Vumxe V1 L 84 Aq N7 PH

Date: 06/11/2023
Policy Number: 31046638202304

Customer ID: 2000606620
MR. UMESH SINGH VISEN

587-A-103 GANDHINAGAR TELIBAGH,,
LUCKNOW,
UTTAR PRADESH - 226029
Mobile: XXXXXX2221
Subject : Niva Bupa Health Insurance Policy No. 31046638202304
Dear MR. UMESH SINGH VISEN,
Thank you for renewing your Niva Bupa health insurance policy. At Niva Bupa, we put your health first and are committed to provide you access to
the very best of healthcare, backed by the highest standards of service.
Please find enclosed your Niva Bupa Policy Kit which will help you understand your policy in detail and give you more information on
how to access our services easily. Your policy kit includes the following:
• Insurance Certificate: Confirming your specific policy details like date of commencement, persons covered and specific conditions related to
your plan.
• Premium Receipt: Receipt issued for the premium paid by you.
Do visit us online at www.nivabupa.com to view and download our updated list of network hospitals in your city, download claim forms and for other
useful information. You can register with us online using your policy number, date of birth & email id and access your policy details. In case of any
further assistance, call us at 1860-500-8888 (customer helpline number) or email us at customercare@nivabupa.com.
We request you to read your policy terms and conditions carefully so that you are fully aware of your policy benefits. For benefits related to section
80D, please consult your tax advisor.
Assuring you of our best services and wishing you and your loved ones good health always.
Yours Sincerely,
Director - Operations & Customer Service

For and on behalf of Niva Bupa Health Insurance Co. Ltd.
(Formerly known as Max Bupa Health Insurance Co. Ltd.)
Important - Please read this document and keep in a safe place.
Product Name: Health Companion, Product UIN: NBHHLIP23108V062223

Product Name: Health Companion | Product UIN: NBHHLIP23108V062223
Health Companion Insurance Certificate
Policyholder Name: MR. UMESH SINGH VISEN Policy Number 31046638202304

Policyholder Address: Policy Commencement Date and Time From 08/11/2023 00:00
587-A-103 GANDHINAGAR TELIBAGH, Policy Expiry Date and Time To 07/11/2024 23:59
LUCKNOW, Sum Insured INR 5,00,000
UTTAR PRADESH - 226029 Variant Opted Variant 2022

Plan opted Family Floater
Details of Electronic Insurance Account (eIA)
Policy Period 1 Year
eIA Number None
Renewal / Payment Due Date 07/11/2024
Insurance Repository Name None
Reported claims in the policy since 0
inception
Optional Benefit/Feature Details
Particulars Effective[Y/N] Details
Hospital Cash opted N Not Opted
Annual Aggregate Deductible opted (INR) N 0
Treatment only in Tiered Network opted N N
Safeguard (Rider) opted N 0
Cover Details
Name of the Insured Base Sum Insured No Claim Bonus Re-fill amount Safeguard Sum Sum Insured (Base Sum
Person(s) (INR) amount accrued (INR) Insured Insured + No Claim Bonus
(INR) (INR) + Re-fill amount +
Safeguard Sum Insured)
(INR)
Mr. Umesh Singh Visen 5,00,000 4,00,000 5,00,000 0 14,00,000
Ms. Aparajita Singh
Ms. Aadya Singh
Mrs. Aradhana Singh
Intermediary Details
Intermediary Name Intermediary Code Intermediary Contact No.

Policybazaar Insurance WEB0030001 18002088787
Brokers Private Limited
Premium Details
Net Integrated Central Goods State/UT Goods Loading (INR) Gross Premium Gross Premium (INR)
Premium/Tax Goods and and Service Tax and Service Tax (INR) (in words)
able Value Service (9.00 %) (9.00 %)
(INR) Tax (18.00
%)
15,538.00 0.00 1,398.42 1,398.42 0.00 18,335.00 Eighteen Thousand Three Hundred
Thirty-Five Only

Nominee Details
Nominee Name Relationship with the Policyholder
Aradhana Singh Spouse
Permanent Exclusion (if any):
None
Claim Administrator Servicing Branch Details
Niva Bupa Health Insurance Company Limited Logix Infotech Park , Plot no D-5, Sector 59, Noida, Gautam Budh Nagar, Uttar Pradesh
201301
Insured Person Details
Name of the Age (in Insured Gender Relationship Insured Additional Pre-existing Personal Waiting
Insured Person (s) Years) DOB with the Policy with Niva Sum Disease#,## Period*,##
Holder Bupa Insured
(Since)
Mr. Umesh Singh 40 23/02/1983 Male Applicant 08/11/2019 0 None None

Visen
Ms. Aparajita 3 22/09/2020 Female Daughter 08/11/2023 0 None None

Singh
Ms. Aadya Singh 8 05/12/2014 Female Daughter 08/11/2019 0 None None
Mrs. Aradhana 35 14/07/1988 Female Spouse 08/11/2019 0 None None

Singh
(# - Pre Existing Diseases as disclosed by You/Insured Person or discovered by us during medical underwriting)
(* - Please refer to Policy terms & Condition for details)
(## - As per clause 5 of the policy terms & conditions , on renewal, if an enhanced Sum Insured is applied, the Waiting Periods would apply afresh to the
extent of the increase in Sum Insured only.)
Product Benefit Table2

Inpatient Care Up to Sum Insured
Eligible Room Category Up to Sum Insured
Pre-hospitalization Medical Expenses 60 days, Up to Sum Insured
Post-hospitalization Medical Expenses 180 days, Up to Sum Insured
Alternative Treatments Up to Sum Insured
Day Care Treatment Up to Sum Insured
Home Care / Domiciliary Hospitalization Up to Sum Insured
Organ Donor Up to Sum Insured
Emergency Ambulance Road ambulance: up to Rs. 2,000 per hospitalisation
Air ambulance: up to Rs. 2,50,000 per hospitalisation
Re-fill Benefit Up to Sum Insured
No Claim Bonus In case of no claim, increase of 20% of expiring Base Sum Insured in a
Policy Year; maximum up to 100% of Base Sum Insured
Vaccination for Animal Bite Up to Rs. 5,000
Health Checkup Annual (From Day 1), For defined lists of tests up to Rs. 2,500 per policy
Modern treatments Up to Sum Insured
Hospital Cash Not Opted
The details of the benefits will change depending upon the plan opted. All the benefits are on per Policy Year basis, if otherwise not mentioned.
Please refer to policy document for all benefit details.
Pursuant to Notification no 13/2020- Central Tax and Notification no 14/2020- Central Tax both dated 21st March 2020 read with rule 54 (2) of
CGST Rules 2017, the provisions of E Invoicing & QR code are not applicable to an Insurance company, hence E Invoice number and QR code has
not been printed on this document. GST under RCM: NIL

Policy issuing office : Delhi , Consolidated Stamp Duty deposited as per the order of Government of National Capital Territory of Delhi.
GSTI No.: 09AAFCM7916H1Z6 SAC Code / Type of Service : 997133 / General Insurance Services
Niva Bupa State Code: 9 Customer State Code / Customer GSTI No.: 9 /NA
Location: New Delhi Director - Operations & Customer Service

Date: 06/11/2023 For and on behalf of Niva Bupa Health Insurance Company Limited
(formerly known as Max Bupa Health Insurance Co. Ltd.)

Health Companion Premium Receipt
Dear MR. UMESH SINGH VISEN
587-A-103 GANDHINAGAR TELIBAGH
LUCKNOW
UTTAR PRADESH - 226029
We acknowledge the receipt of payment towards the premium of the following health insurance policy:
Policy Holder's Name Mr. Umesh Singh Visen Policy Number 31046638202304
#
Policy Commencement Date 08/11/2023 Policy Expiry Date 07/11/2024
Plan Opted for HC VARIANT2022 FLOATER 5L 2A2C
Net Premium/Taxable Value (INR) 15,538.00
Integrated Goods and Service Tax (18.00 %) (INR) 0.00
Central Goods and Service Tax (9.00 %) (INR) 1,398.42
State/Union Territory Goods and Service Tax (9.00 %) (INR) 1,398.42
Loading (INR) 0.00
Gross Premium (INR) 18,335.00

#
Issuance of policy is subject to clearance of premium paid
Details of persons Insured:

Name of Person Insured Age Gender Relationship with Proposer
Mr. Umesh Singh Visen 40 Male Applicant
Ms. Aparajita Singh 3 Female Daughter
Ms. Aadya Singh 8 Female Daughter
Mrs. Aradhana Singh 35 Female Spouse
Upon issuance of this receipt, all previously issued temporary receipts, if any, related to this policy are considered null and void. For the
purpose of deduction under section 80D of the income Tax Act, 1961, please consult your tax advisor for more details. The benefit shall be as
per the provisions of the Income Tax Act, 1961 and any amendments made thereafter.
In the event of non-realization of premium, Tax benefits cannot be obtained against this premium receipt
GSTI No.: 09AAFCM7916H1Z6 SAC Code / Type of Service : 997133 / General Insurance Services
Niva Bupa State Code: 9 Customer State Code / Customer GSTI No.: 9 /NA
Policy issuing office: Delhi, Consolidated Stamp Duty deposited as per the order of Government of National Capital Territory of Delhi.
Location: New Delhi Director - Operations & Customer Service

Date: 06/11/2023 For and on behalf of Niva Bupa Health Insurance Company Limited
(formerly known as Max Bupa Health Insurance Co. Ltd.)

