Niva Bupa Ultimate Guide to Health Insurance

Page 1

THE LEADER SPEAKS

As the CEO of Niva Bupa, I want to address the rising cost of medical care in India, an important issue affecting us all.

Healthcare expenses in the country are increasing significantly, including doctor consultations, tests, surgeries, and hospital stays. This trend can burden individuals and families financially and limit their access to quality healthcare.

At Niva Bupa, our purpose is to give every Indian confidence in accessing the best healthcare available. We offer comprehensive health insurance solutions to protect you from the escalating medical costs.

Health insurance safeguards your health and provides peace of mind during challenging times. By choosing Niva Bupa, you protect yourself and your loved ones from unexpected medical expenses.

We are proud to contribute to the growth of health insurance in India, but there is still work to be done. Together with our healthcare providers, we continuously explore innovative ways to improve the quality and accessibility of healthcare services.

Join the Niva Bupa family and experience the confidence of having a trusted partner by your side. Let us help secure your health and financial well-being, ensuring access to the best healthcare whenever you need it.

Thank you for considering Niva Bupa as your health insurance provider. We look forward to serving you and being a part of your healthy and happy life.

Warm regards,

THE LEADER SPEAKS

I am excited to share the growth and opportunities ahead for Niva Bupa in the health insurance industry in India. With health insurance penetration at just 3%, there is ample room for us to make a difference. Our commitment is to expand accessibility to health insurance and become leaders in this field.

Niva Bupa’s retail business is experiencing impressive year-on-year growth. Our physical presence in over 350 markets reflects our dedication to reach and serve clients nationwide. Thanks to our advisors and sales team, our retail market share has significantly increased. We are now a trusted partner for individuals and families seeking health insurance solutions.

We are determined to provide comprehensive health insurance solutions that cater to diverse needs. Together, we can make a significant impact on the lives of millions of Indians, ensuring access to quality healthcare and peace of mind.

Best regards,

4 CONTENTS 05 10 08 13 15 17 19 22 06 11 12 09 14 16 18 21 Why Health Insurance Reasons to Buy at a Young Age Health Insurance: The Cover of All Covers Health Insurance Comparison Checklist Tax Exemption Benefit Claim with Confidence Claim Testimonials Product Literature India’s healthcare scenario – some alarming facts Reasons to Buy along with a Corporate Cover How to select the right Health Insurance Plan What is covered under Health Insurance Health Insurance Suitability Checklist Why Niva Bupa? Our Claim Story Health Insurance for Every Segment

THINK YOU DON’T NEED HEALTH INSURANCE? THINK

AGAIN

1 2 3 4 5 6

Get

Rising

Health insurance helps you combat the consequences of inflation by covering a wide variety of medical expense.

Corporate Health Insurance isn’t enough

Corporate insurance is usually one solution for all needs with limited features which doesn’t give enough flexibility and the sum insured is not sufficient..

Due to the current lifestyle, health ailments are more commonly seen today. Therefore, it is more crucial than ever to protect your health with a full health insurance coverage.

Access

Health Insurance gives you the confidence and access to the best healthcare specialists in the country.

Tax

In addition to effectively covering future expenses, health insurance provides financial relief under Section 80D by reducing one’s tax liability for the premium paid.

5
Coverage
Financial
Medical
Inflation
Changing Lifestyle
to Best
Healthcare
Exemption
financial
health insurance plan to pay for
medical expenses without
on
financial plans.
security from a
the
having any impact
the

INDIA’S HEALTHCARE SCENARIO –SOME ALARMING FACTS

6
Highest medical inflation rate among Asian countries Population is pushed into poverty every year due to healthcare costs 14% 7% Cost of common treatments in India Head & Neck Cancer Surgery ` 3,50,000 Hemodialysis (12/month) ` 12-15000/month Chemotherapy ` 1,00,000 Kidney Transplant ` 8,00,000 IMRT (Stage 2 Cancer) ` 2,00,000 Peritoneal Dialysis ` 18-20000/month Avg. Cancer treatment cost ` 15,00,000 Post Transplant Cost ` 5000-10000/ month CANCER KIDNEY
7 Healthcare expenses are out of pocket expenses Government’s spending of GDP on health 63% 1.5% Cost of common treatments in India Angioplasty ` 4,10,000 Lung Transplant ` 20,00,000 Valve Replacement ` 6,84,000 Pancreas Transplant ` 17,50,000 By Pass ` 5,68,000 Liver Transplant ` 30,00,000
HEART # ORGAN TRANSPLANT
The Rising Cost of Medical Treatment [Infographic] - The Economic Times (indiatimes.com) *HealthInsurance-forIndiasMissingMiddle_28-10-2021.pdf (niti.gov.in) #Source : https://www.niti.gov.in/sites/default/files/2021-03/InvestmentOpportunities_HealthcareSector_0.pdf

Don’t let a medical emergency become a financial emergency!

