Niva Bupa Health Pulse Policy

Buying a health insurance plan is the most important and smartest decision one takes to financially protect himself and his family against a medical emergency. It prepares you to deal with any medical situation without having to worry about the funds. Niva Bupa health insurance company is one of the leading stand-alone health insurance companies in India, offering many plans for its customers. The company has a network of 7600+ hospitals and promises direct settlement of claims without the involvement of any third-party agents. It also offers paperless reimbursements, which are done completely online without the need for any paperwork.

In this article, we will discuss the Niva Bupa health pulse plan in detail.

Pulse plan by Niva Bupa insurance is a cost-effective, comprehensive health insurance plan that is pocket friendly and offers customised benefits at a great value. The available plans are in two variants: Classic and Enhanced. Given below are the features offered by the plan.

• The policy has a sum insured from ₹ 3 lakhs to ₹ 25 lakhs, where the classic variant has a sum insured upto ₹ 10 lakhs, and the enhanced variant has a sum insured upto ₹ 25 lakhs.

• The entry age for the policy is between 18 years to 65 years.

• The policy is available on an individual as well as family floater basis with lifelong renewability.

• Annual health check-up facility is available from the second policy year.

• The policy has no cap on room rents for a sum insured of ₹ 5 lakhs and above.

• If the sum insured gets exhausted in a policy year, the plan offers a restoration benefit of 100% of the sum insured.

Following is the list of the inclusions under the Niva Bupa Health Pulse plan.

• In-patient treatment, including nursing costs, doctors’ fees, physiotherapy and diagnostic procedures related to the treatment, consumables and medicines, OT charges, and other medical supplies required for treatments such as fluids, blood, injections, etc., are covered in the plan to the sum insured limit.

• Per day Room rent is covered up to the lower of the two values: 1 % of the sum insured or a single private room if the sum insured is less than ₹ 5 lakhs. In case of a sum insured above ₹ 5 lakhs, it is covered upto the single private room.

• ICU Charges are covered upto 2 % of the Sum insured per day for the sum insured less than ₹ 5 lakhs. For the sum insured above ₹ 5 lakhs, it is covered up to the sum insured.

• Pre and post-hospitalization expenses are covered up to the sum insured for 30 days and 60 days, respectively.

• Daycare treatments, domiciliary treatment, alternative treatment, and living organ donor transplants are covered upto the sum insured.
• Emergency Ambulance is covered upto ₹ 1500 for each hospitalisation (SI less than ₹ 5 lakhs) and upto ₹ 2000 for each hospitalisation (SI more than ₹ 5 lakhs).

• Mental disorder treatment, HIV treatment, and modern treatments are also covered as per the policy terms.

• Optional Benefits like personal accident cover, critical illness cover, hospital cash, e-consultation, enhanced refill benefit of up to 150% of the sum insured, and enhanced no-claim bonus of upto 20% of the sum insured are also available.

Following are some permanent exclusions in the policy.

• Ancillary hospital expenses
• Artificial life support charges
• AYUSH treatments
• Convalescence benefits
• Dental treatments
• Ophthalmic treatments
• Hormone replacement treatments
• Incidental diagnostic procedures
• Weight control procedures.

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A policyholder can make two types of claims - cashless and reimbursement. Let us see how the Niva Bupa general insurance company entertains the two types of claims.

1). Cashless Claims

Cashless claim can be availed only if the insured is hospitalised in a panel or network hospital and follow the following process.

• For planned hospitalisation, inform the insurer 48 hours in advance. For emergency hospitalisation, you can inform within 24 hours of hospitalisation. You can inform the company by calling the toll-free number.

• Download the pre-authorisation form from the website of the insurance company. Fill it out and submit it at the hospital at the time of admission. The hospital informs the insurer, and after verification and approval, the payment is directly settled with the insurer.

In case the cashless claim is rejected, you can apply for reimbursement after discharge from the hospital. In such a situation, you have to clear the hospital bills from your pocket.

2). Reimbursement Claim

A reimbursement claim is filled if the insured is admitted to a non-network hospital or the cashless claim is rejected by the insurer. In both scenarios, follow the following steps;

• After the patient is discharged from the hospital, submit all the bills and required documents related to the claim to the insurer.

• The insurer will verify the documents, and if all the details are up to the mark, the claim amount will be reimbursed.

• The documents required for reimbursement claim include a Completed and signed claim form, Policy document, insured’s KYC documents, discharge summary, doctor’s prescription advising hospitalisation, original hospital bills, and FIR copy in case of an accident.

If you are looking for an affordable health insurance plan with wider coverage for yourself and your family, the Niva Bupa health pulse plan is the right plan for you. You can purchase this plan online as well as offline and can get it customised as per your family's medical needs. The plan is lifelong renewable so you will not have to worry about the future medical needs of your family.