Max Bupa, currently known as Niva Bupa, was founded in 2008. The brand has grown immensely since the rising demand for online health insurance plans. This standalone insurer is a joint venture between Fettle Tone LLP and Bupa Singapore Holdings and has brought industry-first features into the market at affordable rates.
However, in the last few years, we have had concerns over the insurer’s rising complaint volume and deteriorating operational efficiency. And our personal experience with the insurer has proved nothing different.
| Pros | Cons |
|---|---|
| Comprehensive policies | High complaint volume |
| Good Claim Settlement Ratio | |
| Decent Incurred Claim Ratio | |
| Affordable Premiums |
Metrics of Niva Bupa Health Insurance
Niva Bupa is one of the few popular standalone health insurance providers, offering a diverse portfolio of comprehensive and niche-specific policies. The health insurance plans provided by the insurer are supreme in its feature line-up and are considered pocket-friendly. However, Niva Bupa’s declining overall operational performance, issues with claim settlement, and dissatisfaction among its existing clients (leading to complaints) - are significant concerns.
Claim Settlement Ratio of Niva Bupa Health Insurance
An insurer's Claim Settlement Ratio (CSR) is the total number of claims settled against the total number of claims filed to an insurer across a year, and the ratio is multiplied by 100.
A health insurer's ideal Claim Settlement Ratio is 90% and above. Please avoid insurers with a CSR of below 80% or above 100% because while the former indicates that the insurer is not so keen on settling claims, the latter delays its claim settlements. Neither of these two is good for you as a policyholder since, with health insurance, claim settlement is a time-sensitive matter. Otherwise, you end up paying from your pocket, putting redundant pressure on your savings despite having a policy.
| Years | Niva Bupa Health Insurance | Industry Average |
|---|---|---|
| 2020 - 2021 | 90.68 | 91.484 |
| 2021 - 2022 | 90.78 | 89.967 |
| 2022 - 2023 | 90.53 | 91.460 | Average (2020 - 2023) | 90.66 | 90.970 |
Insight: Niva Bupa’s CSR is barely above 90%. The insurer is also behind the industry average. While the numbers aren’t unsatisfactory, when looking at a credible health insurance provider with an extensive insurance track record, like Niva Bupa, you would expect a higher number, close to the industry's best.
Incurred Claim Ratio of Niva Bupa Health Insurance
While CSR reflects the number of claims settled, and the data for the number of claims settled in the last 30 days shows the insurer's efficiency, both fail to indicate how sustainable the brand is. Considering health insurance policies are long-term financial commitments, you need an insurer who holds financial stability for the long run
The best way to ensure this is to take a look at its Incurred Claim Ratio or ICR. This is given by
(The amount of claim settled by an insurer across a year/ The total amount collected by this insurer via premiums for the year) * 100
The ICR of a health insurance provider reflects its claim settlement potential and sustainability for the future. The ideal range of ICR is 50 to 70, and it reflects that the health insurance provider has an equal focus on ensuring the business stability of the brand and settling claims raised by its clients. On the other hand, an insurer with
- less than 50 ICR indicates that the provider is more inclined towards ensuring its profits and
- ICR over 100 is indicative that the insurer is paying off a significant amount of claims and may face a financial crunch in the future, leading to sustainability issues for the brand.
| Years | Niva Bupa Health Insurance | Industry Average |
|---|---|---|
| 2020 - 2021 | 56.09 | 78.27 |
| 2021 - 2022 | 62.12 | 91.79 |
| 2022 - 2023 | 54.05 | 78.82 | Average (2020 - 2023) | 57.42 | 82.96 |
Insight: While NIva Bupa’s ICR numbers lie within the ideal range, the numbers are too close to the lower threshold of 50, which is not a good indication. We would rather have an insurer with 80%+ ICR since that indicates that the insurer prioritises its client’s requirements over its business interests.
Complaint Volume of Niva Bupa Health Insurance
When choosing a health insurance provider, you must prioritise tallying the claim settlement experience of previous policyholders with an insurer. The best way to gauge this insurance track history is to look at an insurer's complaint volume. Since most complaints are related to claim settlement (delays, rejections, etc.), you will get a clear picture of the claim experience this insurer offers.
| Years | Niva Bupa Health Insurance | Industry Average |
|---|---|---|
| 2020 - 2021 | 44.46 | 13.212 |
| 2021 - 2022 | 42.74 | 35.969 |
| 2022 - 2023 | 46.36 | 19.578 | Average (2020 - 2023) | 44.52 | 24.029 |
Insight: Now, it’s true that since NIva Bupa is a standalone health insurance provider, its complaint volume numbers tend to be higher than that of general insurance companies. However, there are other standalone insurers in the market with much lower complaint numbers. Hence, Niva Bupa’s complaint volume history and average over the last 3 years are significant concerns. This reflects its deteriorating overall operational efficiency that needs swift improvement.