Financial planning is sustainable only when you have a Health Insurance cover. Otherwise, in a medical emergency, you would be forced to break your other investment(s), leaving their own financial goals unmet. So, to keep your personal financial planning on track, Health Insurance is a must.

8 Read more at://economictimes.indiatimes.com/tomorrowmakersshow/69426234.cms?utm_source=contentofinterest&utm_ medium=text&utm_campaign=cppst • It covers your hefty hospital bills • It safeguards your other investments • Adequate health cover beats inflation • It offers tax benefits Children’s Future Planning Tax Savings Planning Retirement Planning Life Insurance Planning Investment Planning Cashflow Planning Real Estate Planning Financial Planning Health Insurance Cover How Health Insurance secures your life’s financial plans/goals HEALTH INSURANCE THE COVER OF ALL COVERS Get peace of mind with Health Insurance

MEDICAL EXPENSES COME IN VARIOUS FORMS. THEIR ANSWER COMES IN ONE

HEALTH INSURANCE

Diagnostic

Diagnostic

9 Pre-hospitalisation Expense Emergency Expense Surgical Expense Other Expense In-patient Expense Post-Hospitalisation Expense
Fees OPD expenses Organ Transplant Ambulance expense
Rent Follow-ups with Doctors Medication Dental Treatment Post-operative care Loss of income/salary due to hospitalization
Theatres Charges Physiotherapy
Doctor’s
Room
Operation
Tests
Medications
Doctor’s Fees
Test
Medication Medical
Tests
therapy
Rehabilitation

Rising medical inflation

Medical cost has been on rise on a yearly basis, Health insurance helps ease the financial burden.

Corporate insurance isn’t enough

Limited sum insured from corporate isn’t enough to cover rising medical needs with age.

Rejection

Health Insurance hold right to reject Health Insurance application with age or if the risk is higher.

Pre-existing conditions

Insurers often put pre-existing conditions for certain existing diseases which is avoidable if plan is bought when young.

Cost of Procrastination

Lower Premiums

For lower premium buy it young because with age, Health insurance cost increases.

Waiting period

Complete the applicable waiting periods in a policy while you are young and healthy.

More Coverage

At young age, one can avail more coverage at lower cost.

Tax benefits

Loss of tax refund which can be claimed for health insurance premium payments from young age.

Procrastination can be costly. Just one time hospotilisation is enough to exhaust you entire life time saving

10
Myth: “I am young and healthy; I don’t need Health Insurance.”
FACT: THE YOUNGER YOU START, THE MORE BENEFITS YOU RECEIVE

Co-payment clause

Co-payment usually exists for all the corporate health insurance which in turn increases the financial burden. This mean you have to pay a fixed % of the total hospital expenses.

Insufficient Sum Insured

Corporate health insurance has standard plan with a fixed sum insured for everyone which cannot be customized according to one’s personal needs and thus it’s always insufficient.

Policy tenure

Policy tenure is only valid until one is employed with the company.

Cap on number of insured members

There is a limited number of family number which can be insured under corporate’s standard health insurance plan.

Room rent capping

Room rent and other hospital expenses can be covered only according to the standard policy of the corporate health insurance plan.

Cover lapse between jobs

While one is switching jobs, one remains uncovered during the time. Any medical emergency can increase financial burden during this time.

In case of unfortunate situation

During uncertain times like COVID and recession, any unfortunate unemployment can again make a big hole in pockets.

What about Post Retirement?

By the time one reaches retirement, it becomes utmost important to keep the health insurance cover intact due to old age plus an individual plan bought in young age will give you coverage from the pre-existing medical conditions, no claim bonus & life time renewability.

