Overview
Niva Bupa Heartbeat Gold is a premium health insurance plan with sum insured options ranging from ₹5 lakhs to ₹50 lakhs. Key features include maternity benefits (with a short waiting period of 24 months), newborn baby coverage, restoration of the sum insured, and coverage for alternative treatments like AYUSH (up to SI). The plan also offers teleconsultations, critical illness cover, and personal accident cover as optional covers, making it suitable for diverse healthcare needs. Additionally, it includes lifetime renewability and cashless treatment at over 10,000 network hospitals.
Experts Review
Written by Nikhil Nair
Senior Writer
The Niva Bupa Heartbeat Gold plan stands out due to its focus on family-centric benefits and comprehensive coverage. Its maternity benefits with a short waiting period of 24 months are particularly appealing for young families planning parenthood. The inclusion of newborn baby coverage and vaccination expenses adds further value. At the same time, the plan’s restoration of the sum insured ensures financial security during multiple claims in a policy year, while day care, domiciliary, and AYUSH treatment coverage broaden healthcare options.
On the downside, the plan has certain limitations. The room rent is covered up to the Sum Insured (except for Suite or above room category), which may restrict flexibility during hospitalization. Additionally, premiums can escalate with add-ons like critical illness cover and personal accident cover (if opted for)..
Pros
Feature set is satisfactory.
Insurer has a solid track record with great claim and service metrics.
Cons
Premiums are relatively high.
Doctor consultations are not covered, which is a notable gap. Need to opt add-on for doctor consultations.
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
Maternity
STANDOUT
The insurer will also cover expenses related to maternity— Think hospitalization expenses incurred while giving birth. But they’ll only pay upto ₹40,000 and make you wait 2 years before covering this expense. Also, you’ll only get the benefits if both, you and your spouse are enrolled in a single-family floater plan.
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
No funny business here. If your insurer hasn’t explicitly stated they won’t cover a certain illness, you can claim the full amount up to the sum insured, irrespective of the disease you’re dealing with. Meaning this policy doesn't impose the dreaded disease wise sub-limits.
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.
Add-ons
Hospital Cash
Hospital cash benefit paid out if hospitalization is at least 2 days, with a maximum payout of ₹1000 for up to 30 days.
Critical Illness
Paid out as a lump sum of 1000000 (as per the sum insured) for null illnesses.
Personal Accident Cover
Paid out as a lump sum of 500% of sum insured for Accidental Death, Total Permanent Disability, Permanent Partial Disability up to a limit of ₹10000000.
Tele-OPD Consultation
Each insured member can get unlimited e-consultations.
Aggregate Deductible
Choose deductible between ₹10,000 and ₹10,00,000 and get a discount on premiums.
Premium Waiver
Waives off the premium for 1 year, if the Policyholder dies or is diagnosed or undergoes treatment for the first time for the listed Illnesses.
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 2 years.
Pancreatitis and stones in biliary and urinary system
Cataract, glaucoma and retinal detachment
Hyperplasia of prostate, hydrocele and spermatocele
Prolapse of uterus and cervix, endometriosis, fibroids, PCOD, hysterectomy (unless necessitated by malignancy)
Hemorrhoids, fissure, fistula or abscess of anal and rectal region
Waiting Period
30 days Initial waiting period
2 years Specific illness waiting period
2 years Pre-existing disease waiting period
Ditto's Take
◦ Excellent ◦
After a close look at the waiting periods, we can say that the waiting periods on this policy are excellent. Especially the PED waiting period which is better than usual.
What's missing in the policy
Doctor consultations are not covered. Need to opt add-on for doctor consultations.
Customer Reviews
U
Ujala Khanna
Maternity benefits with only a 24-month waiting period! Perfect for family planning.
V
Varun Jaiswal
Newborn baby coverage included is a huge plus.
Y
Yamini Saini
Unlimited restoration of sum insured gives me confidence for any medical emergency.
F
Firoz Mansuri
The 24-month waiting for maternity is good, but still a wait.
D
Deepak Gusain
This is a premium plan, so the cost is definitely on the higher side.
B
Bhaskar Joshi
Sum insured options up to ₹50 lakhs, offers good flexibility.
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Frequently Asked Questions
Does HeartBeat Gold 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 2-year waiting period for a list of diseases which is a mandate before you can start claiming for persons above the age of 45 years. (Exception - Cancer cover after a 30-day waiting period.)
- 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 HeartBeat Gold have room rent restrictions?
Does HeartBeat Gold offer a restoration benefit?
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