Niva Bupa Aspire Health Insurance: Customised Review

Health insurance policies have come a long way from being merely mediclaims. Can you imagine a health insurance plan prioritising maternity benefits or a policy that is designed to cover your future spouse’s waiting period via you, the policyholder?

Well, Niva Bupa’s newest product in the market, Aspire, is offering all of that and more. This policy has an M-iracle perk that doesn’t just cover maternity but funds your journey into parenthood (that’s the tagline). Among other features, it also has a Future Ready perk, where if you have opted for the policy and are single, you can cover the waiting period for your future spouse (whom you can add to your plan after you get married).

Now, needless to say, Niva Bupa is one of the biggest health insurance providers in the market who have forever brought innovation into the health industry and Aspire might be a great success. However, as with any of Niva Bupa’s plans, Aspire too isn’t without its fair share of caveats. So the question then is- how good is the product, will M-iracle cover all parenthood medical requirements, will the premiums be affordable, and what will be the claim settlement experience?

We will look at this and more.

But first, a quick look at Niva Bupa’s Aspire!

Quick Verdict on Niva Bupa Aspire

Niva Bupa Aspire can be a good product considering it offers maternity benefits, coverage for outpatient consultations, Fast Forward and Future Ready features. However, the product is new with multiple updates/changes under process and several restrictions that Niva Bupa has yet to offer more clarity on. Moreover, Niva Bupa isn’t doing any favours for itself with its high complaint volume and low Incurred Claim Ratio ICR.

Overall, maybe wait for a few months if you are sure that you want to purchase the product.

Niva Bupa Aspire Plan: Brief Overview

Established in 2008, Niva Bupa Health Insurance, formerly known as Max Bupa has been in the health insurance industry for a decade and a half. With the prevalence of online insurance purchases, Niva Bupa has hopped on the trend to become one of the most well-known health insurance providers in the market.

Now, while Niva Bupa’s average (of last 3 years) Claim Settlement Ratio (CSR) stands at a promising 90.66% (as compared to the industry average of 90.97%), it’s their Complaint Volume that is a concern for us. Based on numbers (44.52, which is way higher than the industry average of 24.029), our first-hand experience and concerns raised by our new clients, Niva Bupa’s overall operational efficiency need massive improvement, else the hassles of claim settlement is not going to get resolved soon.

Heads Up: It takes an average person up to 5 hours to read & analyze a policy, and 10 hours or more to compare different plans and make a decision.

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On the other hand, Niva Bupa’s Aspire seems like a great policy on pen and paper. The plan comes with 4 variants (1 more may be launched in the future) and has completely innovated the maternity perk benefits by including coverage for surrogacy, legal adoption, infertility and assisted reproduction, guaranteed issuance for newborns since Day 1, and more. The plan is being marketed specifically for young adults considering how its Booster+ perk (and M-iracle) helps carry forward the unutilised sum insured in multipliers (that depend on your entry age). The Future Ready feature is a definite first considering how the policyholder can cover the waiting period for the future spouse to be added on later in the plan. Needless to say, these features don’t come without its restrictions.

Here’s a quick look at some of the highlighted features of Niva Bupa Aspire -

Features of Niva Bupa Aspire Health Insurance Plan

Should You Buy Niva Bupa Aspire?

Before any health insurance policy purchase, you must take into account both - the provider and the provided plan. Here’s a look into some of the crucial considerations that should help with your Niva Bupa Aspire purchase intent -

1. Niva Bupa as an insurer: Niva Bupa as a health insurance provider, is a popular name in the industry. While the provider has successfully earned its reputation as an innovative feature bringer in the industry at affordable prices, its overall operation efficiency is a major concern for us.

After all, what good is a product and its feature if the provider has a high complaint volume and only adequate ICR? Its CSR might be close to the industry average, but that’s not enough to reflect that it’s a great health insurance provider.

We hope to see a quick improvement in its claim settlement complications because the insurer has a lot to offer in terms of its policy features.

2. M-iracle as an innovative maternity perk: This is THE HIGHLIGHT of Niva Bupa Aspire. The perk is innovative alright. You won't find many health insurance plans in the market that offer coverage for legal adoption, infertility treatment, vaccinations for mothers (pre-natal), assisted reproductive procedures, surrogate delivery, medical termination of pregnancy, and guaranteed issuance of policies to newborns.