11
Myth: “I have corporate Health Insurance; I don’t need a personal one.”
FACT: CORPORATE HEALTH INSURANCE OFTEN FALLS SHORT IN THE TIME OF NEED.

IT’S NOT ENOUGH TO HAVE ANY HEALTH INSURANCE HAVING THE RIGHT ONE IS IMPORTANT

Here’s what to consider while buying a Health Insurance plan

Choose The Right Policy

It’s important to assess own requirements from available health plans like Individual/Family floater/Senior Citizen/Top up/Super top up etc. to get a right policy which caters to your need in the best manner.

Opt for an Adequate Sum Insured

A large insured amount caters to rising medical inflation leading to hefty premium. One can choose top-up or super-top-up health insurance policies to increase the coverage limit without incurring a substantial additional expense.

Look for Comprehensive Coverage Benefits

To ensure that all potential medical costs are covered, it’s crucial to get comprehensive coverage. For instance, a newlywed couple may choose a health plan with maternity coverage.

Check the Hospital Network of the Insurance Company

Evaluate the network of hospitals before purchasing a family health plan to check whether the preferred local hospital has a tie-up with the insurance company. Stronger the PAN India hospital network, the better.

Check the Pre-Existing Waiting Period

Pre-existing diseases are those that you or any family members have prior to buying Health Insurance. For such cases, one needs to look for insurance policies with a short waiting time.

Check the Exclusion List

Every health plan contains a list of circumstances which are referred to as policy exclusions. Check the policy’s exclusion list before purchasing a health insurance.

Look for Value-Added Benefits

Value-added benefits are additional benefits which are offered along with the coverage features like Sum insured restoration, Health checkups, Telemedicine facilities, doctor’s consultation etc.

Smooth Claim Settlement Process

It is advisable that you familiarize yourself with your health insurance company’s cashless and claims process before purchasing the policy.

12

WHEN EVERY HEALTH INSURANCE POLICY LOOKS SIMILAR, LOOK AT THE DETAILS

13 IRDAI Recognition Sum Insured Premium List of Network Hospitals Refill Sum Insured Carry Forward of Unutilized Sum Insured Waiting Period Check for Critical Illness Benefit Claim Settlement Ratio Organ Donation Expenses Cover for Day-care Procedures Daily Hospital Cash Checklist while comparing health insurance plans

NEWLY MARRIED OR HAVE ADULT

Select the right Health Insurance plan basis your life stage

CHILDREN? 7

Family Floater or Individual Plan

Younger families will find the floater policies cheaper but Older family should take individual plan.

NEWLY MARRIED Husband 27 yrs, wife 25 yrs

Recommended plan

Why It works better

Family Floater

• One policy for the entire family.

• Cost effective

YOUNG FAMILY Husband 32 yrs, wife 30 yrs, kids 4 yrs and 2 yrs

Recommended plan

Why It works better

Family Floater

Low chance of all members requiring medical treatment at the same time. Floater plans are more affordable and brings more value for money.

OLDER FAMILY Husband 40 yrs, wife 38 yrs, kids 12 yrs and 10 yrs

Recommended plan

Why It works better

Family Floater

Though oldest member is 40, floater plan still works out cheaper because all members share the ₹ 10 lakh cover.

GROWN UP FAMILY Husband 50 yrs, wife 42 yrs, kids 22 yrs and 20 yrs

Recommended plan

Why It works better

Family Floater for the couple aid Individual Plans for the children

Premium is Linked to age of the oldest member. Separate plans for children will work out cheaper.

14

NOT JUST AN INSURANCE IT’S A SAVING TOOL TOO

Tax Exemptions Benefits*

Individual, and parents below the age of 60 years.

Individual, and parents below the age of 60 years, but parents above the age of 60 years.

Both individual, family, and parents above the age of 60 years.

*Tax benefits are subject to changes in tax laws. Please consult your tax advisor for more details

15
Category Premium Paid Self, family and children Parents Deduction under Section 80D Rs. 25,000 Rs. 25,000 Rs. 50,000 Rs. 25,000 Rs. 50,000 Rs. 50,000 Rs. 50,000 Rs. 75,000 Rs. 1,00,000 Hindu Undivided Family (HUF) Rs. 25,000 Rs. 25,000 Rs. 50,000

“BUT WHY NIVA BUPA?”

