What is the Senior First Policy?

Having the right health insurance for seniors is crucial in ensuring they can access the care they need without worrying about the financial burden. As healthcare expenses rise, comprehensive insurance plans can provide the security and peace of mind necessary for older individuals to maintain their well-being.

Niva Bupa’s Senior First Health Insurance plan is designed specifically for individuals aged 60 and above, offering a wide range of coverage including modern treatments, AYUSH therapies and pre/post-hospitalization care. With up to 10 lakh rupees in coverage, this plan ensures that you or your loved ones receive top-quality healthcare. It also provides additional options such as domiciliary hospitalization and comprehensive ambulance coverage for immediate and suitable medical attention.

The right health insurance plan is crucial for your health and financial security. Niva Bupa offers more than just insurance, it provides a commitment to care and support you as you age. Take the time to understand the coverage options, benefits and features of the Senior First Health Insurance plan to safeguard yourself and your family in various health scenarios.

Types of Senior First Health Insurance Policies

Understanding the coverage options and benefits of different health insurance plans is essential for making the right choice. Whether you prefer a comprehensive plan with higher coverage limits or a more budget-friendly option, selecting the right policy can offer peace of mind and financial security.

Niva Bupa Senior First Gold Plan

The Gold plan is designed for individuals and families seeking affordable yet comprehensive health coverage. It offers up to 10 lakh rupees in coverage and includes room accommodation, ambulance cover and air ambulance cover. With starting coverage at 5 lakh rupees and premiums as low as 13,453 rupees per year, this plan provides significant protection at a reasonable cost.

Niva Bupa Senior First Platinum Plan

On the other hand, the Platinum Plan is perfect for those who desire maximum coverage and added benefits. With coverage up to ₹25 lakhs, this plan not only offers the same ambulance cover as the Gold Plan but also includes a single private room for added comfort.

The Platinum plan also includes a health check-up benefit of up to 500 rupees for every 1 lakh rupees of base sum insured and a No Claim Bonus that can boost coverage by 10%, up to a maximum of 100% of the base sum insured. Additionally, the ReAssure Benefit provides the opportunity to avail unlimited sum insured, ensuring comprehensive protection in any situation.

With an annual premium of just 13,453 rupees, the Platinum plan offers top-tier health insurance coverage.

Senior First Health Insurance Policy Specifications

Specification	Details
Product Name	Senior First
Product UIN	MAXHLIP21575V012021
Plan Variants	Gold, Platinum
Base Sum Insured	Gold: ₹5 Lakhs / ₹10 Lakhs; Platinum: ₹5 Lakhs / ₹10 Lakhs / ₹15 Lakhs / ₹20 Lakhs / ₹25 Lakhs
Entry Age	The minimum and maximum age requirements for this policy are 61 and 75 years respectively
Family Composition	Choose between the Individual or Family Gloater plans, which cover up to 2 adults
Policy Term	1, 2, or 3 years
Waiting Period	General coverage lasts for 30 days, pre-existing diseases are covered after 24 months and specified illnesses are covered after 24 months
Renewability	Lifetime renewability
In-patient Care	Covered up to Sum Insured
Room Category	Gold: Shared Room; Platinum: Single Private Room
Pre-Hospitalization	Covered for up to 60 days
Post-Hospitalization	Covered for up to 180 days
Day Care Treatment	Covered up to Sum Insured
M-iracle Waiting Period	9 to 48 months depending on the variant
Ambulance Charges	Road ambulance: up to ₹2,000; Air ambulance: up to ₹2,50,000
AYUSH Treatments	Covered up to Sum Insured
Domiciliary Hospitalization	Covered up to Sum Insured
Organ Donor Coverage	Covered up to Sum Insured
ReAssure Benefit	Unlimited sum insured for all illnesses after the first claim
Health Check-up	Yearly check-up from the start, including different tests
No Claim Bonus	10% increase in base sum insured for each claim-free year, max up to 100%
Co-payment Options	You can choose between a co-payment of 0%, 20%, 30%, or 40%, and also have the option of an available deductible.
Exclusions	War, self-injury, diseases at birth, treatments after waiting periods
Tax Benefits	Tax relief under Section 80D of the Income Tax Act
Network Hospitals	Over 10,000 hospitals across India
Incurred Claim Ratio	54.05%
Solvency Ratio	1.7