List of Un-recognized Hospitals
Sr. State City Hospital Address
No.
1 Gujarat Surat Aakanksha Hospital 126, Aaradhnanagar Soc., B/H. Bhulkabhavan
School, Aanand-Mahal Rd., Adajan, Surat
2 Gujarat Surat Abhinav Hospital Harsh Apartment, Nr Jamna Nagar Bus Stop,
God Dod Road Surat
3 Gujarat Surat Adhar Ortho Hospital Dawer Chambers, Nr. Sub Jail, Ring Rd., Surat
4 Gujarat Surat Aris Care Hospital A 223-224, Mansarovar Soc, 60 Feet ,
Godadara Road, Surat
5 Gujarat Surat Arzoo Hospital Opp. L.B. Cinema, Bhatar Rd., Surat
6 Gujarat Surat Auc Hospital B-44 Gujarat Housing Board, Nandeshara
7 Gujarat Surat Dharamjivan General Hospital Karmayogi - 1, Plot No. 20/21, Near Piyush Point,
& Trauma Centre Pandesara
8 Gujarat Surat Dr. Santosh Basotia Hospital Bhatar Road, Surat
9 Gujarat Surat Ghevariya Dental Clinic 202, M K Complex, Variya Compound, Hirabag
Circal
10 Gujarat Surat God Father Hospital 344, Nandvan Soc., B/H. Matrushakti Soc.,
Puna Gam, Surat.
11 Gujarat Surat Govind-Prabha Arogya Opp. Ratna-Sagar Vidhyalaya, Kaji Medan,
Sankool Gopipura, Surat
12 Gujarat Surat Hari Milan Hospital L H Road
13 Gujarat Surat Jaldhi Ano-Rectal Hospital
Tadwadi, Surat
14 Gujarat Surat Jeevan Path Gen. Hospital 2nd. Fl., Dwarkesh Nagri, Nr. Laxmi Farsan,
Sayan, Surat.
15 Gujarat Surat Kalrav Children Hospital Yashkamal Complex, Nr. Jivan Jyot, Udhna
16 Gujarat Surat Kanchan General Surgical Plot No. 380, Ishwarnagar Soc, Bhamroli-Bhatar,
Hospital Pandesara Surat
17 Gujarat Surat Krishnavati General Hospital Bamroli Road
18 Gujarat Kutch Mantra Orthopaedic Hospital Dr. Bhavin N. Patel
Gandhidham(Kutch)
19 Gujarat Surat Niramayam Hosptial & Shraddha Raw House, Near Natures Park
Prasutigruah
20 Gujarat Surat Patna Hospital 25, Ashapuri Soc - 2, Bamroli Road, Surat
21 Gujarat Surat Poshia Children Hospital Harekrishan Shoping Complex 1St Floor, Varachha
Road, Surat
22 Gujarat Surat Prayosha Hospital A-102/103, Shagun Residency, Puna Bombay Mar-
ket Road, Puna, Surat, Gujarat
23 Gujarat Surat R.D Janseva Hospital 120 Feet Bamroli Road, Pandesara, Surat
24 Gujarat Surat Radha Hospital & Maternity 239/240 Bhagunagar Society, Opp Hans Society,
Home L H Road, Varachha Road
25 Gujarat Surat Santosh Hospital L H Road
26 Gujarat Surat Shaurya Hospital Udhna, Surat
27 Gujarat Surat Shikha General Hospital 14 – Umiya Nagar – 1, Navagam Dindoli Road,
- Changed Name To Sai Udhna
Hospital
28 Gujarat Surat Shishumangal Children Surat
Hospital
ProductName:
Product Name: Health
Health Companion
Companion | Product
| Product UIN: NBHHLIP23108V062223
UIN: NBHHLIP23007V052223
No.
29 Gujarat Surat Shree Ramdev General & 248,Shiv Nagar G.I.D.C. Road,Nr:Udhna Citizen
Surgical Hospital Co-Operative Bank,Pandasara
30 Gujarat Surat Shree Sai Hospital & Prasuti 14, Umiya Nagar-1, Navagam Dindoli Road, Udhna
Gruh
31 Gujarat Surat Shreyans Anorectal & Daycare 5Th Floor, Opp. Ayurvedic Collage,
Hospital Station Road, Surat
32 Gujarat Surat Shri Panchratna Hospital & Geetanagar, Near Dindoli Jakat Naka,
Prasutugruah Navagam, Udhna, Surat
33 Gujarat Surat Shubham General Hospital 2nd Floor, Nirmal Complex, Near Maruti Gaushala,
Opp. Bhagwati Rus
34 Gujarat Surat Siddhi Clinic & Nursing Home 33- Nandanvan Apt., Naginawadi, Surat
35 Gujarat Surat Sparsh Multy Specality G.I.D.C Road, Nr Udhana Citizan Co-Op.Bank
Hospital & Trauma Care
Center
36 Gujarat Surat Sree Uday Narayan General 193,Sukhi Nagar, Bamroli Road, Near New Bridge,
Hospital Pandesara, Surat
37 Gujarat Surat Tripathi Chartiable Hospital Geetanagar, Near Dindoli Jakat Naka, Navagam,
Udhna, Surat
38 Gujarat Ahmedabad Umiya Medical & Surgical 2Nd Floor, Centre Plaza, Sattadhar Char Rasta,
Hospital Sola Road
39 Gujarat Surat Varachha General Hospital 17-26, Samarth Park Near Archana School
40 Uttar Kushi Nagar Aastha Multispecialty Hospital Padrauna Road, Kushinagar, Up, Ph :
Pradesh 9598440966/9793196178
41 Maharashtra Thane Ashwini Nursing Home Prashanti, Ground Floor, Agarkar Road,
Dombivli East, Thane
42 Maharashtra Thane Asmita Nursing Home Prashanti, Ground Floor, Agarkar Road,
43 Maharashtra Thane Balaji Nursing Home Prashanti, Ground Floor, Agarkar Road,
44 Haryana Rohtak Channan Devi Memorial Plot No.952, Ward No.23, Lal Chand Colony Chowk,
Hopital Near Durga Mandir, Rohtak
45 Telangana Hyderabad Goodlife Hospitals #1-7-309, Hanuman Nagar, Opp. Jaginis Foodland,
Chaitanyapri X Roads, Dilskhnagar
46 Orissa Dhenkanal Jagannath Clinic & Nursing Durgabazar, Nuahata, Kantabania, Banarpal
Home
47 Uttar Allahabad Jeevan Jyoti Hospital 162, Bai Ka Bagh, Lowther Road, Allahabad, Up
Pradesh
48 Tamilnadu Mayiladuthurai Krishna Hospital No 8 Pattamangala Street Mayiladuthurai
49 Maharashtra Mumbai Mumtaz Nursing Home 3/299/3774, Opp. Choti Masjid, Tagore Nagar,
Near Hariyali Police Chowki, Vikhroli (E),
Mumbai-400083
50 Telangana Kesava Nagar Padmaja Hospital # 17-1- 386/1/18 Kesava Nagar Colony Champapet
Colony Hyderabad
51 Bihar Harnaut Pragya Nurshing Home Harnaut
52 Telangana Jeedimetla Ram Hospitals Shapur Nagar, Ida, Jeedimetla
53 Haryana Gurgaon Ramanarayan Hospital Vill Bass Hariya P.O Bass Lambi Ggn-122503
54 Maharashtra Mumbai Royal Nursing Home Plot No 7, Sector-1, Airoli,, Navi Mumbai-400708
55 Orrissa Cuttak Sabarmati General Hospital Mahanadi Vihar
56 Uttar Meerut Sahara Hospital Ajanta Colony, Garh Road
Pradesh
ProductName:
Health Companion
Companion | Product
No.
57 Maharashtra Mumbai Sb Nursing Home Powai
58 Uttar Meerut Shagun Hospital 24 Tyagi Market Tej Garhi
Pradesh
59 Haryana Gurgaon Shri Balaji Hospital & Trauma Gadoli, Pataudi Road, Gurgaon
Center
60 Telangana Hyderabad Sri Sai Thirumala Hospitals Kishan Kumar Complex, Durga Nagar, Karmanghat
Main Road
61 Madhya Bhopal Venus Hospital And Medical H. No-2,Pipal Square,Karond, Bhopal
Pradesh Research Centre
62 Telangana Vanasthali Vijaya Nursing Home Near Double Road, Vanasthali Puram
Puram
63 Uttar Allahabad Virendra Hospital 7 Stanley Road (Next To Mishra Bhavan)Civil Lines,
Pradesh Allahabad
64 Uttar Meerut Yog Nursing Home Near Tej Garhi, University Road
Pradesh
Note:
1. Claims whether Cashless or reimbursement pertaining to treatments taken at the above mentioned Hospitals shall not
be entertained, processed or paid by Niva Bupa.
2. The above list is only for the purpose of admissibility of claims with respect to any health insurance policies of Niva
Bupa Health Insurance Company Limited.
3. The above list is subject to be updated from time to time. For updated list please visit this site at www.nivabupa.com
or call our customer care at 1860 500 8888
ProductName:
Health Companion
Companion | Product
Customer Information Sheet
Policy Clause
Sl. No Title Description
Number
1 Product Name Health Companion
2 What am I Base Coverage:
covered for • Hospital admission for 2 hours or more. Also cover treatment taken for Dialysis (Hemo / 3.2
Peritoneal), Radiotherapy or Chemotherapy for cancer.
• AYUSH Treatments are also covered if admitted for 24 hours or more in AYUSH Hospital 3.2
• Modern treatments like Robotic surgeries, oral chemotherapy etc. are covered 3.2
• Related medical expenses up to Sum Insured incurred 60 days prior to hospitalization 3.3
• Related medical expenses incurred up to Sum Insured within 180 days from date of discharge 3.3
• Organ donor expenses covered up to Sum Insured 3.4
• Road ambulance covered up to Rs. 2,000 and air ambulance up to Rs. 2,50,000 per
hospitalization 3.1
• No Claim Bonus – For every claim free year, we will add 20% of expiring policy base sum
insured as NCB, maximum up to 100%. 3.5
• Refill – Reinstatement up to base Sum Insured (applicable for both same & different illness) 3.6
• Health Check-up can be availed from day 1 of the policy 3.7
• Vaccination post an animal bite covered up to Rs. 5,000 3.8
• Home Care / Domiciliary Treatment covered up to Sum Insured 3.9
Optional Coverage:
• Hospital Cash – Fixed amount of Rs. 1,000 / 2,000 / 4,000 (depends upon chosen Sum
Insured) per day of hospitalization 3.10
3 What are • Investigation & Evaluation 4
the major • Rest Cure, rehabilitation and respite care
exclusions • Obesity/ Weight Control
in the • Cosmetic or plastic Surgery
policy • Hazardous or Adventure sports
• Breach of law
• Excluded Providers
• Refractive Error
• Unproven Treatments
• Sterility and Infertility
• Maternity Expenses
• Circumcision
• Conflict & Disaster
• External Congenital Anomaly
• Dental/oral treatment
• Any expenses incurred on OPD treatment.
• Unrecognized Physician or Hospital
(Note: the above is a partial listing of the policy exclusions. Please refer to the policy clauses
for the full listing)

4 Waiting period • 30-day Waiting Period: 30 days for all illness (not applicable on renewal or for accidents) 4.1.3
• Specified Disease/Procedure Waiting Periods: 24 months for few conditions as specified
in policy clause number 4.2 4.1.2
• Pre-existing diseases: Covered after 36 months of continuous coverage 4.1.1
• Personal Waiting Periods: Covered after up to 48 months of continuous coverage 4.2.1
5 Payment basis Cashless treatment or Reimbursement of covered expenses up to specified limits. 5.2.4
6 Loss Sharing Annual Aggregate Deductible: Options of Rs 1 Lac, 2 Lac, 3 Lac, 4 Lac, 5 Lac and 10 Lac can 3.11
be availed along with premium discount.
In case of a claim, this policy will cover up to the amount / limits mentioned below:
• Sub-limits
- Modern Treatments – sublimit of Rs. 1Lac per claim applicable on few robotic surgeries 3.2
- Road ambulance is covered up to Rs. 2,000 and air ambulance is covered up to
Rs. 2,50,000 per hospitalization 3.1
- Health Check up limits as per Sum Insured chosen by you and specified in the policy
schedule 3.7
- Vaccination for Animal Bite – up to Rs. 5,000 3.8
7 Renewal The Policy shall ordinarily be renewable except on grounds of fraud, moral hazard, 5.1.3
Conditions misrepresentation by the Insured Person.
• The Company shall endeavor to give notice for renewal. However, the Company is not
bound to give any notice for renewal.
• Renewal shall not be denied on the ground that the Insured had made a claim or claims
in the preceding policy years.
• Request for renewal along with requisite premium shall be received by the Company
before the end of the Policy Period.
• At the end of the Policy Period, the Policy shall terminate and can be renewed within
the Grace Period to maintain continuity of benefits without Break in Policy. Coverage is
not available during the Grace Period.
• If not renewed within Grace Period after due renewal date, the Policy shall terminate.
• No loading shall apply on renewals based on individual claims experience.
8 Renewal No Claim Bonus – For every claim free year, we will add 20% of expiring policy base sum 3.5
Benefits insured as NCB, maximum up to 100%.
9 Cancellation This policy would be cancelled, and no claim or refund would be due to you if: 5.1.2
• you have not correctly disclosed details about current and past health status OR
• you have otherwise encouraged or participated in any fraudulent claim under the policy.
10 Claims For Cashless Service: 5.2.4
• Hospital Network details can be obtained from www.nivabupa.com
For Reimbursement of Claim:

• Provide all claim related documents within 30 days from discharge

11 Policy • In case of any grievance the Insured Person may contact the company through: 6.16
Servicing/ Website: www. nivabupa.com
Grievances/ Customer Services Department
Complaints Niva Bupa Health Insurance Company Limited
D-5, 2nd Floor, Logix Infotech Park
opp. Metro Station, Sector 59, Noida, Uttar Pradesh, 201301
Contact No: 1860-500-8888
Fax No.: +91 11 41743397
Email ID: customercare@nivabupa.com
Senior citizens may write to us at at: seniorcitizensupport@nivabupa.com
lnsured person may also approach the grievance cell at any of the company’s branches
with the details of grievance
• If Insured person is not satisfied with the redressal of grievance through one of the
above methods, Insured Person may contact the grievance officer at:
Grievance Redressal Officer

Niva Bupa Health Insurance Company Limited
Email: GRO@nivabupa.com
For details of grievance officer, kindly refer the link https://www. nivabupa.com/
customer-care/health-services/grievance-redressal.aspx
• IRDAI/(IGMS/Call Centre): Email ID: www.igms.irdai.gov.in

• Ombudsman (Refer Annexure II of policy document for List of Insurance Ombudsmen)
12 Insured’s • Free Look - If you do not agree to the terms and conditions of the Policy, you may cancel 5.1.1
Rights the Policy, stating your reasons within 15 days (thirty days for policies with a term of 3
years, if sold through distance marketing) of receipt of the Policy document provided no
claims have been made under any benefits. The free look provision is not applicable at the
time of Renewal of the Policy.
• Implied renewability - Your policy is ordinarily renewable for life provided the due premium
is paid on time.
• Migration and Portability - You can migrate / port your policy at the time of renewal 5.1.12 &
according to the IRDAI guidelines. You can contact Customer Service Department (phone 5.1.13
no. and email ID provided above) for migration and portability.
• Increase in Sum Insured during the Policy term - You may opt for enhancement of Sum
Insured at the time of Renewal, subject to underwriting. You can contact Customer Service
Department (phone no. and email ID provided above) for increasing the Sum Insured.
• Turn Around Time (TAT) for issue of Pre-Auth – 4 hours
• Turn Around Time (TAT) for settlement of Reimbursement - We shall settle or repudiate a
claim within 30 days of the receipt of the last necessary document.
13 Insured’s • Please disclose all pre-existing disease/s or condition/s before buying a policy. Non-
Obligations disclosure may result in claim not being paid.
• Disclosure of material information at the time of Renewal such as change in address,
geographical location etc.
Legal Disclaimer Note: The information must be read in conjunction with the product brochure and policy document. In case of any
conflict between the CIS and the policy document, the terms and conditions mentioned in the policy document shall prevail.

Benefit Illustration
Benefit Illustration (5 Lac Sum Insured, Policy Term 1 year)

Age Coverage opted Coverage opted on individual basis Coverage opted on family floater basis with
of the on individual basis covering multiple members of the family overall Sum Insured (Only one Sum Insured is
members covering each under a single policy (Sum Insured is available for the entire family)
insured member of the family available for each member of the family)
separately (at a single
point in time)
Premium Sum Premium Discount, Premium Sum Premium or Floater Premium Sum
(Rs.) Insured (Rs.) if any after Insured Consolidat- discount, after Insured
(Rs.) discount (Rs.) ed premi- if any discount (Rs.)
(Rs.) um for all (Rs.)
members of
family (Rs.)
Illustration 1
18 7,365.04 500,000 7,365.04 736.50 6,628.53 500,000 7,365.04
21 7,365.04 500,000 7,365.04 736.50 6,628.53 500,000 7,365.04
14,361.49 20,099.00 500,000
39 9,238.13 500,000 9,238.13 923.81 8,314.31 500,000 9,238.13
45 10,492.29 500,000 10,492.29 1,049.23 9,443.06 500,000 10,492.29
Total premium for all members of Total premium for all members of the Total premium when the policy is opted on floater
the family is Rs.34,460.49, when family is Rs.31,014.44, when they are basis is Rs.20,099.00
each member is covered separately. covered under a single policy.
Sum Insured of Rs.500,000 is available for the
Sum Insured available for each Sum Insured available for each family entire family.
individual is Rs.500,000. member is Rs.5,00,000.
Illustration 2
55 17,414.63 500,000 17,414.63 1,741.46 15,673.17 500,000 17,414.63
4,209.97 43,529.67 500,000
63 30,325.00 500,000 30,325.00 3,032.50 27,292.50 500,000 30,325.00
the family is Rs.47,739.63, when family is Rs.42,965.67, when they are basis is Rs.43,529.67
Sum Insured of Rs.500,000 is available for the
Illustration 3
65 30,325.00 500,000 30,325.00 3,032.50 27,292.50 500,000 30,325.00
13,109.55 56,202.37 500,000
70 38,986.92 500,000 38,986.92 3,898.69 35,088.23 500,000 38,986.92
the family is Rs.69,311.92, when family is Rs.62,380.73, when they are basis is Rs. 56,202.37
Sum Insured of Rs. 500,000 is available for the
Note: Premium rates specified in the above illustration are standard premium rates without considering any loading. Also, the premium
rates are exclusive of taxes applicable.
Zone 1 premium is considered

Registered office:- C-98, First Floor, Lajpat Nagar, Part 1, New Delhi-110024
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. Customer Helpline: 1860-500-8888. Website: www.nivabupa.com.
CIN: U66000DL2008PLC182918. For more details on terms and conditions, exclusions, risk factors, waiting period & benefits,
please read sales brochure carefully before concluding a sale.

HEALTH COMPANION
POLICY DOCUMENT
1. Preamble
This Policy covers Allopathic and AYUSH treatments taken in India ONLY. Expense incurred outside the policy period will NOT
be covered. Unutilized Sum Insured will expire at the end of policy year. All applicable benefits and details are mentioned in
your Policy Schedule.
2. Definitions
2.1. Standard Definitions:
2.1.1 Accident or Accidental means a sudden, unforeseen and involuntary event caused by external, visible and violent
means.
2.1.2. AYUSH Hospital is a healthcare facility wherein medical / surgical / para-surgical treatment procedures and
interventions are carried out by AYUSH Medical Practitioner(s) comprising of any of the following:
a. Central or state government AYUSH Hospital; or
b. Teaching Hospital attached to AYUSH college recognized by the Central Government / Central Council of Indian
Medicine / Central Council of Homeopathy; or
c. AYUSH Hospital, standalone or co-located with in-patient healthcare facility of any recognized system of medicine,
registered with the local authorities, wherever applicable and is under the supervision of a qualified registered
AYUSH Medical Practitioner and must comply with all the following criterion:
i. Having at least five in-patient beds;
ii. Having qualified AYUSH Medical Practitioner in charge round the clock;
iii. Having dedicated AYUSH therapy sections as required and/or has equipped operation theatre where surgical
procedures are to be carried out;
iv. Maintaining daily records of the patients and making them accessible to the insurance company’s authorized
representative.
AYUSH Hospitals referred above shall also obtain either pre-entry level certificate (or higher level of certificate)
issued by National Accreditation Board for Hospitals and Healthcare Providers (NABH) or State Level Certificate (or
higher level of certificate) under National Quality Assurance Standards (NQAS), issued by National Health Systems
Resources Centre (NHSRC).
2.1.3. AYUSH Treatment refers to the medical and / or hospitalization treatments given under Ayurveda, Yoga and
Naturopathy, Unani, Sidha and Homeopathy systems.
2.1.4. Cashless Facility means a facility extended by the insurer to the insured where the payments, of the costs of treatment
undergone by the insured in accordance with the policy terms and conditions, are directly made to the network
provider by the insurer to the extent pre-authorization is approved.
2.1.5. Congenital Anomaly means a condition which is present since birth, and which is abnormal with reference to form,
structure or position.
a. Internal Congenital Anomaly: Congenital Anomaly which is not in the visible and accessible parts of the body.
b. External Congenital Anomaly: Congenital Anomaly which is in the visible and accessible parts of the body.
2.1.6. Cumulative Bonus means any increase or addition in the Sum Insured granted by the insurer without an associated
increase in premium.
2.1.7. Day Care Centre means any institution established for Day Care Treatment of Illness and/or Injuries or a medical set-
up with a Hospital and which has been registered with the local authorities, wherever applicable, and is under the
supervision of a registered and qualified Medical Practitioner AND must comply with all minimum criterion as under:
a. has Qualified Nursing staff under its employment;
b. has qualified Medical Practitioner(s) in charge;
c. has a fully equipped operation theatre of its own where Surgical Procedures are carried out;
d. maintains daily records of patients and will make these accessible to the insurance company’s authorized personnel.
2.1.8. Day Care Treatment refers to medical treatment, and/or Surgical Procedure which is:
a. undertaken under General or Local Anaesthesia in a Hospital/Day Care Centre in less than 24 hrs because of
technological advancement, and
b. which would have otherwise required a Hospitalization of more than 24 hours.
Treatment normally taken on an out patient basis is not included in the scope of this definition.

2.1.9. Deductible means a cost-sharing requirement under a health insurance policy that provides that the Insurer will not
be liable for a specified rupee amount in case of indemnity policies and for a specified number of days/hours in case
of hospital cash policies which will apply before any benefits are payable by the insurer. A deductible does not reduce
the Sum Insured.
2.1.10. Dental Treatment means a treatment related to teeth or structures supporting teeth including examinations, fillings
(where appropriate), crowns, extractions and Surgery.
2.1.11. Domiciliary Hospitalization means medical treatment for an Illness/disease/Injury which in the normal course would
require care and treatment at a Hospital but is actually taken while confined at home under any of the following
circumstances:
a. the condition of the patient is such that he/she is not in a condition to be removed to a Hospital, or
b. the patient takes treatment at home on account of non availability of room in a Hospital.
2.1.12. Emergency care means management for an Illness or Injury which results in symptoms which occur suddenly and
unexpectedly, and requires immediate care by a Medical Practitioner to prevent death or serious long term impairment
of the Insured Person’s health.
2.1.13. Grace Period means the specified period of time immediately following the premium due date during which a payment
can be made to Renew or continue a policy in force without loss of continuity benefits such as Waiting Periods and
coverage of Pre-existing Diseases. Coverage is not available for the period for which no premium is received.
2.1.14. Hospital means any institution established for Inpatient Care and Day Care Treatment of Illness and / or Injuries and
which has been registered as a Hospital with the local authorities under the Clinical Establishments (Registration
and Regulation) Act, 2010 or under the enactments specified under the Schedule of Section 56(1) of the said Act OR
complies with all minimum criteria as under:
a. has Qualified Nursing staff under its employment round the clock;
b. has at least 10 Inpatient beds in towns having a population of less than 10,00,000 and at least 15 Inpatient beds in
all other places;
c. has qualified Medical Practitioner(s) in charge round the clock;
d. has a fully equipped operation theatre of its own where Surgical Procedures are carried out;
e. maintains daily records of patients and makes these accessible to the Insurance company’s authorized personnel.
2.1.15. Hospitalization means admission in a Hospital for a minimum period of 24 consecutive ‘In-patient Care’ hours except
for specified procedures/treatments, where such admission could be for a period of less than 24 consecutive hours.
2.1.16. Illness means a sickness or a disease or pathological condition leading to the impairment of normal physiological
function and requires medical treatment.
a. Acute condition - Acute condition is a disease, illness or injury that is likely to respond quickly to treatment which
aims to return the person to his or her state of health immediately before suffering the disease/ illness/ injury
which leads to full recovery
b. Chronic condition - A chronic condition is defined as a disease, illness, or injury that has one or more of the
following characteristics:
i. it needs ongoing or long-term monitoring through consultations, examinations, check-ups, and /or tests
ii. it needs ongoing or long-term control or relief of symptoms
iii. it requires rehabilitation for the patient or for the patient to be specially trained to cope with it
iv. it continues indefinitely
v. it recurs or is likely to recur
2.1.17. Injury means Accidental physical bodily harm excluding Illness or disease solely and directly caused by external,
violent and visible and evident means which is verified and certified by a Medical Practitioner.
2.1.18. Inpatient Care means treatment for which the Insured Person has to stay in a Hospital for more than 24 hours for a
covered event.
2.1.19. Medical Advice means any consultation or advice from a Medical Practitioner including the issuance of any prescription
or follow-up prescription.
2.1.20. Medical Expenses means those expenses that an Insured Person has necessarily and actually incurred for medical
treatment on account of Illness or Accident on the advice of a Medical Practitioner, as long as these are no more than
would have been payable if the Insured Person had not been insured and no more than other Hospitals or doctors in
the same locality would have charged for the same medical treatment.
2.1.21. Medical Practitioner means a person who holds a valid registration from the Medical Council of any State or Medical
Council of India or Council for Indian Medicine or for Homeopathy set up by the Government of India or a State
Government and is thereby entitled to practice medicine within its jurisdiction; and is acting within the scope and
jurisdiction of his licence.