However, M-iracle comes with a separate sum insured (based on the coverage chosen) that might seem, for a lack of a better word, inadequate, considering the standard expenses involved in the aforementioned procedures.

Moreover, its legal adoption coverage also has a capping of only ₹10k.

On the other hand, newborns are covered from Day 1 up to the base sum insured and if you purchase a policy for him/her from their 91st day, your insurer offers you guaranteed issuance. The slight hiccup here is that - despite their declarations, we are not exactly confident in how Niva Bupa will deal with the issuance if the child has an ailment - maybe a permanent exclusion on the condition?

On the bright side, M-iracle is bringing forward one of the shortest waiting periods in its coverage - 9 months (in the case of Titanium+ and Platinum+ variants). However, if you go for the Gold+ variant (the most basic variant), you are still looking at a 4-year waiting period, and with the Diamond+ variant, it’s 2 years.

(P.S. The M-iracle uninsured sum insured can be carried forward to the next year. Considering you are a financially savvy person, you may just end up accumulating enough to form an adequate pool to fund your parenthood expenses. But then there’s medical inflation!)

Now, please note -

• In the case of M-iracle, the biological mother has to be insured under this policy. The only exception to this rule is in the cases of surrogacy and legal adoption where the biological mother doesn’t need to be insured.

So, say,

- USE CASE 1: A single father can opt for the M-iracle benefit and be covered for his surrogate/legally adopted child.

- USE CASE 2: A single mother can opt for the M-iracle benefit and be covered for prenatal care, delivery, ectopic pregnancy, surrogacy (policy as a surrogate and policyholder as an adopting mother of a surrogate child - both are covered), infertility treatment, and legal adoption.

- USE CASE 3: A couple (as long they have taken the plan within 90 days of getting married/a spouse is added to the plan within 90 days of getting married) can opt for the M-iracle benefit and be covered for prenatal care, delivery, ectopic pregnancy, surrogacy, infertility treatment, and legal adoption.

3. Booster+ Benefits: Under this perk, you can carry forward your unutilised sum insured to the next year, and so on. The maximum multiplier depends on your entry age. Here’s a small table to help you understand better:

As you can see, the earlier you avail of this policy, the more unutilised sum insured you can accumulate. And hence, Aspire is being marketed as a young adult product (there’s also the M-iracle perk).

4. ReAssure+ Benefits: This is Niva Bupa’s version of Restoration benefits, but here you can use both the sum insured and the restoration together for a single claim. Under ReAssure+, after your 1st claim, the perk is triggered, and it stays triggered for the entire policy duration. Subsequently, after each claim, irrespective of whether it’s for the same or different ailments, your sum insured is restored for unlimited times.

5. Lock the Clock & Lock the Clock(+): Under this perk of Niva Bupa Aspire, your premium stays locked in as per your entry age until you make your first claim. So, you are saved from paying a per year or per age slab rise in premiums, provided you don’t make a claim.

1. Lock the Clock: Available for the Diamond+ and Platinum+ variants (an M-iracle claim will affect this and end the perk).
2. Lock the Clock+: Available only for the Titanium+ variant (an M-iracle claim won’t affect the perk and you can continue with the same premiums).

(Please note, this perk won’t shield you from the inflation rise that affects premiums each year.)

6. Safeguard+: Niva Bupa’s recent variants across ReAssure 2.0 brought out this perk. With Niva Bupa Aspire too, Booster+ offers you a 3-way protection:

- Increase the base sum insured based on the increase in CPI (Consumer Price Index), which measures the inflation rate.

- Shields your bonus from any claims filed by you. So, irrespective of any claims you raise, your restored amount (ReAssure+) stays indifferent/unaffected over the years, provided the claim is less than ₹1 lakh.

- Offers you coverage for consumables (medical equipment, products, and services required for surgeries and across hospitalisation, like gloves, cotton, PPI kit, etc.)

7. Zonal variations in premiums: For the 1st time ever, Niva Bupa has launched a 4-zone policy in its health insurance plan. However, no zonal copayment has been declared, as of yet. But, you should be looking at differences in premiums based on your address/city.

Here’s a look at its 4-zone divisions:

8. Future Ready Add-On: Say you are an unmarried 24-year-old seeking a health insurance policy. Here’s how things differ for you in case you take Niva Bupa Aspire or opt for any other policy -

• CASE 1: Any other policy

You continue with the plan for a few years and then get married and start thinking about kids. Soon you realise that considering the expenses involved in delivering a child, you need a maternity health insurance plan.

