Overview
Niva Bupa’s Senior First Gold plan is a specialized health insurance offering tailored exclusively for senior citizens aged 61 to 75 years. It provides coverage for pre-existing conditions after only 2 years, along with benefits like AYUSH treatments and organ donor expenses. However, coverage options range from ₹5 lakhs to ₹10 lakhs, which is quite limiting compared to standard health insurance plans.
Experts Review
The Senior First Gold plan by Niva Bupa is specially designed for senior citizens, offering coverage without the hassle of mandatory pre-policy medical tests and aiming to address common healthcare needs at an older age. While it does have a 24-month waiting period for pre-existing diseases, it still stands out with practical features like pre- and post-hospitalization cover (60 and 180 days respectively), day care and domiciliary treatments covered up to the sum insured, and ambulance expenses up to ₹2,000 by road and up to ₹2.5 lakhs by air (for emergency hospitalizations).
The inclusion of AYUSH treatments, while coverage for organ donor expenses, adds value during critical medical procedures. However, the plan has limitations such as room rent restrictions (shared rooms only) and sub-limits on modern treatments like robotic surgeries, capped at ₹1 lakh per claim. It also comes with a default co-payment of 50%, which can be reduced or removed by paying a higher premium. These restrictions may significantly reduce your flexibility during hospitalization. Also, note that the plan does not include the ReAssure (unlimited restoration) benefit, which is available in some of Niva Bupa’s other offerings.
Additionally, while Niva Bupa’s direct claim settlement process is a positive feature, recent feedback from Ditto’s customers regarding operational inefficiencies raises concerns about service quality.
Pros
Feature set is satisfactory.
Premiums are relatively well priced.
Insurer has a solid track record with great claim and service metrics.
Cons
No Restoration Benefit, which is a notable gap.
No Bonus for being healthy and not claiming insurance, which could be a drawback for some.
Your insurer doesn’t provide free health check-ups, which is a key feature.
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
Bad
Co-payment
The policy will only cover 50% of the final bill. The rest is on you. They call this a co-payment.
Room Rent
Tough luck if you are thinking about opting for a single private room. Because the policy only lets you stay in a shared room. If you still want to pick a better room, then be ready to pay a lot more when the final bill shows up.
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 - 60 days before you are hospitalized and 180 days after discharge. This includes the cost of medication by the way.
Add-ons
Safeguard
Recommended
Cover increases in line with inflation, consumables covered, and No Claim Bonus is protected.
Co-payment Modifier
Recommended
Safeguard
With this add-on, the insurer will increase your cover in line with inflation every year, your bonus amount will not be affected if the claim is less than ₹50,000 in the entire year and you also get extended coverage for generally excluded items like syringes, gloves, PPE kits etc.
Deductible
Deductible will be 1/5th of the base sum insured chosen. If deductible is opted, then co-payment will NOT apply except for treatment taken in higher than eligible category of room.
Co-payment Modifier
This benefit helps to modify the co-payment from 50% to 0%, 20%, 30% or 40%. But remember, you need to pay extra premiums to reduce the co-payment.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
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.
Expenses for admission primarily for bed rest and not for 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 or 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
No Restoration Benefit.
No Bonus for being healthy and not claiming insurance.
Your insurer doesn’t provide free health check-ups.
Maternity benefits not offered.
Doctor consultations are not covered.
Consumables aren't covered in this policy.
Customer Reviews
N
Nirmala Rao
Although PEDs have a 2-year wait, the refill benefit ensures added protection when needed.
R
Rekha K.
Unfortunately, annual health check-ups aren’t part of the Gold variant—wish that was more clear.
S
Sunil Bhagat
Annual health check-ups being part of the plan was a helpful feature, especially for senior care.
J
Jagdish Chandra Bose
The flexibility with annual aggregate deductibles is good, but one needs to choose it carefully.
H
Harishankar Yadav
The plan is specifically for 61-75 years, so if you are outside this, it's not for you.
F
Fatima Bi
Finally, a plan that truly caters to senior citizens without too many hassles.
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Frequently Asked Questions
Does Senior First 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.
- Pre-Existing Disease Waiting Period: There's a 2-year waiting period for any pre-existing disease you may have while buying the policy.
Does Senior First Gold have room rent restrictions?
Does Senior First Gold offer a restoration benefit?
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