Overview
Niva Bupa’s Health Pulse Enhanced plan is a comprehensive health insurance policy offering sum insured options ranging from ₹3 lakhs to ₹25 lakhs. Key features include a 150% enhanced refill benefit (as an add-on) for exhausted coverage, no co-payment clause, and no disease-specific sub-limits (however, modern treatments are covered up to the Sum Insured with a sub-limit of Rs. 1Lac on a few robotic surgeries), ensuring transparent claims. It covers pre- and post-hospitalization expenses (30 and 60 days), daycare treatments (up to SI), domiciliary hospitalization (up to SI), and organ donor expenses (up to SI). The plan also comes with annual health check-ups starting from the second year and room rent caps (Up to 1% of Base Sum Insured or Single Private Room (whichever is lower) for SI < ₹5L; Single Private Room for SI ≥ ₹5L).
Experts Review
Written by Nikhil Nair
Senior Writer
The Niva Bupa Health Pulse Enhanced plan is an excellent choice for those seeking advanced health insurance coverage with standout features like the 150% refill benefit (through add-on), which offers additional financial security during multiple claims in a policy year. The absence of co-payment ensures hassle-free claims processing, making it ideal for families with diverse healthcare needs. Coverage for daycare treatments and domiciliary hospitalization adds versatility for minor procedures or home-based care. Similar to the Health Pulse Classic Variant, it also covers for HIV/AIDS (up to 10% of Base Sum Insured, subject to a maximum of 50,000) and mental disorder treatments (up to SI with sub-limits on a few conditions).
Meanwhile while compared to the Health Pulse Classic variant, the Enhanced plan offers higher sum insured options (up to ₹25 lakhs vs. ₹10 lakhs), This upgrade makes it more suitable for larger families or individuals seeking higher sum insured benefits.
That said, the plan’s premiums are relatively higher due to its offerings, which may not suit budget-conscious buyers. Additionally, while comprehensive, the waiting period for pre-existing conditions remains the same as the Classic variant (three years), which might deter those looking for reduced waiting periods at this price point.
Pros
Feature set is satisfactory.
Great pick if you're looking for something affordable.
Insurer has a solid track record with great claim and service metrics.
Cons
Some Restoration Benefit, which is a notable gap.
Maternity benefits not offered, which could be a drawback for some.
Doctor consultations are not covered, which is a key feature. Need to opt add-on for doctor consultations.
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
92% claims settled in 30 Days
Niva Bupa (erstwhile Max Bupa) settles 92% 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
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
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
Your insurance cover won’t be fully available in case you are treated for null 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 you wait for 3 years.
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 - 30 days before you are hospitalized and 60 days after discharge. This includes the cost of medication by the way.
Add-ons
Safeguard
Recommended
Increase your cover in line with inflation every year, your bonus amount will not be affected if the claim is less than Rs. 50,000 in the entire year and you also get extended coverage for generally excluded items like syringes, gloves, PPE kits etc as per List I.
Enhanced NCB
Recommended
Additional bonus of 20% up to a maximum of 200%, irrespective of any claim in the previous year.
Hospital Cash
Hospital cash benefit paid out if hospitalization is at least 1 day, with a maximum payout of ₹1000 for up to 30 days.
Critical Illness
Paid out as a lump sum of 1000000 for listed illnesses.
Personal Accident Cover
Paid out as a lump sum of 500% of sum insured for Accidental Death, Total Permanent Disability, Permanent Partial Disability up to a limit of ₹5000000.
Enhanced Refill
Restores the cover once a year up to 150% of the sum insured for different illness.
E-consultations
Get unlimited tele/ online consultations.
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 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/adenomyosis, fibroids, PCOD, hysterectomy (unless necessitated by malignancy), abnormal utero-vaginal bleeding
Hemorrhoids, fissure, fistula or abscess of anal and rectal region
Waiting Period
30 days Initial waiting period
2 years Specific illness waiting period
3 years Pre-existing disease waiting period
Ditto's Take
◦ Standard ◦
After a close look at the waiting periods, it’s safe to say they are fairly standard.
What's missing in the policy
Some Restoration Benefit.
Maternity benefits not offered.
Doctor consultations are not covered. Need to opt add-on for doctor consultations.
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Frequently Asked Questions
Does Health Pulse Enhanced 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 3-year waiting period for any pre-existing disease you may have while buying the policy.
Does Health Pulse Enhanced have room rent restrictions?
Does Health Pulse Enhanced offer a restoration benefit?
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