2.1.22. Medically Necessary Treatment means any treatment, tests, medication, or stay in Hospital or part of a stay in Hospital
which:
i. is required for the medical management of the Illness or Injury suffered by the insured;
ii. must not exceed the level of care necessary to provide safe, adequate and appropriate medical care in scope,
duration, or intensity;
iii. must have been prescribed by a Medical Practitioner;
iv. must conform to the professional standards widely accepted in international medical practice or by the medical
community in India.
2.1.23. Migration means the right accorded to health insurance policyholders (including all members under family cover and
members of group health insurance policy), to transfer the credit gained for pre-existing conditions and time bound
exclusions, with the same insurer.
2.1.24. Network Provider means Hospital enlisted by an insurer, TPA or jointly by an insurer and TPA to provide medical
services to an insured by a Cashless Facility.
2.1.25. Non-Network Provider means any Hospital, Day Care Centre or other provider that is not part of the network.
2.1.26. OPD Treatment means the one in which the Insured visits a clinic / Hospital or associated facility like a consultation
room for diagnosis and treatment based on the advice of a Medical Practitioner. The Insured is not admitted as a day
care or In-patient.
2.1.27. Pre-existing Disease means any condition, ailment, injury or disease
a. That is/are diagnosed by a physician within 48 months prior to the effective date of the policy issued by the
insurer or its reinstatement or
b. For which medical advice or treatment was recommended by, or received from, a physician within 48 months prior
to the effective date of the policy issued by the insurer or its reinstatement.
2.1.28. Pre-hospitalization Medical Expenses means medical expenses incurred during pre-defined number of days
preceding the hospitalization of the Insured Person, provided that:
a. Such Medical Expenses are incurred for the same condition for which the Insured Person’s Hospitalization was
required, and
b. The Inpatient Hospitalization claim for such Hospitalization is admissible by the Insurance Company.
2.1.29. Post-hospitalization Medical Expenses means medical expenses incurred during pre-defined number of days
immediately after the Insured Person is discharged from the Hospital, provided that:
a. Such Medical Expenses are for the same condition for which the Insured Person’s Hospitalization was
required, and
b. The Inpatient Hospitalization claim for such Hospitalization is admissible by the Insurance Company.
2.1.30. Portability means the right accorded to an individual health insurance policyholders (including all members under
family cover), to transfer the credit gained for pre-existing conditions and time bound exclusions, from one insurer to
another insurer.
2.1.31. Reasonable and Customary Charges means the charges for services or supplies, which are the standard charges
for the specific provider and consistent with the prevailing charges in the geographical area for identical or similar
services, taking into account the nature of the Illness / Injury involved.
2.1.32. Renewal means the terms on which the contract of insurance can be renewed on mutual consent with a provision
of Grace Period for treating the renewal continuous for the purpose of gaining credit for pre-existing diseases, time
bound exclusions and for all Waiting Periods.
2.1.33. Room Rent means the amount charged by a Hospital towards Room and Boarding expenses and shall include the
associated medical expenses.
2.1.34. Surgery or Surgical Procedure means manual and / or operative procedure (s) required for treatment of an Illness or
Injury, correction of deformities and defects, diagnosis and cure of diseases, relief from suffering or prolongation of
life, performed in a Hospital or Day Care Centre by a Medical Practitioner.
2.2. Specific Definitions

2.2.1. Base Sum Insured means the coverage amount for which the premium is computed and charged for this policy.
2.2.2. Insured Person is the one for whom the company has received full premium (including additional premium if any),
completed the risk assessment and issued the policy. The names of the Insured persons covered in the policy are
specified in the policy document, who are also referred as You/Your/Policyholder in this policy.
2.2.3. Policy Year means the period of one year from the date of commencement of the policy.

3. Benefits covered under the policy
No treatments or benefits other than outlines in the following section are covered under this product.
DESCRIPTION (What we pay and what we DON’T)

3.1. Expenses to reach hospital (Ambulance)
By road, maximum Rs. 2,000 & by air maximum Rs. 2,50,000 per hospitalization. Applies ONLY when Hospital
admission claim is paid.
IMPORTANT: You MUST use a registered ambulance / air ambulance provider. Air ambulance is available only for
Emergency care.
3.2. Expenses during hospitalization (Hospital admission)

a. We will pay the expenses incurred by you on treatment (Naturally this excludes expenses not linked to treatment
like food, beverage, toiletries and cosmetics) if you were:
• Admitted for 2 hours or more
NOTE: minimum 24 hours admission in AYUSH Hospital MUST for AYUSH treatment
• You had Dialysis (Hemo / Peritoneal), Radiotherapy or Chemotherapy for cancer
NOTE: Admission in a hospital happens in what is called wards or rooms of various categories, ICUs, CCUs, NICU
etc or in Day care.
IMPORTANT:
i. We will NOT pay, even if you were admitted, if there was no treatment and only investigations were done.
Example: Admission only for investigations like MRI, CT Scan, Endoscopy, Colonoscopy etc.
ii. We will NOT pay for Automation machine for peritoneal dialysis
iii. We will pay for Invasive Angiography even though it is an investigation. But we will not pay for non-invasive
angiography like CT angiogram
b. We pay for Modern treatments as specified below
1. Uterine Artery 3. Vaporisation of the 4. Stem cell therapy:

2. Immunotherapy-
Embolization and HIFU prostrate (Green laser Hematopoietic stem cells for
Monoclonal Antibody to
(High intensity focused treatment or holmium bone marrow transplant for
be given as injection
ultrasound) laser treatment) haematological conditions
5. Balloon Sinuplasty 6. Oral Chemotherapy 7. Robotic surgeries 8. Stereotactic radio Surgeries
11. Bronchical
12. IONM - (Intra Operative Neuro
9. Deep Brain stimulation 10. Intra vitreal injections Thermoplasty
Monitoring)
NOTE: A limit of maximum Rs. 1,00,000 per claim will apply to all robotic surgeries, except for total radical
prostatectomy, cardiac surgeries, partial nephrectomy and surgeries for malignancies.
3.3. Expenses before and after hospitalization (Pre & Post hospitalization)
We will pay expenses incurred on consultations, medicines, physiotherapy, diagnostic tests 60 days before date of
admission and 180 days after date of discharge IF these are related to the condition for which hospital admission
claim is paid.
3.4. Organ donor
If you ever undergo an organ transplant, we will pay the hospitalization expenses of the donor for harvesting the
organ ONLY when your Hospital admission claim is paid.
If you donate any of your organs, we will pay for the expenses for harvesting the organ from you. We respect this
noble deed. Remember, organ donation saves many lives.
3.5. No Claim Bonus(NCB)
For every claim free year, we will add 20% of expiring policy base sum insured as NCB, maximum up to 100%.
NOTE:
IMPORTANT: Below points apply for changes made within the same product. Change in product is called Migration
in which you CAN NOT carry NCB.
a. NCB applies the same way as the policy sum insured type. If policy is floater, NCB is floater & if policy is individual
sum insured, NCB too is individual basis.

b. Individual NCB can be carried to any policy with individual sum insured as long as sum insured is NOT reduced.
c. If two or more policies merge into a floater policy, the lowest of the NCB among all policies will be carried to the
new merged floater policy.
d. In case You change individual sum insured policy to Floater, the lowest of the NCB of members in previous policy
will be carried to floater policy.
e. If Floater policy is converted to individual sum insured policy, NCB of previous policy will be given to each of
previously insured member on individual basis as long as sum insured is NOT reduced.
f. If any one reduces base sum insured, same percentage of NCB will be given as was the previous NCB of the
previous base sum insured.
Example:
Base Sum Accumulated Revised Base Revised

Insured NCB Sum Insured Accumulated NCB
10 Lac Base Sum

(after 5 claim Insured is
10 Lac 5 Lac 5 Lac
free years) reduced to 5
Lac
g. The sub-limits applicable to any benefit will remain the same and shall NOT increase with NCB.
3.6. Refill
We will add an amount equal to the base sum insured, after the first claim is paid. This will be added even at partial
utilization of base sum insured.
NOTE:
a. Benefit applies ONLY once in a policy year.
b. Benefit applies for any illness (same or different).
Illustration:
Balance 2nd Claim Balance Balance 3rd Claim
Base Sum 1st paid Refill
Base Sum payable amount Base Sum Refill Payable amount
Insured Claim Benefit
Insured claim paid Insured Benefit claim paid
12 Lac
(3 Lac
Refill 1 Lac
from base
10 Lac 7 Lac benefit is 3 Lac 10 Lac 12 Lac Nil 1 Lac 3 Lac from
SI and 9
triggered Refill
Lac from
Refill)
3.7. Health Checkup

Available once every Policy Year, from day 1 of the policy. You can choose any test(s) from the list specified below
up to your eligibility limit. The tests MUST be booked through our digital assets (e.g. Mobile App). This benefit is
available ONLY on cashless and no re-imbursement is allowed
List of tests covered:
Complete blood count Complete Physical Examination by Physician Serum Electrolytes
Urine Routine Post prandial/lunch blood sugar (PPBS / PLBS) HbA1C
Erythrocyte Sedimentation Rate (ESR) Uric Acid Thyroid profile (TSH)
Fasting Blood Glucose Lipid Profile Liver Function Test (LFT)
Electrocardiogram Kidney function test Treadmill test (TMT)
S Cholesterol Serum Vitamin D Ultrasound test
Note:
If you undergo multiple tests, make sure that all these are done within 7 days

3.8. Vaccination for Animal Bite
Vaccination required post an animal bite is covered up to Rs. 5,000.
3.9. Home Care / Domiciliary Treatment

Home Care Treatment means treatment availed by the insured person at home which in normal course would require
care and treatment at a hospital but is actually taken at home provided that:
a. The medical practitioner advices the insured person to undergo treatment at home
b. There is continuous active line of treatment with monitoring of health status by a medical practitioner for each day
through the duration of the home care treatment
c. Daily monitoring chart including records of treatment administered duly signed by the treating doctor is maintained
Note: We will pay for Pre & Post hospitalization benefit as per section 3.3 for Home Care / Domiciliary Treatment.
Optional Benefit:
3.10. Hospital Cash
We will pay a fixed amount as specified in your Policy Schedule for each day (continuous period of 24 hours) of
Hospitalization, maximum up to 30 days for an insured person.
Note: Benefit applies ONLY when admitted in a Hospital for 48 hours or more continuously and such claim is
paid by us.
Claim cost sharing option:

