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Niva Bupa CritiCare – Critical Illness Insurance

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A health insurance plan that protects you and your family from 20 major critical illnesses
Criticare may be availed by an Individual or a Family (of 2 adults) on a Floater Basis. In the Family Option the payouts will be
  • Self (policyholder) : 100% of Sum Insured
  • Spouse : 100% of Sum Insured
The Fixed Benefit Amount can be paid out in two options which are as follows:
  • Option 1 : Sum Insured Paid as a Lumpsum
  • Option 2 : Lumpsum equal to 100% of Sum Insured + Staggered Payment equal to 10% of Sum Insured p.a subsequently as Income for 5 years

Niva Bupa Health Insurance review

Niva Bupa Health Insurance
Niva Bupa Health Insurance sum insured
2 lacs − 300 lacs options available
Incurred Claims Ratio *
54.00%
Niva Bupa Health Insurance tenure options
1 year
Claims Settlement Ratio **
85.96%
List of network hospitals
6,900+ hospitals
Number of policies issued *
696,107
Maximum family floater coverage
Self, Spouse + 4 dependent children
Number of lives covered *
54,33,000
* As per IRDAI report for 2018-19   |   ** As per NL25 data published on the Insurance Company website

Niva Bupa CritiCare – Critical Illness Insurance Policy review

  • Benefits
  • Features
  • Exclusions

Benefits of Niva Bupa CritiCare – Critical Illness Insurance Policy

  • Sum Insured Options: ₹3 lacs to ₹200 lacs
  • Age of Entry:For Adults 18 yrs to 65 yrs
  • Policy Tenure:1 / 2 / 3 years
  • Coverage Allocation:
    For Family Option (on Floater Basis):
    • Self (policyholder) : 100% of Sum Insured
    • Spouse : 100% of Sum Insured
  • Option 1
    • For Individual Option : Lumpsum equal to 100% of Sum Insured
    • For Floater Option :
      • Coverage for Self : 100% of Sum Insured
      • Coverage for Spouse : 100% of Sum Insured
(In any policy year, claim can be made for only one Life)

  • Option 2
    • For Individual Option : Lumpsum equal to 100% of Sum Insured + Staggered Payment equal to 10% of Sum Insured p.a subsequently as Income for 5 years
    • For Floater Option : Lumpsum equal to 100% of Sum Insured + Staggered Payment equal to 10% of Sum Insured p.a subsequently as Income for 5 years
(In any policy year, claim can be made for only one Life)

The 20 Critical Illnesses Covered under the Plan are listed below:
  • Cancer of specified severity
  • Open chest CABG
  • First heart attack of specified severity
  • Open heart replacement or repair of heart valves
  • Stroke resulting in permanent symptoms
  • Permanent paralysis of limbs
  • Coma of specified severity
  • Kidney failure requiring regular dialysis
  • Major organ/bone marrow transplant
  • Motor neurone disease with permanent symptoms
  • Multiple sclerosis with persisting symptoms
  • End stage liver disease
  • End-stage lung disease
  • Major burns
  • Loss of speech
  • Deafness
  • Aplastic anaemia
  • Bacterial meningitis
  • Fulminant viral hepatitis
  • Muscular dystrophy

Key Features of Niva Bupa CritiCare – Critical Illness Insurance Policy

The key features under the plan include:
  • We give you coverage from up to 20 critical illnesses like cancer and paralysis
  • Save taxes under section 80D of the income tax act for the amount paid as premium
  • Take a policy for two or three years and get a discount on the second and third year’s premium
  • There are no third-party agents involved. Get your claims processed painlessly by our customer service team directly
  • Get the health companion policy now you have up to 15 days to reconsider and cancel it with refund
  • Renew your policy indefinitely and only your age and city of residence will be considered

Specific Exclusions for CritiCare

In addition to any conditions and exclusions listed under each Critical Illness, We shall not be liable to make any payment of the CritiCare Benefit if the claim is attributable to, or based on, or arise out of, or are directly or indirectly connected to any of the following:
  • The Insured Person's attempted suicide or self-inflicted injuries while sane or insane; or
  • Narcotics used by the Insured Person unless taken as prescribed by a Medical Practitioner, or the Insured Person's abuse of drugs and/or consumption of alcohol; or
  • Taking part in any naval, military or air force operation during peace time; or
  • Participation in aviation/marine including crew other than as a passenger in an aircraft/water craft that is authorized by the relevant regulations to carry such passengers between established airport or ports;
  • Including but not limited to engaging in or taking part in professional/adventure sports or any hazardous pursuits, such as speed contest or racing of any kind (other than on foot), bungee jumping, parasailing, ballooning, parachuting, skydiving, paragliding, hang gliding, mountain or rock climbing necessitating the use of guides or ropes, potholing, abseiling, deep sea diving using hard helmet and breathing apparatus, polo, snow and ice sports, hunting etc; or
  • Participation by the Insured Person in a criminal or a breach of law with criminal intent

Niva Bupa Health Insurance FAQ's

The hospital may ask you for a security deposit as part of its internal policy. However, this may vary from hospital to hospital and the deposit may be refunded as per hospital guidelines.

For your grievances, please write to the General Manager and grievance redressal officer at grievanceredressal@maxbupa.com

An unrecognised hospital or health facility refers to establishments who aren’t recognised by the relevant authorities in India or any other country where the treatment takes place. We have listed them on our website, and they can also be found on the policy document claims for treatment at hospitals which are not covered. Un-recognised hospitals can be seen on our website by visiting www.maxbupa.com and clicking on hospital network followed by clicking on List of Un-recognised hospitals.

The following KYC documents are required from the insured person/proposer in cases of reimbursement-
  • If claim amount is below 1 lakh- Photo Id proof & address proof
  • If claim amount is above 1 lakh- Photo Id proof, address proof and a recent photograph

Brochure

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CIN: U66000KA2018PTC117713 | IRDAI Web aggregator License Code Number: IRDAI / INT / WBA /53/ 2018, Valid till 07/08/2022
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