompass consultation fees, laboratory tests, checkups, and medical reports, among other items. Your post-hospitalisation expenses must be related to the condition you were hospitalised for, and the claim must be approved for inpatient hospitalisation. With the Niva Bupa Aspire (Titanium+) with Disease Management Rider plan, you can be confident that your pre-hospitalisation expenditures will be covered for a period of 60 days, up to the sum insured.
• Post-hospitalisation coverage: Post-hospitalization coverage is necessary for the patient's recovery after discharge. It allows for frequent medical consultations along with regular follow-ups with care and medication. To ensure your expenses are covered, they need to be directly related to your hospital stay and backed by as part of your inpatient hospitalisation coverage. With the Niva Bupa Aspire (Titanium+) with Disease Management Rider, you get comprehensive coverage for post-hospitalisation expenses up to the sum insured for 180 days after your hospitalisation.
• Daycare treatment coverage: Daycare treatment is a medical procedure or surgery that used to need an extended hospital stay but can now be finished within 24 hours due to advancements in medical technology.  The Niva Bupa Aspire (Titanium+) with Disease Management Rider plan covers all daycare treatment procedures up to the sum insured. However, expenses related to the use of an automation machine for peritoneal dialysis during hospitalisation for daycare treatments will not be covered.
• Domiciliary treatment coverage: Domiciliary treatments involve providing urgent medical care at home instead of in a hospital. This is typically necessary when a patient is too ill or injured to be safely transported to a hospital or when hospital beds are unavailable nearby. With the Niva Bupa Aspire (Titanium+) with Disease Management Rider plan, all expenses pertaining to domiciliary treatments are covered up to the sum insured. Domiciliary treatments are eligible for coverage provided that a daily monitoring chart containing records of administered treatments is diligently maintained and signed by the attending doctor. However, it's important to note that under the Domiciliary Treatment Cover, expenses for medical and ambulatory devices utilised at home, such as Pulse Oximeters, Sugar monitors, BP monitors, CPAP machines, automation devices for peritoneal dialysis, BiPAP machines, crutches, wheelchairs, and similar equipment, will not be covered. Under the Domiciliary Treatment Cover, coverage will be provided for peritoneal dialysis and chemotherapy administered at home.
• Organ donor coverage: The Niva Bupa Aspire (Titanium+) with Disease Management Rider plan also covers organ donor expenses. It covers the donor's inpatient costs associated with organ transplantation up to the sum insured. Additionally, if you donate any of your organs, the expenses incurred for harvesting the organ from you will also be covered.
• Modern treatment coverage: Modern treatments incorporate commendable medical advancements in the field of healthcare that were previously considered untreatable. These facilities encompass a wide array of options, including stem cell therapies, radio surgeries, and even robotic surgeries, tailored to meet the individual needs of each patient. The Niva Bupa Aspire (Titanium+) with Disease Management Rider plan is carefully crafted to keep up with these developments and covers the expenses associated with these modern treatments up to the sum insured.
• Non-medical expenses coverage: Non-medical expenses coverage consists of expenses like vaccination, gloves, nebulisation kits, oxygen masks, medical footwear, urine bags and hospital gowns. With the Niva Bupa Aspire (Titanium+) with Disease Management Rider plan, you can have peace of mind as these non-medical expenses are covered up to the sum insured. However, it's important to note that this benefit is available as an add-on option. 
• No Claim Bonus: The No Claim Bonus is a reward given by the insurance company if no claim is made during the policy period.  The Niva Bupa Aspire (Titanium+) with Disease Management Rider plan offers a maximum bonus accumulation of 300%, 500%, or 1000%, based on the entry age. There is no reduction in accumulated bonus due to claims, with a bonus of 100% awarded every claim-free year. 
• Super No Claim Bonus: The Super No Claim Bonus functions as an enhanced variant of the standard No Claim Bonus, operating in a similar manner. However, the Niva Bupa Aspire (Titanium+) with Disease Management Rider does not have any provisions for the super no-claim bonus. 
• Restoration benefit: The restoration benefit is a special feature designed to replenish your sum insured in case it is fully utilised within a policy year due to unfortunate circumstances. The refill benefit of the Niva Bupa Aspire (Titanium+) with Disease Management Rider plan can be applied for unlimited times within a policy year, with eligibility triggered from the first paid claim. Once the restoration benefit is activated after the first claim payment, it remains in effect permanently. This means there is no need for another initial claim to re-trigger this benefit upon renewal. Restoration benefit comes into effect when there is partial exhaustion of the sum insured and the No Claim Bonus. It applies to a comprehensive range of illnesses, encompassing both related and unrelated conditions. 