3.11. Annual Aggregate Deductible
This is an aggregate amount in a year that is incurred by you on Hospital admission, which we will NOT pay. Once the
total expense exceeds this amount, balance we will pay.
Note:
a. Deductible amount borne by you should also be payable as per policy terms and conditions.
b. Deductible will NOT apply to Health Check-up, Vaccination for Animal Bite and Hospital Cash benefits.
4. Exclusions
4.1. Standard Exclusions
4.1.1. Pre-existing Diseases (Code–Excl01):
a. Expenses related to the treatment of a Pre-existing Disease (PED) and its direct complications shall be excluded
until the expiry of 36 months of continuous coverage after the date of inception of the first Policy with Us.
b. In case of enhancement of Sum Insured the exclusion shall apply afresh to the extent of Sum Insured increase.
c. If the Insured Person is continuously covered without any break as defined under the portability norms of the
extant IRDAI (Health Insurance) Regulations, then waiting period for the same would be reduced to the extent of
prior coverage.
d. Coverage under the Policy after the expiry of 36 months for any Pre-existing Disease is subject to the same being
declared at the time of application and accepted by Us.
4.1.2. Specified disease/procedure waiting period (Code- Excl02)

a. Expenses related to the treatment of the listed conditions, surgeries/treatments shall be excluded until the expiry
of 24 months of continuous coverage after the date of inception of the first Policy with us. This exclusion shall not
be applicable for claims arising due to an Accident (covered from day 1) or Cancer (covered after 30-day waiting
period).
b. In case of enhancement of Sum Insured the exclusion shall apply afresh to the extent of Sum Insured increase.
c. If any of the specified disease/procedure falls under the waiting period specified for pre-Existing diseases, then
the longer of the two waiting periods shall apply.
d. The waiting period for listed conditions shall apply even if contracted after the Policy or declared and accepted
without a specific exclusion.
e. If the Insured Person is continuously covered without any break as defined under the applicable norms on
portability stipulated by IRDAI then waiting period for the same would be reduced to the extent of prior coverage.

f. List of specific diseases/procedures:
i. Pancreatitis and stones in biliary and urinary system
ii. Cataract, glaucoma and retinal detachment
iii. Hyperplasia of prostate, hydrocele and spermatocele
iv. Prolapse uterus and cervix, endometriosis, Fibroids, PCOD, hysterectomy (unless necessitated by Malignancy)
v. Hemorrhoids, fissure or fistula or abscess of anal and rectal region
vi. Hernia of all sites,
vii. Osteoarthritis, joint replacement, osteoporosis, systemic connective tissue disorders, inflammatory polyarthropathies,
Rheumatoid Arthritis, gout, intervertebral disc disorders, arthroscopic surgeries for ligament repair
viii. Varicose veins of lower extremities
ix. All internal or external benign or neoplasms/ tumours, cyst, sinus, polyp, nodules, mass or lump
x. Ulcer, erosion and varices of gastro intestinal tract
xi. Surgical treatment for diseases of middle ear and mastoid (including otitis media, cholesteatoma, perforation of
tympanic membrane), Tonsils and adenoids, nasal septum and nasal sinuses
4.1.3. 30-day waiting period (Code- Excl03):

a. Expenses related to the treatment of any Illness within 30 days from the first Policy commencement date shall
be excluded except claims arising due to an Accident, provided the same are covered.
b. This exclusion shall not, however, apply if the Insured Person has continuous coverage for more than twelve
months
c. The within referred waiting period is made applicable to the enhanced Sum Insured in the event of granting
higher Sum Insured subsequently.
4.1.4. Investigation & Evaluation(Code-Excl04)

a. Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded.
b. Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment are
excluded.
4.1.5. Rest Cure, rehabilitation and respite care(Code-Excl05)

Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. This also includes:
a. Custodial care either at home or in a nursing facility for personal care such as help with activities of daily living
such as bathing, dressing, moving around either by skilled nurses or assistant or non-skilled persons.
b. Any services for people who are terminally ill to address physical, social, emotional and spiritual needs.
4.1.6. Obesity/ Weight Control(Code-Excl06)

Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions:
a. Surgery to be conducted is upon the advice of the Doctor.
b. The surgery/Procedure conducted should be supported by clinical protocols.
c. The member has to be 18 years of age or older and;
d. Body Mass Index (BMI);
i. greater than or equal to 40 or
ii. greater than or equal to 35 in conjunction with any of the following severe co-morbidities following failure of
less invasive methods of weight loss:
1. Obesity-related cardiomyopathy
2. Coronary heart disease
3. Severe Sleep Apnea
4. Uncontrolled Type2 Diabetes
4.1.7. Cosmetic or plastic Surgery (Code-Excl08)

Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following
an Accident, Burn(s) or Cancer or as part of medically necessary treatment to remove a direct and immediate
health risk to the insured. For this to be considered a medical necessity, it must be certified by the attending
Medical Practitioner.
4.1.8. Hazardous or Adventure sports (Code-Excl09)

Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure
sports, including but not limited to, para-jumping, rock climbing, mountaineering, rafting, motor racing, horse racing
or scuba diving, hand gliding, sky diving, deep-sea diving.

4.1.9. Breach of law (Code-Excl10)
Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to
commit a breach of law with criminal intent.
4.1.10. Excluded Providers (Code-Excl11)

Expenses incurred towards treatment in any Hospital or by any Medical Practitioner or any other provider specifically
excluded by Us and disclosed in Our website / notified to the Policyholders are not admissible. However, in case of
life threatening situations or following an Accident, expenses up to the stage of stabilization are payable but not the
complete claim.
The complete list of excluded providers can be referred to on our website.
4.1.11. Treatment for, alcoholism, drug or substance abuse or any addictive condition and consequences thereof.
(Code-Excl12)
4.1.12. Treatments received in heath hydros, nature cure clinics, spas or similar establishments or private beds registered as a
nursing home attached to such establishments or where admission is arranged wholly or partly for domestic reasons.
(Code-Excl13)
4.1.13. Refractive Error (Code-Excl15)

Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres.
4.1.14. Unproven Treatments(Code-Excl16)

Expenses related to any unproven treatment, services and supplies for or in connection with any treatment. Unproven
treatments are treatments, procedures or supplies that lack significant medical documentation to support their
effectiveness.
4.1.15. Sterility and Infertility (Code-Excl17)

Expenses related to sterility and infertility. This includes:
a. Any type of contraception, sterilization
b. Assisted Reproduction services including artificial insemination and advanced reproductive technologies such as
IVF, ZIFT, GIFT, ICSI
c. Gestational Surrogacy
d. Reversal of sterilization
4.1.16. Maternity Expenses (Code-Excl18)

a. Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections
incurred during Hospitalization) except ectopic pregnancy;
b. Expenses towards miscarriage (unless due to an Accident) and lawful medical termination of pregnancy during
the Policy Period.
4.2. Specific Exclusions

4.2.1. Personal Waiting Period
Conditions specified for an Insured Person under Personal Waiting Period in the Policy Schedule will be subject to a
Waiting Period of upto48 months from the inception of the First Policy with Us.
4.2.2. Circumcision:
Circumcision unless necessary for the treatment of a disease or necessitated by an Accident.
4.2.3. Conflict & Disaster:

Treatment for any Injury or Illness resulting directly or indirectly from nuclear, radiological emissions, war or war
like situations (whether war is declared or not), rebellion (act of armed resistance to an established government or
leader), acts of terrorism.

4.2.4. External Congenital Anomaly:
Screening, counseling or treatment related to external Congenital Anomaly.
4.2.5. Dental/oral treatment:

Treatment, procedures and preventive, diagnostic, restorative, cosmetic services related to disease, disorder and
conditions related to natural teeth and gingiva except if required by an Insured Person while Hospitalized due to an
Accident.
4.2.6. Medical & ambulatory devices used at home like BP monitors, Sugar monitors, automation device for peritoneal
dialysis, CPAP, BiPAP, Crutches, wheel chair etc.
4.2.7. Any expenses incurred on OPD treatment.
4.2.8. Unrecognized Physician or Hospital:

a. Treatment or Medical Advice provided by a Medical Practitioner not recognized by the Medical Council of India or
by Central Council of Indian Medicine or by Central council of Homeopathy.
b. Treatment provided by anyone with the same residence as an Insured Person or who is a member of the Insured
Person’s immediate family or relatives.
c. Treatment provided by Hospital or health facility that is not recognized by the relevant authorities in India.
4.2.9. Treatment related to intentional self inflicted Injury or attempted suicide by any means.
4.2.10. Costs which are not Reasonable and Customary and treatments which are not Medically Necessary. Refer Definition
2.1.31 for Reasonable and Customary Charges.
4.2.11. Artificial life maintenance for the Insured Person who has been declared brain dead or in vegetative state
5. General Terms and Clauses
5.1. Standard General Terms and Clauses What it means?

5.1.1. Free Look Period
The Free Look Period shall be applicable on new individual health insurance policies and Free look is a 15 / 30 days
not on renewals or at the time of porting/migrating the policy. period during which you can
The insured person shall be allowed free look period of fifteen days (thirty days for policies return back your policy, if
with a term of 3 years, if sold through distance marketing) from date of receipt of the policy you don’t like what you have
document to review the terms and conditions of the policy, and to return the same if not purchased.
acceptable.
lf the insured has not made any claim during the Free Look Period, the insured shall be
entitled to:
i. a refund of the premium paid less any expenses incurred by the Company on medical
examination of the insured person.
5.1.2. Cancellation
i. The policyholder may cancel this policy by giving 15 days’ written notice and in such an
event, the Company shall refund premium for the unexpired policy period as detailed
below.
Notwithstanding anything contained herein or otherwise, no refunds of premium shall be

made in respect of Cancellation where, any claim has been admitted or has been lodged or
any benefit has been availed by the insured person under the policy.

1 year 2 years 3 years
You can cancel your policy
Policy Refund Policy Refund Policy Refund whenever you wish.
in-force up to Premium (%) in-force up to Premium (%) in-force up to Premium (%)
NOTE: We will NOT refund
Up to 30 days 75% Up to 30 days 87.5% Up to 30 days 90%
any premium if we have paid
31 to 90 days 50% 31 to 90 days 75% 31 to 90 days 87.5% a claim.
91 to 180 days 25% 91 to 180 days 62.5% 91 to 180 days 75%
We will refund part of the
exceeding 180 days 0% 181 to 365 days 50% 181 to 365 days 60% premium depending on how
many days your policy has
366 to 455 days 25% 366 to 455 days 50%
been running for, if there is no
456 to 545 days 12% 456 to 545 days 25% claim.
Exceeding 545 days 0% 545 to 720 days 12%
Exceeding 720 days 0%
The above grid shall be applicable for ‘Yearly / Annual’ premium payment frequency. For Half
Yearly or Quarterly premium payment frequencies, the Company shall refund premium as per
below grid:
Refund %
No. of completed months at the time of cancellation
Half Yearly Quarterly
0 62.5% 50%
1 33.3% 16.7%
2 25% 0%
3 8.3% 50%
4 4.2% 16.7%
5 0% 0%
6 62.5% 50%
7 33.3% 16.7%
8 25% 0%
9 8.3% 50%
10 4.2% 16.7%
11 0% 0%
For monthly premium payment frequency, no refund shall be applicable for cancellation of the
Policy.
ii. The Company may cancel the policy at any time on grounds of misrepresentation non-
disclosure of material facts, fraud by the insured person by giving 15 days’ written notice.
There would be no refund of premium on cancellation on grounds of misrepresentation,
non-disclosure of material facts or fraud.
In case of death of an Insured, pro-rate refund of the premium for the deceased insured will be
refunded, provided there is no history of claim.
5.1.3. Renewal of Policy