Because our features and numbers are unmatched

Fastest Growing Retail Health Insurer in FY 22 & FY 23

NBHI Retail Health GDPI growth stood at 38% growth stood at 38% for FY’23 as against SAHI Retail GDPI growth of 22% fastest among SAHIs.

10,000+¶ Network Hospitals

3

30 minutes§ Cashless Claims processing

202 Retail Branch presence in 22 States

9.5 million+ active lives as of 31st March’23

24 X 7 Self-serve capabilities using host of technology solutions: chat bot, web-form, IVR and established feedback process from service data

16

CLAIM WITH CONFIDENCEEASY, FAST AND STRESS FREE!

Watch our 2-min videos for a seamless

hassle free. You get treated at one of our network hospitals and we pay for the expenses directly to the hospital. Reach out to us at least 72 hours before the treatment in case of planned hospitalization, within 24 hours of admission in case of emergency hospitalization.

network hospital, you can settle your bills with the hospital and file for reimbursement of those expenses with us within 30 days of discharge. Your claim will be processed within 7 days of submission.

Please Note: Before choosing a hospital, refer to the list of Unrecognized Hospitals. We will be unable to pay claims-both cashless and reimbursement, for treatment availed for at these hospitals.

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THE PROOF IS IN THE NUMBERS

Total Claim Amount Paid `1563 Crores

Highest single claim paid `2.3 Crores

Total Number of Claims Paid 4 Lakhs

Claims delivered by Niva Bupa in FY 2022-23 claim kar le Zindagi ko Zindagi ko claim kar le Zindagi ko claim kar le

OUR CLAIM STORY
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DON’T GO BY WHAT WE SAY

Listen to our customers sharing their claim experience

When me and my mother were hospitalised, I did not spend a single rupee out of my pocket because I had a Niva Bupa policy.

KAWALJEET

With the help of Niva Bupa Health Insurance, I was able to get my son treated without worrying about the high medical treatment cost.

VIJAY KAPOOR

We needed approximately 40 to 50 Lacs within the span of 30-40 days. Whatever was written in Niva Bupa policies, I have seen it in practical form. That’s what I call reliability.

RAJEEV SETHI

19
Niva Bupa Policy Holder Niva Bupa Policy Holder Niva Bupa Policy Holder SCAN TO WATCH SCAN TO WATCH SCAN TO WATCH
20 Health Insurance plans from Niva Bupa Health Insurance customized for every need.

MARKET LEADERS WITH A UNIQUE PROPOSITION FOR EVERY SEGMENT

Curated affordable and comprehensive healthcare policies catering to the different needs of our consumers

HEALTH PULSE

HEALTH

Indemnity policies for partners

HEALTH

(Contextual byte sized products- loan, savings a/c, wallet etc.)

Acute

21
Management
Disease
Care
Smart Health+
COMPANION SENIOR FIRST
Smart Health+ HEALTH
Advisory Attachment Sales Process Segments Income Age Health Mass Market Wellness Focused Disease Management Senior Citizen Mass Affluent Upper/ Aspiring Affluent HNI
& employers
XPRESS HEALTH
PLUS SMART HEALTH
XPRESS HEALTH
PLUS SMART HEALTH
22 Nothing Seems Impossible Lock the Clock(1) Save as you age. Pay as per entry age, until you claim. Booster+(3) Don’t lose what you don’t use. Carry forward the balance sum insured. Live Healthy(6) Up to 30% discount on renewal premium basis step count. ReAssure Forever(2) Turns on after 1st claim. Unlimited times and forever. Safeguard+(4) All non-payables covered(5) Hospitalisation covered(7) for 2 hours and more 30 % Disclaimer: (1)Part of ReAssure+ Benefit. The premium of the age you entered at, will apply until a claim is paid. The product may be repriced as per IRDAI guidelines and policy terms and conditions. Applicable for Platinum+ and Titanium+ Variants. (2)Part of ReAssure+ benefit (Titanium+ and Platinum+ Variants)/ReAssureX benefit (Bronze+ Variant). A single claim under the ReAssure+/ReAssureX bucket will always be paid up to the base sum insured. (3)Unutilized base sum insured will be carried forward up to a maximum of 10X as per the variant chosen. (4)Safeguard+ is an optional benefit and is available on payment of an extra premium. (5)As per the list I, II, III, IV under Annexure I of policy terms and conditions. (6)Eligible insured person for this benefit will be - a. All members except son/daughter under a Family Floater policy & b. Any member of age at least 18 years under an Individual policy. (7)Minimum 24 hours hositalization required for AYUSH hospitals. Product Name: ReAssure 2.0. Product UIN: NBHHLIP23169V012223. Unlimi 10X ed Age 30min Claim ssing Carry Forward Carry Forward Forever Entry 30min Entry 30min Claim ssing Carry orward Fore Unlimi Unlimi 10X 10X 10X Never run out of Sum Insured Don’t lose what you don’t use Win-Win 2Hrs.