Now, while your insurer has a maternity add-on available with your policy (that you can add during your policy renewal), they also have a condition that both you and your spouse will have to be in the policy and have to complete the waiting period together.

You add your spouse to the policy, sacrifice the spontaneity and wait for 3-4 years (waiting period) to ensure that your maternity coverage can kick in, and then go ahead to have a child.

• CASE 2: Niva Bupa Aspire

You continue with the policy for 3-4 years, get married, add your spouse to the plan, and continue with your family planning. Your M-iracle cover has already kicked in since you completed the waiting period on your policy even before you got married.

So, with Niva Bupa Aspire’s Future Ready perk, any waiting period on pre-existing conditions, specific illness, or maternity benefits (M-iracle), can be covered by you. Your spouse can simply be added to the plan later on to enjoy the perks without any additional waiting period involved.

However, this perk comes with a few terms and conditions -

• Your spouse needs to be added to the Niva Bupa Aspire policy within 90 days of getting married.
• In case you were already married when you purchased the policy and added your spouse, the Future Ready benefit will not be available for you or your spouse.

9. Fast Forward Add-On: This is a unique perk in Niva Bupa Aspire. Let’s explain this with an example:

Kaveri is a 25-year-old who has purchased the Niva Bupa Aspire policy. Considering she is financially stable, she opts for a 3-year payment on her ₹10 lakhs coverage.

Since she opted for a 3-year payment, the entire sum insured for 3 years is made available to her as a lumpsum fund to be used as per her medical discretion. In case the entire sum insured is covered before 3 years, her triggered ReAssure still offers ample coverage.

This is quite possibly one of the best features of Niva Bupa Aspire, considering the financial cushioning it offers over lumpsum coverage.

10. Disease Management Add-On: This add-on is specific to those with pre-existing conditions like hypertension, diabetes type 2 (no insulin), etc. The add-on can only be added during the inception of the policy and can’t be removed. It extends perks like no loading charges and no waiting period for those with hypertension and diabetes.

However, since the add-on requires an additional premium payment, the “no loading” perk becomes null and void and wants you to question if the rider is a value-adding one or not.

11. Borderless Add-On: Available only for Indian residents (not NRIs), the international coverage add-on is a decent pick for the Niva Bupa Aspire plan considering -

• It has an optional copayment (0% - 50%)
• It offers coverage across countries (USA and Canada included)
• Cashless and Reimbursement modes are both available
• Covers both emergency and scheduled medical treatments

The only caveat of this add-on is that this is capped at ₹1 crore. Considering the expenses involved in treatments abroad, the coverage might become inadequate and you may end up paying a significant amount out of your pocket. And since the rider won’t be exactly pocket-friendly (it includes USA and Canada too), you might want to consider other options.

RECENT UPDATE:

Well Consult Add-On: This rider has a great many features to offer.

• Unlimited virtual consultation
• Coverage for physical consultation (up to ₹10k), diagnostic tests (up to ₹10k), and pharmacy coverage (up to ₹2.5k) - provided a licensed doctor has suggested them.
• Coverage for a virtual gym membership (up to 2 visits/week/adult)
• Coverage for AI online fitness consultation
• Unlimited online consultation coverage for diet and nutrition
• Coverage for 10 sittings of emotional wellness sessions per year.
• Our concern is that this add-on has a 20% co-pay in case you opt for the reimbursement option.

What’s Unique with Niva Bupa Aspire?

Niva Bupa Aspire Fast Forward, Future Ready, Well Consult add-ons, and M-iracle are truly one of a kind. In case they follow up with their promises, streamline the claim procedure and do not keep changing their terms and conditions, these features could eventually strike a chord with young adults.

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Conclusion

The features are great but it is still a new product. In fact, Niva Bupa still hasn’t offered a lot of clarity on several features that it extends. So, based on market influence, Aspire is swiftly undergoing multiple changes in the terms and conditions of its features. Availing of this plan so close to its launch, might not be a smart move. If you are intrigued by the plan, we recommend you be a bit more patient and see how the market reacts to the plan before purchasing it. And honestly, it’s as much about the policy as it’s about the policy provider!