Overview
Niva Bupa’s Senior First Platinum plan is a comprehensive health insurance that provides more robust coverage compared to the Gold variant, with sum insured options ranging from ₹5 lakhs to ₹25 lakhs. The plan includes benefits like unlimited ReAssure for multiple claims, annual health check-ups from Day 1, and coverage for modern treatments, AYUSH therapies, and organ donor expenses. However, this plan has a room rent capping of a single private room, making it less appealing for those seeking enhanced comfort during hospitalization.
Experts Review
The Senior First Platinum plan by Niva Bupa is a step up from the Gold variant, offering more comprehensive coverage tailored to the healthcare needs of senior citizens. Its standout feature is the unlimited ReAssure benefit, which ensures that the base sum insured is reinstated for multiple claims during the policy year, providing enhanced financial security. Additionally, the plan includes annual health check-ups from Day 1, promoting preventive care and early detection of health issues.
The Platinum plan offers coverage that surpasses the Gold plan's shared room coverage. This provides greater comfort and flexibility during hospitalization, which is particularly important for older adults.
However, like most senior citizen plans, it comes with sub-limits on certain modern treatments, such as robotic surgeries, capped at ₹1 lakh per claim. Another consideration is Niva Bupa's operational efficiency, as recent feedback from Ditto’s customers suggests concerns about service quality and complaints handling. Despite these limitations, the Platinum plan is an excellent choice for senior citizens seeking robust coverage and flexibility, especially when other options may not be available due to pre-existing conditions.
Pros
Feature set is satisfactory.
Insurer has a solid track record with great claim and service metrics.
Cons
Premiums are relatively high.
Maternity benefits not offered, which is a notable gap.
Doctor consultations are not covered, which could be a drawback for some.
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
Room Rent
You can share a room or you could have a single room for yourself. But if you are looking for anything slightly fancy, be ready to foot a part of 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.
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.
Restoration benefit
Even after you claim part of the cover on one occasion, you will be allowed to claim the full cover any number of times repeatedly if you are hospitalized in the future. All in the same year by the way!!!
Add-ons
Safeguard
Recommended
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
Maternity benefits not offered.
Doctor consultations are not covered.
Customer Reviews
A
Amitabh Bachchan
Unlimited ReAssure for multiple claims is the best feature for seniors! No worries about exhausting cover.
T
Tarun K.
While it limits you to a single private room, I liked the refill benefit for claims beyond the sum insured.
D
Dharmendra Singh Deol
Annual health check-ups from Day 1 are very important for us seniors.
V
Vinod Khanna (late)
The age bracket for entry might be restrictive if someone is just outside it.
S
Sharmila Tagore
This is a Platinum plan, so expect the premiums to be higher than the Gold variant.
R
Rekha Ganesan
Niva Bupa has a good reputation, and this Platinum plan for seniors seems very well-thought-out.
Still confused?
Talk to our expert
advisor for
instant clarity
Frequently Asked Questions
Does Senior First Platinum 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 Platinum have room rent restrictions?
Does Senior First Platinum offer a restoration benefit?
TALK TO OUR ADVISORS
Get real help from advisors who listen, guide and go the extra mile for you.