Coverage Benefits of Senior First Health Insurance Policy

Attribute	Gold Plan	Platinum Plan
Base Sum Insured	5 Lacs / 10 Lacs	5 Lacs / 10 Lacs / 15 Lacs / 20 Lacs / 25 Lacs
In-patient Care	Covered up to Sum Insured
Room Category	Shared Room	Single Private Room
Pre-Hospitalization (60 days)	Covered up to the sum insured.
Post-Hospitalization (180 days)	Covered up to the sum insured.
Day Care Treatment	Covered up to the sum insured.
Modern Treatments	Certain robotic surgeries are covered up to the Sum Insured amount, with a sub-limit of 1 lakh rupees per claim
Ambulance	Road ambulance coverage of up to 2,000 rupees per hospitalization Air ambulance coverage provided up to 2,50,000 rupees per hospitalization
AYUSH Treatments	Covered up to Sum Insured
Domiciliary Hospitalization	Covered up to Sum Insured
Organ Donor	Covered up to Sum Insured
No Claim Bonus	Not applicable	The base sum insured amount increases by 10% annually with no reduction for claims
ReAssure	Not applicable	Unlimited coverage of up to the policy limit for both same and different illnesses
Health Check-up	Not applicable	Yearly coverage of up to 500 rupees per 1 lakh rupees of the base sum insured for specific tests. Individual policy: max INR 5,000 per Insured. Family Floater policy: max INR 10,000 per policy.
Co-payment	50%	Co-payment modification is available at 40%/30%/20%
Optional Benefits	Annual aggregate deductible options include 1 lakh, 2 lakhs, 3 lakhs, 4 lakhs, and 5 lakhs.

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Senior First Health Insurance Claim Process

Below is the Niva Bupa Senior First health insurance claims procedure for your convenience.

Cashless Claims

1

Admit yourself at a Niva Bupa network hospital

2

Use the Niva Bupa Health Card or provide the policy number at the hospital with ID proof

3

The Network hospital will verify your identity and submit the pre-authorization request to the insurer

4

The insurer validates, reviews and confirms the network hospital by fax and email. You will be notified by text message and email. Niva Bupa usually responds within 30 minutes of filing the claim request

5

Finalize the insurance claim settlement with the hospital after completing the formalities

Reimbursement Claim Process

1

Notify the insurer within 48 hours of admission in its network or non-network hospital. Pay the amount directly to the hospital.

2

Get your documents after leaving the hospital for reimbursement

3

Send the completed and signed claim form along with your valid ID proof and age proof to the insurer. The claim form can be found on Niva Bupa’s website or in your policy document

4

The insurer will review the claim request upon receipt of your documents and either approve, query or reject it based on the policy terms and conditions

5

The insurer will settle and reimburse the approved amount according to the policy terms

OPD Reimbursements

1

Access “My Account” and then select “Raise a Claim” under the OPD tab

2

Search for the doctor by entering the details

3

Click “Raise a Claim” from the search results against the doctor who provided OPD services

4

Complete the health claim form with accurate bill and bank details, along with the required documents uploaded. Submit after completion

5

The insurer will review the insurance claim and approve, send a query or reject based on the policy terms

Diagnostic Center Reimbursements

1

Have a valid copy of the diagnostic claim reimbursement

2

Access “My Account” and select “Reimbursement Claim” in the annual health check-up tab

3

Fill out the claim form with accurate bill and bank details and upload specified documents. Submit after completion

4

The insurer will review your claim and then approve/send a query\reject it according to the policy terms

Niva Bupa Senior First Health Insurance Contact Details

For any assistance or query regarding Niva Bupa health insurance, kindly use the following channels to get in touch with Niva Bupa representatives.

Website: Bupa Health Insurance
Fax : +91 11 41743397
Toll-Free Number : 1860-500-8888
Office Address : 14th Floor, Capital Cyberscape, Sector 59, Gurgaon

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