Please remember that the limitations and conditions mentioned in the benefits above apply to a sum insured of Rs. 10 lakhs.

Niva Bupa Aspire (Titanium+) with Disease Management Rider: Financial Limits

• Room rent limit: The room rent limit signifies the maximum amount provided by your insurance provider to cover expenses related to your hospital room. When you choose a room within this limit, you won't have to pay any extra charges. But a proportionate deduction will be applied if you decide to go for a pricier room. With the Niva Bupa Aspire (Titanium+) with Disease Management Rider plan, you can select any room without any restrictions.
• ICU rent limit: The ICU rent limit is the maximum amount through which your plan will pay for your stay in the intensive care unit at the hospital. In the Niva Bupa Aspire (Titanium+) with Disease Management Rider plan, there is no limit on ICU rent, ensuring that the plan covers the entire cost of your ICU stay up to the sum insured.
• Copayment: A copayment, often known as a copay, represents a fraction of the approved claim amount that you are required to cover personally. The insurer will cover the remaining expenses once payment is made. The Niva Bupa Aspire (Titanium+) with Disease Management Rider plan provides provisions for co-payment only when you choose a borderless add-on.
• Deductible: The deductible is the amount you need to pay to cover healthcare services before the insurance starts paying for the remaining medical costs. The Niva Bupa Aspire (Titanium+) with Disease Management Rider plan provides a few options for deductibles at 20K/30K/50K and 100K as options.   
• Limits on surgeries/treatments: When assessing your health insurance policy, it's vital to grasp the parameters regarding surgeries and treatments. These constraints determine the maximum coverage that your policy extends for particular medical procedures or treatments. While some plans impose pre-set restrictions on coverage for certain procedures, others may offer more flexibility in this regard. With the Niva Bupa Aspire (Titanium+) with Disease Management Rider plan, the joint replacement surgeries and cataract treatment are covered up to the sum insured.

Please note that the above financial limits are taken for a 30-year-old individual opting for a sum insured of Rs. 10 Lakhs.

Niva Bupa Aspire (Titanium+) with Disease Management Rider: Waiting Periods & Exclusions

👉Waiting period

A waiting period is a specific timeframe when certain illnesses and medical conditions aren't covered right away after you get your policy. Claims for these specific conditions can only be made once the waiting period has passed. Additionally, the waiting period rate is different for different insurance agencies. Here are the different types of waiting periods-

• Initial waiting period: For all medical conditions, except accidents, there's an initial waiting period of 30 days. During this time, you will not be eligible to make a claim for any hospitalisation except in cases of accidents. 
• Waiting period for pre-existing conditions: A pre-existing medical condition refers to any health problem or illness you had in the past 36 months prior to obtaining a health insurance policy. There is a waiting period of 36 months for pre-existing conditions under the Niva Bupa Aspire (Titanium+) with Disease Management Rider plan. You cannot make any claims for costs associated with your pre-existing diseases during this waiting period. However, hypertension and diabetes are covered from the 1st day of purchasing the policy.
• Waiting period for specific diseases: In addition to pre-existing conditions, insurers also maintain a list of certain medical conditions or illnesses with waiting periods, irrespective of your medical history. These waiting periods are decided by the insurer and aren't influenced by your current health condition. There is also a waiting period of 24 months for specific diseases under the Niva Bupa Aspire (Titanium+) with Disease Management Rider plan.

👉Exclusions

Exclusions in health insurance policies refer to specific medical conditions or situations for which coverage is not provided. Here are some of the types of exclusions -

• Standard Permanent Exclusions: All insurance providers must adhere to the ‘standard permanent exclusions’ established by IRDAI. These include -