Lock the Clock

Save as you age. Pay as per entry age, until you claim

ReAssure Forever

Turns on after 1st claim. Unlimited times and forever.

Booster+

Don’t lose what you don’t use. Carry forward your balance sum insured up to 10x.

23
SCAN TO WATCH THE VIDEO

Your Health Deserves Nothing Less

A comprehensive health insurance plan, ‘Health Premia’ provides the perfect coverage for you and your family according to your needs and lifestyle. So, whether it’s going in for newborn child benefits or emergency medical treatments abroad, Health Premia ensures that you get the best in healthcare. After all, your health deserves nothing less.

day 1

Refill benefit for any illness in a policy year

Loyalty Additions of 10% in sum insured per year

25
and
In- built
Insurance*
for
30
Maternity (worldwide)
and newborn
HEALTH PREMIA Health check-up from day 1 Maternity
newborn baby cover (not available under individual plan)
travel
Refill benefit
any illness in a policy year Loyalty Additions of 10% in sum insured per year
mins cashless claims processing$ Comprehensive coverage up to ` 3cr
baby cover# Modern Treatments coverage International coverage for specified illness and medical emergencies∞ In-built travel insurance coverage for multiple trips in a year∞ Annual health check-up of your choice from
Disclaimer: #For details, please refer to the Product Benefit Table. ∞By default, coverage is not available for USA & Canada. However, coverage can be extended to USA & Canada on payment of additional premium. $Niva Bupa processes pre-authorisation requests within 30 minutes for all active policies, subject to receiving all documents and information(s) upto Niva Bupa’s satisfaction. The above commitment does not include pre-authorisation settlement at the time of discharge or system outage. *Applicable for Gold Plan only. Please refer to the policy wordings for details on coverage. Product Name: Health Premia. Product UIN: MAXHLIP21176V022021.

ReAssure Benefit#

ReAssure Benefit will trigger after the 1st claim itself. It is unlimited. Each claim will be up to the base sum insured.

Day 1 Health Check-up

Avail Annual Health-check up from Day 1

No sub-limits on common health condition - Like cataract, joint replacements, cancer or any other common health conditions

A Promise of Love

No mandatory pre-issuance medical tests**

Safeguard (Add-on)*

Coverage even for non-payable items like gloves etc.^^

Annual Aggregate Deductible

If deductible is opted, then co-payment will not apply

26
SENIOR
Disclaimer: #Single claim under this benefit will be payable up to base sum insured. *Safeguard is an optional benefit and is available on payment of extra premium. ^^As per the list I under Annexure I of policy Terms and conditions. **Pre-Policy Medical checkup may be required as per Underwriting guidelines. Product Name: Senior First. Product UIN: MAXHLIP21575V012021 | Add-on Name: Safeguard, Add-on UIN: MAXHLIA21576V012021
FIRST

Emergency In-patient Medical Treatment Coverage for overseas hospitalization up to $5,00,000 without any sublimits

Pre-Existing Diseases Coverage for pre-existing diseases.

Dental Treatment

Coverage of medical expenses for dental treatment.

Personal Accident Coverage for injury casued due to accidental event.

Medical Evacuation Coverage for cost of transporation in case of unsatisfactory medical services in a hospital.

EmergencyOutpatient Treatment Coverage for out-patient treatment due to an accident or illness.