Top Health Insurance Plans Offered by Niva Bupa Health Insurance
While the metrics for Niva Bupa haven’t been promising, and its complaint volume raises some significant hurdles, the brand offers some of the best health insurance plans in the market. Niva Bupa is well-known in the health insurance industry for its industry-first and innovative features across its affordable policies. Here is a look at some of its more popular plans -
- Niva Bupa ReAssure 2.0
ReAssure 2.0 is one of the recent launches from the stable of Niva Bupa and is an updated version of its existing flagship ReAssure plan. ReAssure 2.0 has 3 variants - Bronze+, Titanium+, and Platinum+. While all three 3 variants have their list of pros and cons, the best variant of the lot is Platinum+, which doesn’t have any outrageous terms and conditions and multiple beneficial features like -
- Age-Lock feature: The premiums for the plan stay locked in as per your purchase age until you make the first claim.
- Forever Restoration: Once you file a claim, your unlimited restoration feature kicks in for the same and different ailments. Also, you can claim the total amount restored and the base amount in one go, in case you need it.
- Carry forward your unutilised cover: Your unutilised insured sum can be carried forward to the following year. This amount is capped at a maximum of 6 times the cover amount (5 times the cover amount + base amount for the year)
Apart from these unique features, the ReAssure 2.0 plan covers most of the standard bases - no room rent restrictions, no copayment, no disease-wise sub-limits, domiciliary coverage, 60 and 180 days of pre and post-hospitalisation coverage, respectively, free health check-ups, and more.
Drawbacks: The plan has a waiting period of 3 years for pre-existing medical conditions that could have been 2 years. However, the most crucial lookout at this point is the insurer. Despite being affordable, since the policy is from the Niva Bupa stable, we have concerns about the claim settlement situation.
Aspire is the latest launch in Niva Bupa's health insurance portfolio. Much like any other plan from this stable, the plan has a few unique features that are innovative and a first in the industry. The plans comes in 4 variants - Gold+, Diamond+, Platinum+, and Titanium+ and offers an extensive coverage of ₹3 lakhs to ₹1 crore
M-iracle: This is the most unique and primary perk of the NIva Bupa Aspire policy. This is a maternity perk that offers 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, the perk comes with a cap on the coverage amount extended by the insurer. This coverage ranges from ₹4k to ₹25k (depending on your sum insured).
- Booster+ Benefits: The unutilised insured sum for one year gets carried forward to the following year, and so on. Your chosen variant and your age determine the maximum carry-forward amount.
| Entry Age | Gold+ | Diamond+ | Platinum+ | Titanium+ |
|---|---|---|---|---|
| 18 - 35 | 3X | 5X | 10X | 10X |
| 36 - 45 | 2X | 3X | 5X | 5X |
| 46+ | 1X | 2X | 3X | 3X |
- ReAssure+ Benefits: Once you file a claim, the unlimited restoration feature kicks in and stays kicked in for the entire policy tenure. This feature is available for the same and different ailments.
- Lock the Clock & Lock the Clock(+): Your premiums stay locked as per your entry age until you make the first claim.
- The “Lock the Clock” feature is available for the Diamond+ and Platinum+ variants. In this case, even if you have filed only the M-iracle benefit, your premiums get affected from the subsequent year.
- The “Lock the Clock(+)” feature is available for the Titanium+ variant. In this case, an M-iracle claim won’t affect your premiums.
- Safeguard+: This feature offers a 3-way protection with coverage for consumables (medical equipment required during hospitalisation), inflation shield, and safeguarding your restored amount if your claims are under ₹1 lakh.
- Future Ready Add-On: If you are not married at the time of your policy purchase, you can cover the waiting period alone. When you get married and add your spouse (within 90 days of getting married), they will not need to cover any additional waiting period to avail of the various perks extended by this policy.
- Fast Forward Add-On: Say you have opted for a ₹10 lakhs coverage and a 3-pay for premium payment mode. The insurer offers you ₹30 lakhs as total coverage from Day 1 for the next 3 years. You can use this sum insured at your discretion. If the amount is utilised before the completion of 3 years, the unlimited restoration amount will remain for your claims.
Drawbacks: The plan’s pre-existing waiting period varies depending on the variant chosen - 3 years (Diamond+, Platinum+, Titanium+) and 4 years (Gold+). Considering the plan is a new launch, we would have preferred a much shorter waiting period. Additionally, since this policy is a new launch, it is undergoing multiple changes across terms and conditions, sub-limits, and more.
Conclusion
If you are looking for unique feature-lined health insurance plans that are easy on your pocket and don’t mind the complaint volume, Niva Bupa is a decent pick. However, considering our first-hand experiences interacting with the brand and client discussions, we recommend that you shop around for similar plans from other insurers to ensure a hassle-free claim settlement process and enhanced overall operational efficiency.