The policy shall ordinarily be renewable except on grounds of fraud, misrepresentation by the
If we ever cancel your policy,
insured person.
it will be for Fraud or Non
i. The Company shall endeavor to give notice for renewal. However, the Company is not
disclosure only. Insurance
under obligation to give any notice for renewal.
contract is a legal contract
ii. Renewal shall not be denied on the ground that the insured person had made a claim or
too and it’s based on trust.
claims in the preceding policy years.
iii. Request for renewal along with requisite premium shall be received by the Company
before the end of the policy period.

iv. At the end of the policy period, the policy shall terminate and can be renewed within the
Grace Period of 30 days (15 days in case of other than single premium policies) to maintain
continuity of benefits without break in policy. Coverage is not available during the grace
period.
v. No loading shall apply on renewals based on individual claims experience.
5.1.4. Possibility of Revision of Terms of the Policy Including the Premium Rates
The Company, with prior approval of IRDAI, may revise or modify the terms of the Policy
including the premium rates. The Insured Person shall be notified three months before the
changes are effected.
5.1.5. Nomination
The policyholder is required at the inception of the policy to make a nomination for the purpose
of payment of claims under the policy in the event of death of the policyholder. Any change of
nomination shall be communicated to the company in writing and such change shall be effective
only when an endorsement on the policy is made. ln the event of death of the policyholder,
the Company will pay the nominee {as named in the Policy Schedule/Policy Certificate/
Endorsement (if any)} and in case there is no subsisting nominee, to the legal heirs or legal
representatives of the policyholder whose discharge shall be treated as full and final discharge
of its liability under the policy.
5.1.6. Fraud
lf any claim made by the insured person, is in any respect fraudulent, or if any false statement, Fraud is an action by you or
or declaration is made or used in support thereof, or if any fraudulent means or devices are used anyone acting on your behalf
by the insured person or anyone acting on his/her behalf to obtain any benefit under this policy, where you receive benefits,
all benefits under this policy and the premium paid shall be forfeited. financial or otherwise, for
which you are either not
Any amount already paid against claims made under this policy but which are found fraudulent eligible at all or not to the
later shall be repaid by all recipient(s)/policyholder(s), who has made that particular claim, who extent under the policy.
shall be jointly and severally liable for such repayment to the insurer.
Pay your renewal premium
For the purpose of this clause, the expression “fraud” means any of the following acts committed before end of policy period
by the insured person or by his agent or the hospital/doctor/any other party acting on behalf to maintain continuity of
of the insured person, with intent to deceive the insurer or to induce the insurer to issue an benefits. A grace period is
insurance policy: a) the suggestion, as a fact of that which is not true and which the insured also available to pay the
person does not believe to be true; b) the active concealment of a fact by the insured person premium after policy expiry.
having knowledge or belief of the fact; c) any other act fitted to deceive; and d) any such act or
omission as the law specially declares to be fraudulent NOTE: You are NOT insured
during the grace period.
The Company shall not repudiate the claim and / or forfeit the policy benefits on the ground
of Fraud, if the insured person / beneficiary can prove that the misstatement was true to the
best of his knowledge and there was no deliberate intention to suppress the fact or that such
misstatement of or suppression of material fact are within the knowledge of the insurer.
5.1.7. Withdrawal of Policy

i. ln the likelihood of this product being withdrawn in future, the Company will intimate the We will cancel your policy,
insured person about the same 90 days prior to expiry of the policy. will not pay any claim, will
ii. lnsured Person will have the option to migrate to similar health insurance product available not refund any premium paid
with the Company at the time of renewal with all the accrued continuity benefits such as and have right to take all
cumulative bonus, waiver of waiting period as per IRDAI guidelines, provided the policy has possible legal action against
been maintained without a break. you including for recovery of
benefits paid earlier, if
5.1.8. Redressal of Grievance: • You withheld any
ln case of any grievance the insured person may contact the company through: information from us,
Website: www.nivabupa.com whole or part that would
Toll free: 1860-500-8888 have invited any decision
E-mail: customercare@nivabupa.com (Senior citizens may write to us at: other than a ‘standard
seniorcitizensupport@nivabupa.com) acceptance’ of your
Fax : +91 11 41743397 application for insurance.
Courier: Customer Services Department

Niva Bupa Health Insurance Company Limited Note: Non standard
D-5, 2nd Floor, Logix Infotech Park decisions are:
opp. Metro Station, Sector 59, Noida, Uttar Pradesh, 201301 • Loading – We ask for
additional premium
lnsured person may also approach the grievance cell at any of the company’s branches with the • Exclusions – We apply a
details of grievance. If lnsured person is not satisfied with the redressal of grievance through additional waiting period
one of the above methods, insured person may contact the grievance officer at: for health conditions or
treatments
Head – Customer Services
• Rejection – We hate to do
this. But sometimes are
compelled to say no to a
customer
Contact No: 1860-500-8888
Fax No.: +91 11 41743397
IMPORTANT: We
Email ID: customercare@nivabupa.com
understand you may not
For updated details of grievance officer, kindly refer the link https://www.nivabupa.com/ know how important is
customer-care/health-services/grievance-redressal.aspx the information on your
health and it’s impact on
If the Insured person is not satisfied with the above, they can escalate to GRO@nivabupa.com. your policy. Hence it’s very
important that you disclose
lf lnsured person is not satisfied with the redressal of grievance through above methods, the all health information
insured person may also approach the office of lnsurance Ombudsman of the respective area/ and we would decide
region for redressal of grievance as per lnsurance Ombudsman Rules 2017 (at the addresses how important (we call it
given in Annexure II). ‘material’) it is.
• Cause fraud of any kind
Grievance may also be lodged at IRDAI lntegrated Grievance Management System -
https://igms. irda.qov. in/
5.1.9. Claim settlement (Provision for Penal interest)

I. The Company shall settle or reject a claim, as the case may be, within 30 days from the
date of receipt of last necessary document.
II. ln the case of delay in the payment of a claim, the Company shall be liable to pay interest
to the policyholder from the date of receipt of last necessary document to the date of
payment of claim at a rate 2% above the bank rate.
III. However, where the circumstances of a claim warrant an investigation in the opinion of
the Company, it shall initiate and complete such investigation at the earliest, in any case
not later than 30 days from the date of receipt of last necessary document- ln such cases,
the Company shall settle or reject the claim within 45 days from the date of receipt of last
necessary document.
IV. ln case of delay beyond stipulated 45 days, the Company shall be liable to
pay interest to the policyholder at a rate 2% above the bank rate from the
date of receipt of last necessary document to the date of payment of claim.
(Explanation: “Bank rate” shall mean the rate fixed by the Reserve Bank of lndia (RBl) at
the beginning of the financial year in which claim has fallen due)
5.1.10. Moratorium Period

After completion of eight continuous years under the Policy no look back to be applied. This
period of eight years is called as moratorium period. The moratorium would be applicable
for the sums insured of the first Policy and subsequently completion of 8 continuous years
would be applicable from date of enhancement of sums insured only on the enhanced limits.
After the expiry of Moratorium Period no health insurance claim shall be contestable except
for proven fraud and permanent exclusions specified in the Policy contract. The policies
would however be subject to all limits, sub limits, co-payments, deductibles as per the Policy
contract.
5.1.11. Multiple Policies

I. ln case of multiple policies taken by an insured person during a period from one or more We will provide our decision
insurers to indemnify treatment costs, the insured person shall have the right to require a on claim within 30 days
settlement of his/her claim in terms of any of his/her policies. ln all such cases the insurer (45 days for investigated
chosen by the insured person shall be obliged to settle the claim as long as the claim is cases) from submission of all
within the limits of and according to the terms of the chosen policy. necessary claim documents.

II. lnsured person having multiple policies shall also have the right to prefer claims under this For any delay in payment of
policy for the amounts disallowed under any other policy / policies even if the sum insured claim, we will pay interest on
is not exhausted. Then the insurer shall independently settle the claim subject to the terms the claim amount at a rate
and conditions of this policy. 2% above bank rate.
III. lf the amount to be claimed exceeds the sum insured under a single policy, the insured
person shall have the right to choose insurer from whom he/she wants to claim the
balance amount.
IV. Where an insured person has policies from more than one insurer to cover the same risk
on indemnity basis, the insured person shall only be indemnified the treatment costs in
accordance with the terms and conditions of the chosen policy.
5.1.12. Migration
The Insured Person will have the option to migrate the Policy to other health insurance products After 8 years, no health
/ plans offered by the Company policy by applying for migration of the policy at least 30 days insurance claim shall be
before the policy renewal date as per IRDAI guidelines on Migration. If such person is presently contestable except for
covered and has been continuously covered without any lapses under any health insurance proven fraud and permanent
product / plan offered by the Company, the insured person will get the accrued continuity exclusions.
benefits in waiting periods as per IRDAI guidelines on migration.
For Detailed Guidelines on migration, kindly refer the link https://www.irdai.gov.in/ADMINCMS/

cms/whatsNew_Layout.aspx?page=PageNo3987&flag=1
This link will be updated as per latest.
5.1.13. Portability
The Insured Person will have the option to port the Policy to other insurers by applying to such In case you have multiple
insurer to port the entire Policy along with all the members of the family, if any, at least 45 policies, you can choose the
days before, but not earlier than 60 days from the policy renewal date as per IRDAI guidelines policy from which you want
related to portability. If such person is presently covered and has been continuously covered to claim first.
without any lapses under any health insurance policy with an Indian General / Health insurer,
the proposed insured person will get the accrued continuity benefits in waiting periods as per If claim amount exceeds the
IRDAI guidelines on portability. Sum Insured of first policy
For Detailed Guidelines on portability, kindly refer the link https://www.irdai.gov.in/ADMINCMS/ you claim from; then you can
cms/whatsNew_Layout.aspx?page=PageNo3987&flag=1 claim the balance amount
from the second policy.
5.1.14. Disclosure of Information
The Policy shall be void and all premium paid thereon shall be forfeited to the Company in
the event of misrepresentation, mis-description or non-disclosure of any material fact by the
policyholder.
(Explanation: “Material facts” for the purpose of this policy shall mean all relevant information You can shift your policy to
sought by the company in the proposal form and other connected documents to enable it to any other health insurance
take informed decision in the context of underwriting the risk) product / plan offered by us
as per migration guidelines.
5.1.15. Condition Precedent to Admission of Liability
The terms and conditions of the policy must be fulfilled by the insured person for the Company
to make any payment for claim(s) arising under the policy.
5.1.16. Complete Discharge

Any payment to the policyholder, insured person or his/ her nominees or his/ her legal You can also shift your
representative or assignee or to the Hospital, as the case may be, for any benefit under the policy to any other insurer as
policy shall be a valid discharge towards payment of claim by the Company to the extent of per portability guidelines.
that amount for the particular claim.
5.1.17. Premium Payment in Installments

lf the insured person has opted for Payment of Premium on an installment basis i.e. Half Yearly,
Quarterly or Monthly, as mentioned in the policy Schedule/Certificate of insurance, the following
Conditions shall apply (notwithstanding any terms contrary elsewhere in the policy)
i. Grace Period of 30 days in case of single premium policies, and a period of 15 days in case
of other than single premium policies, would be given to pay the installment premium due
for the policy.

ii. During such grace period, coverage will not be available from the due date of installment premium till the date of receipt of
premium by Company.
iii. The insured person will get the accrued continuity benefit in respect of the “Waiting Periods”, “Specific Waiting Periods” in
the event of payment of premium within the stipulated grace Period.
iv. No interest will be charged lf the installment premium is not paid on due date
v. ln case of installment premium due not received within the grace period, the policy will get canceled.
vi. ln the event of a claim, all subsequent premium installments shall immediately become due and payable.
5.2. Specific Terms and Clauses