27
Disclaimer: Product Name: TravelAssure. Product UIN: NBHTIOP22148V012122
Covers You Everywhere
28 Super Top-up Plan COVERAGE Up to `95 Lacs e-COnsultation: Unlimited tele / online consultations
PRE & POST HOSPITALISATION
MEDICAL EXPENSES: Covered up to Sum Insured
Day Care Treatments: Coverage for all day care treatments up to sum insured HEALTH RECHARGE Disclaimer: Product Name: Health Recharge. Product UIN: NBHHLIP22156V032122.
Pharmacy and diagnostic services: Available through our empanelled service providers

PERSONAL ACCIDENT PLAN

Live It Up

Stress free living with coverage up to INR 10 Cr for Accidental Death, Permanent Total and Permanent Partial Disability

Child Education & Support

Lump sum payout for child education along with education counseling and placement support.

Monthly Needs Benefit

Lump sum payout for 3 months in case of accidents leading to death, PTD, PPD, coma or burns.

Cashless coverage for accidental inpatient hospitalization.

Temporary Total Disability

Benefit at 2% of base sum insured, maximum up to INR 1L per week

Loan Protector

Additional lump sum payout for outstanding loan.

29
Disclaimer: Product Name: Personal Accident Plan. Product UIN: MAXPAIP21585V012021
30 Niva Bupa now opens more doors to avail services. Contact us at your ease! For Partners For Sales Team For Partners & Sales Team UNO Self-service tool capability to have instant service support. Instant Self-Service Raise Service Request Escalate Digital Marketing Tool

UNO Learn & Grow: The digital marketing toolkit for advisors

Brand Building

Build your brand and differentiate yourself from competition

Lead Generation

Generate leads online

DIGITAL DUKAAN

What

do you get ?

Brand building

Personalized webpage

Cobranded content

Social media marketing

Lead Conversion

To help in lead conversion and customer presentations

Learn / Trainings

Train yourself at your own pace

Lead generation Learn/ Trainings

Lead forms

Webpage sharing

Referrals

Customer birthdays

Lead conversion

Leaflets & brochures sharing

Engagement content

Improve your customer presentations

Flash cards

Product bytes

Training videos

My progress sections

Earning calculator

Intructor led training

Classroom experience

Specific to new advisor

31
32 Niva Bupa now opens more doors to avail services. Contact us at your ease! For Customers Insta Assist Customer self-service tool for real time assistance. Customer self-service videos Scan here for Training Videos Niva Bupa Health App Customer self-service tool to access multiple health benefits related to policy and wellness. Chat Bot Customer self-service tool to access instant service support. You can also chat with us over WhatsApp at 98 1195 6696
Find the best hospital as per your requirement (Network Hospital page) 33

If you would like to find out more, please reach out to our specialised sales team or your Niva Bupa advisor. We are available to fully understand your requirements and help you select the right plan for

Helpline: 1860-500-8888

24x7 Customer Service: https://rules.nivabupa.com/customer-service/

Website: www.nivabupa.com

https://www.facebook.com/NivaBupa

https://www.instagram.com/nivabupaofficial/ https://www.youtube.com/c/nivabupa

34 NIVA BUPA HEALTH INSURANCE COMPANY LIMITED
known as Max Bupa Health Insurance Company Limited) Registered Office Address: C-98 Lajpat Nagar 1, New Delhi-110024. Fax: +91 11 41743397.
(formerly
family.
‘Hi’ to us on WhatsApp: 9811956696
you and your
Say
Disclaimer: Insurance is a subject matter of solicitation. Niva Bupa Health Insurance Company Limited (formerly known as Max Bupa Health Insurance Company Limited) (IRDAI Registration No. 145). ‘Bupa’ and ‘HEARTBEAT’ logo are registered trademarks of their respective owners and are being used by Niva Bupa Health Insurance Company Limited under license. Registered office:- C-98, First Floor, Lajpat Nagar, Part 1, New Delhi-110024, Customer Helpline: 1860-500-8888. Fax: +91 11 41743397. Website: www.nivabupa.com. CIN: U66000DL2008PLC182918. UIN: NB/SS/CA/2023-24/090. ¶Number of network hospitals shown is an approximate figure and is subject to change without prior notice, please visit our website to access latest and updated list of network hospitals. §Niva Bupa processes pre-auth within 30 min for all active policies, subject to receiving all documents and information(s) up to Niva Bupa’s satisfaction. The above commitment doesn’t include pre-authorization settlement at the time of discharge or system outage. For more details on risk factors, terms and conditions, please read sales brochure carefully before concluding a sale.

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