Overview
The Niva Bupa Health Premia Silver plan offers sum insured options from ₹5 lakhs to ₹7.5 lakhs. Key features include 100% restoration of the sum insured, coverage for pre- and post-hospitalization expenses (90 and 180 days), and no room rent restrictions except for suites or higher categories. The plan also offers maternity benefits after two years (covered up to 60,000 depending on SI), coverage for newborns, and annual health check-ups. It includes advanced features like pharmacy benefits, mental health coverage (Covered up to Sum Insured (sub-limit of Rs 50,000 applicable on few conditions)), and optional loyalty additions to the sum insured (20% increase up to maximum 200% of Base SI).
Experts Review
Written by Nikhil Nair
Senior Writer
The Niva Bupa Health Premia Silver plan is an excellent option for those seeking comprehensive coverage with standout features. Its restoration benefit ensures financial security during multiple claims within the same policy year, making it ideal for families. The inclusion of maternity benefits and newborn baby coverage adds value for young families planning parenthood. Pre- and post-hospitalization coverage for extended periods (90 and 180 days) provides robust support during recovery.
However, the plan has certain limitations. While it covers room rent up to the sum insured, suites and higher categories are excluded, which may restrict premium accommodation choices. Additionally, the sum insured options are capped at ₹7.5 lakhs in this variant, making it less suitable for those seeking high-value coverage. Premiums for the Silver plan are competitive but can escalate with optional add-ons like critical illness cover or personal accident benefits.
Pros
Feature set is satisfactory.
Premiums are relatively well priced.
Insurer has a solid track record with great claim and service metrics.
Cons
No significant drawbacks found.
Niva Bupa (erstwhile Max Bupa)
Key Insights
Founded
2008
Niva Bupa (erstwhile Max Bupa) was established 17 years ago and has built strong credibility over time, backed by its long-standing presence in the market.
Claims Experience
91% claims settled in 30 Days
Niva Bupa (erstwhile Max Bupa) settles 91% of all claims it receives demonstrating strong credibility.
Network Hospitals
10,000+
Niva Bupa (erstwhile Max Bupa) maintains a moderate network of 10,000 hospitals, offering reasonable coverage across key locations.
Complaints
43 complaints per 10,000 claims registered
Niva Bupa (erstwhile Max Bupa) has a relatively high volume of complaints, which may point to ongoing issues in customer service or claim handling.
Features
All
Great
Good
Co-payment
The insurer will bear the entire cost of treatment (up to the sum insured). You won’t have to pay a single penny. Meaning this policy has no co-payment.
Room Rent
Shared rooms are okay. Single private rooms are okay. Most rooms are okay unless it’s a suite room — the expensive stuff. Then you’ll have to start splitting the bill.
Disease sub-limit
Your insurance cover won’t be fully available in case you are treated for few robotic surgeries up to 1L and a few other diseases. Meaning the insurance company has a cap on the total amount they’ll pay out if you are treated for these specific illnesses.
Pre existing diseases waiting
If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems after just 2 years. It’s probably the best deal you can get to be honest.
Pre/Post hospitalization
No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount in full for a pretty reasonable duration - 90 days before you are hospitalized and 180 days after discharge. This includes the cost of medication by the way.
Add-ons
Enhanced NCB
Recommended
No increase in bonus at renewal.
Hospital Cash
Hospital cash benefit paid out if hospitalization is at least 2 days, with a maximum payout of ₹3000 for up to 30 days.
Critical Illness
Paid out as a lump sum amount for Critical illnesses between Rs. 5 lakhs to Rs. 10 lakhs based on the cover chosen.
Personal Accident Cover
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
RMO charges
Hormone Replacement Therapy
STD other than HIV
Expenses related to any admission primarily for diagnostics and evaluation purposes are excluded.
Diagnostic expenses not related or incidental to current diagnosis and treatment are excluded.
Disclaimer: For illustration purposes only - exact terms are in the policy wording.
Specific Illness
The following illnesses are not covered under the policy for 1 years.
Pancreatitis and stones in biliary and urinary system
Cataract, glaucoma and other disorders of lens, disorders of retina
Hyperplasia of prostate, hydrocele and spermatocele
Abnormal utero-vaginal bleeding, female genital prolapse, endometriosis/adenomyosis, fibroids, PCOD, or any condition requiring dilation and curettage or hysterectomy
Hemorrhoids, fissure or fistula or abscess of anal and rectal region
Waiting Period
30 days Initial waiting period
1 years Specific illness waiting period
2 years Pre-existing disease waiting period
Ditto's Take
◦ Excellent ◦
Waiting periods on this policy are excellent. The specific illness waiting period is better than usual.
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Frequently Asked Questions
Does Health Premia Silver have waiting periods?
- 30-Day Waiting Period: Hospitalizations won’t be covered for the first 30 days of the policy unless it’s an accident.
- Specific Illness Waiting Period: There’s a 1-year waiting period for a list of diseases which is a mandate before you can start claiming.
- Pre-Existing Disease Waiting Period: There's a 2-year waiting period for any pre-existing disease you may have while buying the policy.
- Maternity and Newborn Waiting Period: There’s a 2-year waiting period before you can make claims related to pregnancy and childbirth.
Does Health Premia Silver have room rent restrictions?
Does Health Premia Silver offer a restoration benefit?
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