5.2.1. Automatic Cancellation:
The Policy shall automatically terminate in the event of death of the all Insured Person(s). A refund in accordance with the table in
Section 5.1.2 shall be payable provided that no claim has been admitted or lodged or not benefit has been availed by the insured
person under the policy.
5.2.2. Additional premium (Risk Loading)

i. We may ask for additional premium after due risk evaluation (it’s what referred to as Underwriting) based on all information
provided by you. We will issue policy to you only after you pay us the additional premium and provide us consent.
ii. We will never ask for more than 100% for any particular health condition and never more than 150% for any individual.
iii. Once applied, Risk loading continues even for all renewals
5.2.3. Other Renewal Conditions:

a. Renewal Premium:
Renewal premium will alter based on Age. For Family Floater policies, the age of eldest insured person will be considered for
calculating the premium.
b. Addition of Insured Persons on Renewal:
If a new member is added in the Policy, either by way of endorsement or at the time of Renewal, the Pre-existing Disease
clause, exclusions, loading (if any) and Waiting Periods will be applicable afresh for that member.
c. Changes to Sum Insured on Renewal:
You may opt for enhancement of Sum Insured at the time of Renewal, subject to underwriting. All Waiting Periods as defined
in the Policy shall apply afresh for this enhanced limit from the effective date of such enhancement.
d. Split of policy for child:
Child under a family floater policy will get a separate policy at renewal after attaining age 26 years.
5.2.4. Claims
a. Cashless claim facility is available at our network hospitals ONLY. As list of network hospitals is dynamic, for the latest list,
refer to our website www.nivabupa.com.
b. Documents required with claim form:
Hospital / Medical records:
• Original Discharge summary with first and subsequent consultation papers.
• Original Final Hospital bill with detailed break-up and payment receipt (including pharmacy bills).
• Laboratory investigation reports with supporting prescriptions.
• MLC/First Information Report (FIR) (in accident cases).
Policyholder documents (Nominee in case of death of Policyholder):
• KYC documents
• Cancelled cheque
IMPORTANT:
• All documents MUST be submitted within 30 days from discharge.
• For any delay in submission, You MUST provide the reasons in writing. We will condone such delay on merits (i.e. reasons
beyond your control).
• You MUST submit all claim related documents for expenses within the Deductible amount (if applicable).
• We reserve the right to check and investigate the hospital / medical records from any doctor, Hospital, clinic, individual
or institution.
c. The expenses that are not covered or subsumed into room charges / procedure charges / costs of treatment are placed as
Annexure I.
d. If you opt for a Hospital room which is higher than the eligible room category as specified in your Policy Schedule,
then We will pay only a pro-rated portion of the total Associated Medical Expenses (including surcharge or
taxes thereon) as per the following formula: (Eligible Room Rent limit / Room Rent actually incurred) * total
Associated Medical Expenses Associated Medical Expenses shall include Room Rent, nursing charges, Medical Practitioners’
fees and operation theatre charges.

e. For any hospitalization, we will pay for items included in the bill by the Hospital during the duration of hospitalization. Items
not included in the bill will not be paid.
5.2.5. Policy Disputes

Any dispute concerning the interpretation of the terms, conditions, limitations and/or exclusions contained herein shall be
governed by Indian law and shall be subject to the jurisdiction of the Indian Courts.
5.2.6. Territorial Jurisdiction

All claims shall be payable in India in Indian Rupees only.
5.2.7. Alteration to the Policy

This Policy constitutes the complete contract of insurance. Any change in the Policy will only be evidenced by a written
endorsement signed and stamped by Us. No one except Us can within the permission of the IRDAI change or vary this Policy.
5.2.8. Zonal pricing

For the purpose of calculating premium, the country has been divided into the following 3 zones:
i. Zone 1: Delhi (NCR), Surat, Kolkata, Mumbai, Thane
ii. Zone 2: Jaipur, Ludhiana, Pune
iii. Zone 3: Rest of India
Your premium depends upon your residential city. Please inform us immediately in case of change in your city.
5.2.9. Assignment
The Policy can be assigned subject to applicable laws.
5.2.10. Sum Insured

In case of Individual or Family Floater policy, Sum Insured means the total of the Base Sum Insured and No claim Bonus (if
applicable). Our maximum, total and cumulative liability for all claims during the Policy Year will be Sum Insured and amount
provided under Refill benefit.
The sequence of utilization of Sum Insured will be as below:
i. Base Sum Insured followed by;
ii. Accumulated No Claim Bonus (if applicable) followed by;
iii. Refill benefit (if applicable)
If the Policy Period is 2 years or 3 years, then the Sum Insured shall be applied separately for each Policy Year in the Policy Period.
All claims paid (except for Health Check-up and Hospital Cash) will reduce the Sum Insured for the Policy Year in which the
insured event has occurred. Any claim admitted under Pre & Post Hospitalization shall reduce the Sum Insured for the Policy Year
in which Hospital admission claim has incurred.

Registered office:- C-98, First Floor, Lajpat Nagar, Part 1, New Delhi-110024
Disclaimer: Insurance is a subject matter of solicitation. Niva Bupa Health Insurance Company Limited (formerly known as
Niva 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.
Customer Helpline: 1860-500-8888. Website: www.nivabupa.com. CIN: U66000DL2008PLC182918. For more details on
terms and conditions, exclusions, risk factors, waiting period & benefits, please read sales brochure carefully before concluding a sale.

Annexure I - The expenses that are not covered or subsumed into room charges /
procedure charges / costs of treatment
List I – Expenses not covered
Sl. No. Item Sl. No. Item Sl. No. Item

1 BABY FOOD 24 ATTENDANT CHARGES 47 LUMBO SACRAL BELT
EXTRA DIET OF PATIENT
NIMBUS BED OR WATER OR AIR
2 BABY UTILITIES CHARGES 25 (OTHER THAN THAT WHICH 48
BED CHARGES
FORMS PART OF BED CHARGE)
3 BEAUTY SERVICES 26 BIRTH CERTIFICATE 49 AMBULANCE COLLAR
4 BELTS/ BRACES 27 CERTIFICATE CHARGES 50 AMBULANCE EQUIPMENT
5 BUDS 28 COURIER CHARGES 51 ABDOMINAL BINDER
PRIVATE NURSES CHARGES-
6 COLD PACK/HOT PACK 29 CONVEYANCE CHARGES 52
SPECIAL NURSING CHARGES
7 CARRY BAGS 30 MEDICAL CERTIFICATE 53 SUGAR FREE Tablets
CREAMS POWDERS LOTIONS
(Toiletries are not payable,
8 EMAIL / INTERNET CHARGES 31 MEDICAL RECORDS 54
only prescribed medical
pharmaceuticals payable)
FOOD CHARGES (OTHER THAN
9 PATIENT's DIET PROVIDED BY 32 PHOTOCOPIES CHARGES 55 ECG ELECTRODES
HOSPITAL)
10 LEGGINGS 33 MORTUARY CHARGES 56 GLOVES
11 LAUNDRY CHARGES 34 WALKING AIDS CHARGES 57 NEBULISATION KIT
OXYGEN CYLINDER (FOR ANY KIT WITH NO DETAILS
12 MINERAL WATER 35 USAGE OUTSIDE THE 58 MENTIONED [DELIVERY KIT,
HOSPITAL) ORTHOKIT, RECOVERY KIT, ETC]
13 SANITARY PAD 36 SPACER 59 KIDNEY TRAY
14 TELEPHONE CHARGES 37 SPIROMETRE 60 MASK
15 GUEST SERVICES 38 NEBULIZER KIT 61 OUNCE GLASS
16 CREPE BANDAGE 39 STEAM INHALER 62 OXYGEN MASK
17 DIAPER OF ANY TYPE 40 ARMSLING 63 PELVIC TRACTION BELT
18 EYELET COLLAR 41 THERMOMETER 64 PAN CAN
19 SLINGS 42 CERVICAL COLLAR 65 TROLLY COVER
BLOOD GROUPING AND
20 CROSS MATCHING OF DONORS 43 SPLINT 66 UROMETER, URINE JUG
SAMPLES
SERVICE CHARGES WHERE
21 NURSING CHARGE ALSO 44 DIABETIC FOOT WEAR 67 AMBULANCE
CHARGED
KNEE BRACES (LONG/ SHORT/
22 TELEVISION CHARGES 45 68 VASOFIX SAFETY
HINGED)
KNEE IMMOBILIZER/SHOULDER
23 SURCHARGES 46
IMMOBILIZER

List II – Items that are to be subsumed into Room Charges
BABY CHARGES (UNLESS
1 14 BED PAN 27 ADMISSION KIT
SPECIFIED/INDICATED)
2 HAND WASH 15 FACE MASK 28 DIABETIC CHART CHARGES
DOCUMENTATION CHARGES /
3 SHOE COVER 16 FLEXI MASK 29
ADMINISTRATIVE EXPENSES
DISCHARGE PROCEDURE
4 CAPS 17 HAND HOLDER 30
CHARGES
5 CRADLE CHARGES 18 SPUTUM CUP 31 DAILY CHART CHARGES
ENTRANCE PASS / VISITORS
6 COMB 19 DISINFECTANT LOTIONS 32
PASS CHARGES
EAU-DE-COLOGNE / ROOM EXPENSES RELATED TO
7 20 LUXURY TAX 33
FRESHNERS PRESCRIPTION ON DISCHARGE
8 FOOT COVER 21 HVAC 34 FILE OPENING CHARGES
INCIDENTAL EXPENSES / MISC.
9 GOWN 22 HOUSE KEEPING CHARGES 35
CHARGES (NOT EXPLAINED)
PATIENT IDENTIFICATION BAND
10 SLIPPERS 23 AIR CONDITIONER CHARGES 36
/ NAME TAG
11 TISSUE PAPER 24 IM IV INJECTION CHARGES 37 PULSEOXYMETER CHARGES
12 TOOTH PASTE 25 CLEAN SHEET
13 TOOTH BRUSH 26 BLANKET/WARMER BLANKET

List III – Items that are to be subsumed into Procedure Charges

WARD AND THEATRE BOOKING
1 HAIR REMOVAL CREAM 9 17 BOYLES APPARATUS CHARGES
CHARGES
DISPOSABLES RAZORS ARTHROSCOPY AND
2 10 18 COTTON
CHARGES (for site preparations) ENDOSCOPY INSTRUMENTS
3 EYE PAD 11 MICROSCOPE COVER 19 COTTON BANDAGE
SURGICAL BLADES,
4 EYE SHEILD 12 20 SURGICAL TAPE
HARMONICSCALPEL,SHAVER
5 CAMERA COVER 13 SURGICAL DRILL 21 APRON
6 DVD, CD CHARGES 14 EYE KIT 22 TORNIQUET
ORTHOBUNDLE, GYNAEC
7 GAUSE SOFT 15 EYE DRAPE 23
BUNDLE
8 GAUZE 16 X-RAY FILM
List IV – Items that are to be subsumed into costs of treatment

ADMISSION/REGISTRATION
1 7 INFUSION PUMP– COST 13 MOUTH PAINT
CHARGES
HOSPITALISATION FOR
HYDROGEN PEROXIDE\SPIRIT\
2 EVALUATION/ DIAGNOSTIC 8 14 VACCINATION CHARGES
DISINFECTANTS ETC
PURPOSE
NUTRITION PLANNING
3 URINE CONTAINER 9 CHARGES - DIETICIAN 15 ALCOHOL SWABES
CHARGES- DIET CHARGES
BLOOD RESERVATION
4 CHARGES AND ANTE NATAL 10 HIV KIT 16 SCRUB SOLUTION/STERILLIUM
BOOKING CHARGES
5 BIPAP MACHINE 11 ANTISEPTIC MOUTHWASH 17 GLUCOMETER & STRIPS
6 CPAP/ CAPD EQUIPMENTS 12 LOZENGES 18 URINE BAG

