Overview
The Health Premia Gold plan by Niva Bupa is a premium health insurance policy tailored for individuals and families, offering sum insured options ranging from ₹10 lakhs to ₹50 lakhs. Its features include emergency international coverage, maternity benefits up to ₹1 lakh (depending on Base SI opted), and coverage for newborns from day one. The plan also provides refill benefits up to SI, loyalty additions increasing the sum insured annually, and AYUSH coverage up to SI. With no co-payment clause and room rent flexibility (except suites), it ensures seamless healthcare access both domestically and globally.
Experts Review
Written by Nikhil Nair
Senior Writer
The Niva Bupa Health Premia Gold plan is a standout health insurance product that offers comprehensive coverage with advanced features. Its emergency international coverage (excluding USA & Canada) makes it particularly appealing for frequent travelers or those seeking treatment abroad. Maternity benefits of up to ₹1 lakh and newborn coverage add significant value for families planning parenthood. The 100%% refill benefit ensures robust financial protection during multiple claims, while loyalty additions enhance long-term coverage.
Compared to the Silver variant, the Gold plan offers higher maternity benefits (₹1 lakh vs. ₹60,000), broader sum insured options (₹10 lakhs to ₹50 lakhs vs. ₹5 lakhs to ₹7.5 lakhs), and emergency international treatment features that make it more suitable for families with diverse healthcare needs.
However, the plan has certain limitations. Premiums are considerably higher due to its advanced features, which may deter budget-conscious buyers. Additionally, while room rent is flexible, suites are excluded from coverage, limiting premium hospitalization choices.
Pros
Feature set is satisfactory.
Insurer has a solid track record with great claim and service metrics.
Cons
Premiums are relatively high.
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 ₹70,000 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
Your insurance cover won’t be fully available in case you are treated for For few robotic surgeries, upto 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.
Add-ons
Enhanced NCB
Recommended
Additional bonus of 20% up to a maximum of 200%, irrespective of any claim in the previous year.
Safeguard
Recommended
Increase your cover in line with inflation every year and get extended coverage for generally excluded items like syringes, gloves, PPE kits etc as per List I.
Safeguard+
Recommended
Increase your cover in line with inflation every year and get extended coverage for generally excluded items like syringes, gloves, PPE kits etc as per List I, II, III & IV.
Hospital Cash
Hospital cash benefit paid out if hospitalization is at least 2 days, with a maximum payout of ₹5000 for up to 30 days.
Critical Illness
Paid out as a lump sum amount for Critical illnesses between Rs. 10 lakhs to Rs. 25 lakhs based on the cover chosen.
Personal Accident Cover
Paid out as a lump sum amount of Rs. 50 lakhs for Accidental Death, Total Permanent Disability, Permanent Partial Disability
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 1 years.
Pancreatitis and stones in biliary and urinary system
Cataract, glaucoma and other disorders of lens, disorders of retina
Hyperplasia of prostate, hydrocele and spermatocele
Abnormal utero-vaginal bleeding, female genital prolapse, endometriosis/adenomyosis, fibroids, PCOD, or any condition requiring dilation and curettage or hysterectomy
Hemorrhoids, fissure or fistula or abscess of anal and rectal region
Waiting Period
30 days Initial waiting period
1 years Specific illness waiting period
2 years Pre-existing disease waiting period
Ditto's Take
◦ Excellent ◦
Waiting periods on this policy are excellent. The specific illness waiting period is better than usual.
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Frequently Asked Questions
Does Health Premia 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 1-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.
- Maternity and Newborn Waiting Period: There’s a 2-year waiting period before you can make claims related to pregnancy and childbirth.
Does Health Premia Gold have room rent restrictions?
Does Health Premia Gold offer a restoration benefit?
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