1. Investigation and evaluation: Hospital admission for observation or monitoring.
2. Rest, rehabilitation, and respite care: Medical treatments not requiring any active treatment or surgeries. 
3. Obesity/weight control: Treatment or surgery related to weight control or obesity.
4. Gender reassignment: Medical treatments and procedures to change to the opposite sex and modify the gender identity. 
5. Plastic/Cosmetic surgery: Treatment or surgery intended to modify body appearance or characteristics.
6. Profession in adventure or hazardous sports: Treatment expenses resulting from participating in adventurous activities such as river rafting, mountaineering, scuba diving, etc., as a professional.  
7. Breach of law: Expenses incurred in treating a person who has committed or attempted a criminal offence.
8. Excluded providers: Treatment obtained from medical professionals or hospitals excluded by the insurance company.
9. Narcotics: Treating addiction to substance abuse disorders such as alcohol, drugs, etc.
10. Treatments in establishments arranged for domestic purposes: Expenses incurred due to treatments in nursing homes and other healthcare institutes for domestic purposes. 
11. Dietary supplements are substances purchased without subscription, such as vitamins, minerals, etc., that a medical practitioner does not prescribe.
12. Refractive error: Expenses associated with correcting refractive errors of up to 7.5 diopters to enhance eyesight.
13. Unproven treatments: Medical procedures, Surgeries, or treatments that are proven to be ineffective.
14. Expenses related to sterility, birth control, and infertility: Contraception, sterilisation, artificial insemination, advanced reproductive technologies such as IVF, GIFT,  ZIFT, ICSI, gestational surrogacy, etc. 
15. Maternity expenses: Pre/post-natal costs and childbirth-related hospitalisation expenses.  

• Additional permanent exclusions: Insurance providers hold the discretion to impose extra exclusions for specific medical conditions or situations beyond the usual permanent exclusions. In cases where insurers perceive certain diseases or severe medical conditions as risky to cover, they may permanently exclude them from your policy. It's important to recognise that health insurers are limited by a list of illnesses defined by the Insurance Regulatory and Development Authority of India (IRDAI) for which they can enforce permanent exclusions. Insurers are not permitted to impose permanent exclusions for illnesses or diseases beyond this specified list.
• Non-standard exclusions (Specific exclusions): Non-standard exclusions or specific exclusions that extend beyond the standard permanent exclusions set by the IRDAI. They vary among insurance companies and are depend on the policy’s terms and conditions. Here are the most important specific exclusions listed under the Niva Bupa Aspire (Titanium+) with Disease Management Rider plan -

1. Any illness or injury resulting directly or indirectly from terrorism, nuclear or radiological emissions, warlike situations, or rebellion.
2. Expenses associated with screening, counselling, or treatment for external birth defects.
3. Coverage for dental treatment unless it is caused due to cancer or accident.
4. Expenses incurred due to the use of a ventilator for a patient in a vegetative state (brain dead) with no prospects of recovery.

What to expect in terms of claims experience if you buy from Niva Bupa Health Insurance Company Limited?

• Speed of claims settlement: Niva Bupa Health Insurance Company Limited has settled  99.95% of its claims within 30 days, ensuring an efficient and timely claim settlement experience. 
• Claim-related complaints: As per our research, Niva Bupa Health Insurance Company Limited has a higher complaint rate than other insurers, 0.49%.
• Claims incurred ratio: The claims incurred ratio is a metric that assesses an insurer's financial performance. It indicates the total claims paid out in relation to the premiums received in a given fiscal year. Niva Bupa Health Insurance Company Limited has a claims incurred ratio of 65.44%.
• Claim settlement ratio: Niva Bupa Health Insurance Company Limited's claim settlement ratio stands at 85.18%. This figure shows the ratio of total claims received to those resolved by the company within a particular fiscal year.
• Network hospitals: Niva Bupa Health Insurance Company Limited provides access to an extensive network of 10,000+ hospitals. This extensive network guarantees that customers can access cashless treatment without any financial concerns.

How is the customer service of Niva Bupa Health Insurance Company Limited?

• Policy purchase-related complaints: Based on our research, Niva Bupa Health Insurance Company Limited has received 0.01% of complaints related to its after-sales service, which is significantly higher than that of other insurance companies. 
• Response on Toll-Free: Our research suggests that Niva Bupa Health Insurance Company Limited’s response time on their toll-free number is average compared to other insurers. 
• Response on Twitter: According to our research, Niva Bupa Health Insurance Company Limited has a slow response time on Twitter compared to others.

About Niva Bupa Health Insurance Company Limited

Niva Bupa Health Insurance Company Limited, formerly known as Max Bupa Health Insurance Company Limited, operates as a joint venture between Bupa Singapore Holdings Pte. Limited and Fettle Tone LLP. As a standalone health insurance provider, it offers a diverse array of health insurance products tailored to fulfil the various needs of its customers, including individual health plans, family floaters, top-up policies, and more. Headquartered in New Delhi, India and established in 2008, the company is led by Mr Ashish Mehrotra, who serves as the CEO and MD.