Annexure II -
List of Insurance Ombudsmen
S. No. Office Details Jurisdiction

AHMEDABAD
Shri Kuldip Singh

1 Gujarat, Dadra & Nagar Haveli, Daman and Diu
Office of the Insurance Ombudsman, Jeevan Prakash Building, 6th floor,
Tilak Marg, Relief Road, AHMEDABAD – 380 001.
Tel.: 079 - 25501201/02/05/06, Email: bimalokpal.ahmedabad@cioins.co.in
BENGALURU
Mr Vipin Anand
2 Office of the Insurance Ombudsman, Jeevan Soudha Building, Karnataka
PID No. 57-27-N-19, Ground Floor, 19/19, 24th Main Road, JP Nagar,
Ist Phase, Bengaluru – 560 078.
Tel.: 080 - 26652048 / 26652049, Email: bimalokpal.bengaluru@cioins.co.in
BHOPAL
Shri R. M. Singh
3 Insurance Ombudsman, Office of the Insurance Ombudsman, Madhya Pradesh, Chhattisgarh
Janak Vihar Complex, 2nd Floor, 6, Malviya Nagar, Opp. Airtel Office,
Near New Market, Bhopal – 462 003.
Tel.: 0755 - 2769201 / 2769202, Email: bimalokpal.bhopal@cioins.co.in
BHUBANESWAR
4 Shri Suresh Chandra Panda Odisha

Office of the Insurance Ombudsman, 62, Forest park, Bhubaneswar – 751 009.
Tel.: 0674 - 2596461 /2596455, Email: bimalokpal.bhubaneswar@cioins.co.in
CHANDIGARH
Mr Atul Jerath Punjab, Haryana (excluding Gurugram, Faridabad, Sonepat and Bahadurgarh),
5
Office of the Insurance Ombudsman, S.C.O. No. 101, 102 & 103, 2nd Floor, Himachal Pradesh, Union Territories of Jammu & Kashmir,Ladakh & Chandigarh
Batra Building, Sector 17 – D, Chandigarh – 160 017.
Tel.: 0172 - 2706196 / 2706468, Email: bimalokpal.chandigarh@cioins.co.in
CHENNAI
Shri Segar Sampathkumar

6 Tamil Nadu, PuducherryTown and Karaikal (which are part of Puducherry)
Office of the Insurance Ombudsman, Fatima Akhtar Court, 4th Floor, 453,
Anna Salai, Teynampet, CHENNAI – 600 018.
Tel.: 044 - 24333668 / 24335284, Email: bimalokpal.chennai@cioins.co.in
DELHI
Shri Sudhir Krishna Delhi & following Districts of Haryana - Gurugram, Faridabad, Sonepat &
7
Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Building, Bahadurgarh
Asaf Ali Road, New Delhi – 110 002.
Tel.: 011 - 23232481/23213504, Email: bimalokpal.delhi@cioins.co.in
GUWAHATI
Shri Somnath Ghosh Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland and
8
Office of the Insurance Ombudsman, Jeevan Nivesh, 5th Floor, Tripura
Nr. Panbazar over bridge, S.S. Road, Guwahati – 781001(ASSAM).
Tel.: 0361 - 2632204 / 2602205, Email: bimalokpal.guwahati@cioins.co.in
HYDERABAD
Shri N. Sankaran
9 Office of the Insurance Ombudsman, 6-2-46, 1st floor, Andhra Pradesh, Telangana, Yanam and part of Union Territory of Puducherry
“Moin Court”, Lane Opp. Saleem Function Palace, A. C. Guards,
Lakdi-Ka-Pool, Hyderabad - 500 004.
Tel.: 040 - 23312122, Email: bimalokpal.hyderabad@cioins.co.in

JAIPUR
Shri Rajiv Dutt Sharma

10 Rajasthan
Office of the Insurance Ombudsman, Jeevan Nidhi – II Bldg.,
Gr. Floor, Bhawani Singh Marg, Jaipur - 302 005.
Tel.: 0141 - 2740363, Email: bimalokpal.jaipur@cioins.co.in
ERNAKULAM
Shri G. Radhakrishnan
11 Kerala, Lakshadweep, Mahe-a part of Union Territory of Puducherry
Office of the Insurance Ombudsman, 2nd Floor, Pulinat Bldg.,
Opp. Cochin Shipyard, M. G. Road, Ernakulam - 682 015.
Tel.: 0484 - 2358759 / 2359338, Email: bimalokpal.ernakulam@cioins.co.in
KOLKATA
Shri P. K. Rath
12 West Bengal, Sikkim, Andaman & Nicobar Islands
Office of the Insurance Ombudsman, Hindustan Bldg. Annexe,
4th Floor, 4, C.R. Avenue, KOLKATA - 700 072.
Tel.: 033 - 22124339 / 22124340, Email: bimalokpal.kolkata@cioins.co.in
Districts of Uttar Pradesh : Lalitpur, Jhansi, Mahoba, Hamirpur, Banda,
LUCKNOW Chitrakoot, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh,
Jaunpur,Varanasi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur,
13 Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad, Amethi, Kaushambi,
Office of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan, Phase-II,
Nawal Kishore Road, Hazratganj, Lucknow - 226 001. Balrampur, Basti, Ambedkarnagar, Sultanpur, Maharajgang, Santkabirnagar,
Tel.: 0522 - 2231330 / 2231331, Email: bimalokpal.lucknow@cioins.co.in Azamgarh, Kushinagar, Gorkhpur, Deoria, Mau, Ghazipur, Chandauli, Ballia,
Sidharathnagar
MUMBAI
Shri Bharatkumar S. Pandya

14 Office of the Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe, Goa, Mumbai Metropolitan Region (excluding Navi Mumbai & Thane)
S. V. Road, Santacruz (W), Mumbai - 400 054.
Tel.: 69038821/23/24/25/26/27/28/28/29/30/31
Email: bimalokpal.mumbai@cioins.co.in
NOIDA State of Uttarakhand and the following Districts of Uttar Pradesh: Agra,
Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah, Kannauj,
Shri Chandra Shekhar Prasad
Mainpuri, Mathura, Meerut, Moradabad, Muzaffarnagar, Oraiyya, Pilibhit,
15 Office of the Insurance Ombudsman, Bhagwan Sahai Palace
Etawah, Farrukhabad, Firozbad, Gautam Buddh nagar, Ghaziabad, Hardoi,
4th Floor, Main Road, Naya Bans, Sector 15,
Distt: Gautam Buddh Nagar, U.P-201301. Shahjahanpur, Hapur, Shamli, Rampur, Kashganj, Sambhal, Amroha, Hathras,
Tel.: 0120-2514252 / 2514253, Email: bimalokpal.noida@cioins.co.in Kanshiramnagar, Saharanpur
PATNA
Shri N. K. Singh
16 Office of the Insurance Ombudsman, 2nd Floor, Lalit Bhawan, Bihar, Jharkhand
Bailey Road, Patna 800 001.
Tel.: 0612-2547068, Email: bimalokpal.patna@cioins.co.in
PUNE
Shri Vinay Sah Maharashtra, Areas of Navi Mumbai and Thane (excluding Mumbai Metropolitan
17
Office of the Insurance Ombudsman, Jeevan Darshan Bldg., 3rd Floor, Region)
C.T.S. No.s. 195 to 198, N.C. Kelkar Road, Narayan Peth, Pune – 411 030.
Tel.: 020-41312555, Email: bimalokpal.pune@cioins.co.in
Council for Insurance Ombudsmen,

3rd Floor, Jeevan Seva Annexe, S. V. Road, Santacruz (W), Mumbai - 400 054.
Tel.: 022 -69038800/69038812| Email: inscoun@cioins.co.in

Customer ID: 2000606620
Member No. Name Age Valid From
7916363 Umesh Singh Visen 40 08/11/2019
17500691 Aparajita Singh 3 08/11/2023
7916365 Aadya Singh 8 08/11/2019
7916364 Aradhana Singh 35 08/11/2019

Vumxe V1 L 84 Aq N7 PH

Uploaded by

Copyright:

Available Formats

Vumxe V1 L 84 Aq N7 PH

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Vumxe V1 L 84 Aq N7 PH

Uploaded by

Copyright:

Available Formats

Date: 06/11/2023

Policy Number: 31046638202304

MR. UMESH SINGH VISEN

Subject : Niva Bupa Health Insurance Policy No. 31046638202304

Dear MR. UMESH SINGH VISEN,

Director - Operations & Customer Service

Important - Please read this document and keep in a safe place.

Product Name: Health Companion, Product UIN: NBHHLIP23108V062223

Policyholder Name: MR. UMESH SINGH VISEN Policy Number 31046638202304

LUCKNOW, Sum Insured INR 5,00,000

UTTAR PRADESH - 226029 Variant Opted Variant 2022

Particulars Effective[Y/N] Details

Hospital Cash opted N Not Opted

Annual Aggregate Deductible opted (INR) N 0

Treatment only in Tiered Network opted N N

Safeguard (Rider) opted N 0

Mr. Umesh Singh Visen 5,00,000 4,00,000 5,00,000 0 14,00,000

Ms. Aparajita Singh

Ms. Aadya Singh

Mrs. Aradhana Singh

Intermediary Name Intermediary Code Intermediary Contact No.

Product Name: Health Companion, Product UIN: NBHHLIP23108V062223

Nominee Name Relationship with the Policyholder

Aradhana Singh Spouse

Permanent Exclusion (if any):

Claim Administrator Servicing Branch Details

Insured Person Details

Mr. Umesh Singh 40 23/02/1983 Male Applicant 08/11/2019 0 None None

Ms. Aparajita 3 22/09/2020 Female Daughter 08/11/2023 0 None None

Ms. Aadya Singh 8 05/12/2014 Female Daughter 08/11/2019 0 None None

Mrs. Aradhana 35 14/07/1988 Female Spouse 08/11/2019 0 None None

Product Benefit Table2

Product Name: Health Companion, Product UIN: NBHHLIP23108V062223

Location: New Delhi Director - Operations & Customer Service

Product Name: Health Companion, Product UIN: NBHHLIP23108V062223

Plan Opted for HC VARIANT2022 FLOATER 5L 2A2C

Net Premium/Taxable Value (INR) 15,538.00

Integrated Goods and Service Tax (18.00 %) (INR) 0.00

Central Goods and Service Tax (9.00 %) (INR) 1,398.42

State/Union Territory Goods and Service Tax (9.00 %) (INR) 1,398.42

Loading (INR) 0.00

Gross Premium (INR) 18,335.00

Details of persons Insured:

Mr. Umesh Singh Visen 40 Male Applicant

Ms. Aparajita Singh 3 Female Daughter

Ms. Aadya Singh 8 Female Daughter

Mrs. Aradhana Singh 35 Female Spouse

Location: New Delhi Director - Operations & Customer Service

Product Name: Health Companion, Product UIN: NBHHLIP23108V062223

Product Name: Health Companion | Product UIN: NBHHLIP23108V062223

For Reimbursement of Claim:

Product Name: Health Companion | Product UIN: NBHHLIP23108V062223

Grievance Redressal Officer

• IRDAI/(IGMS/Call Centre): Email ID: www.igms.irdai.gov.in

Product Name: Health Companion | Product UIN: NBHHLIP23108V062223

Benefit Illustration (5 Lac Sum Insured, Policy Term 1 year)

Niva Bupa Health Insurance Company Limited

Product Name: Health Companion | Product UIN: NBHHLIP23108V062223

Product Name: Health Companion | Product UIN: NBHHLIP23108V062223