Niva Bupa GoActive

FAQs

Do we cover OPD consultation in GoActive?
Yes, we will cover OPD Consultation taken by the Insured Person during the Policy Period (Number of consultation depending on sum insured). Please note that the OPD consultation available under the product can only be availed within the network of doctors empaneled with us. Such doctors can be searched through our website and mobile application.

What is the room rent limit in GoActive?

Up to 1% of base sum insured for policy with the sum insured up to 4 lacs
No restriction (except suite or above room category) for policy with sum insured 5 lacs and above

What is ICU/CCU charges limit in Go Active?

Up to 2% of base sum insured for policy with the sum insured up to 4 lacs
Covered up to sum insured for policy with sum insured 5 lacs and above

What is the limit for ambulance in Go Active?
Emergency ambulance is covered up to Rs.3000 per hospitalization

What is I-Protect benefit in Go Active?
I-Protect is an optional benefit which can be opted only at inception of first policy with us. If the Policy is Renewed with Us without a break, each Policy Year We will increase the Sum Insured applicable under the Policy by 10% of the Base Sum Insured of the immediately preceding Policy Year

Please note that this benefit cannot be opted at renewal of the policy

What is the maximum limit of sum insured increase in I-Protect benefit?
There is no maximum limit of increase in sum insured, if customer opted I-Protect benefit. Every year base sum insured will be increased by 10% at renewal life time.

Do we have two years policy options, if yes then what will be discount factor for same.
No we have only one year policy option.

Do we Family first option in this policy.
No we do not have Family First Option. Only individual and family floater options are available.

What are the cost sharing options available in Go Active?
- Annual Aggregate Deductible
- Zonal Co-Payment (Zone 2 coverage). If You select Zone 2 coverage, then 20% Co-payment will apply for Inpatient treatment in Mumbai (including Thane and Navi Mumbai), Delhi NCR, Kolkata & Gujarat State. This Zone-wise Co-payment shall not be applicable on OPD Consultation, Emergency Ambulance, Health Checkup / Diagnostic Tests, Second Medical Opinion, Behavioral Assistance Program and Personal Accident Cover.

Can I-Protect benefit be opted at the time of renewal?
No, this benefit can be opted only at inception of the first Policy with Us and not at Renewal of the Policy.

what is a Pre-Hospitalization limit in Go Active?
We will cover Pre-Hospitalization Medical Expenses for 90 days immediately preceding the Insured Person’s admission to Hospital for Inpatient Care and it is covered up to sum insured.

what is a Post-Hospitalization limit in Go Active?
Answer: We will Cover Post-Hospitalization Medical Expenses for 180 days immediately following the Insured Person’s discharge from Hospital and it is covered up to sum insured.

Do we cover alternative treatment in Go Active?
Answer: Alternative treatments are covered up to Sum Insured. Any inpatient treatment taken under Ayurveda, Unani, Sidha or Ayurveda in a recognised AYUSH Hopital are covered.

what is initial Waiting period in Go Active?
Answer: All the benefits under the Policy and any treatment taken unless the treatment needed is the result of an Accident that occurs during the Policy Period will be subject to a waiting period of 30 days since the inception of the First Policy with Us. Please note that Waiting Periods shall not apply to Health Checkup / Diagnostic Tests, Second Medical Opinion, OPD Consultation, Behavioral Assistance Program and optional benefits (if opted) under Health Coach and Personal Accident Cover.

What is the specific waiting period and list of illness.
The medical conditions and/or surgical treatment listed below will be subject to a Waiting Period of 24 months unless the condition is directly caused by Cancer (covered after Initial Waiting Period of 30 days) or an Accident (covered from day 1) and will be covered in the third Policy Year as long as the Insured Person has been insured continuously under the Policy without any break:

a. Pancreatitis and Stones in biliary and urinary System
b. Cataract, Glaucoma and other disorders of lens, disorders of retina
c. Hyperplasia of prostate, hydrocele and spermatocele
d. Abnormal utero-vaginal bleeding, female genital prolapse, endometriosis/adenomyosis, fibroids,
PCOD, or any condition requiring dilation and curettage or hysterectomy
e. Hemorrhoids, fissure or fistula or abscess of anal and rectal region
f. Hernia of all sites,
g. Osteoarthritis, Systemic Connective Tissue disorders, Dorsopathies, Spondylopathies, inflammatory Polyarthropathies, Arthrosis such as RA, Gout, Intervertebral Disc disorders
h. Chronic kidney disease and failure
i. Varicose veins of lower extremities
j. Disease of middle ear and mastoid including Otitis Media, Cholesteatoma, Perforation of Tympanic Membrane
k. All internal or external benign or In Situ Neoplasms/Tumours, Cyst, Sinus, Polyp, Nodules, Swelling,
Mass or Lump
l. Ulcer, Erosion and Varices of Upper Gastro Intestinal Tract
m. Tonsils and Adenoids, Nasal Septum and Nasal Sinuses
n. Internal Congenital Anomaly

If the Insured Person is suffering from the above Illness/condition as a Pre-existing Diseases (if disclosed by the Insured Person and accepted by Us), any claim in respect of that Illness/condition shall not be covered until 36 months of continuous coverage have elapsed since the inception of the First Policy with Us.

Please note that Waiting Periods shall not apply to Health Checkup / Diagnostic Tests, Second Medical Opinion, OPD Consultation, Behavioral Assistance Program and optional benefits (if opted) under Health Coach and Personal Accident Cover.

Can I-Protect benefit be opted out at the time of renewal?
Customer has the option to opt out of the benefit at the time of Renewal of the Policy. In such case, the accumulated Increased Sum Insured under I-Protect shall:

i. Not increase further and remain constant, if you pay the same additional percentage of premium as paid in the preceding Policy Year for this benefit. Or
ii. Be reduced to zero, if you do not pay any additional premium for this benefit.

If an insured person is covered in individual policy where he opted for I-Protect benefit and has an accumulated

Sum insured under I-Protect and want to renew policy as family floater, how I-Protect will work?
If the Insured Person in the expiring Policy is covered under an Individual Policy and has an accumulated Increased Sum Insured under I-Protect in the expiring Policy under this benefit, and such expiring Policy is Renewed with Us on a Family Floater Policy, then the I-Protect benefit and the accumulated Increased Sum Insured under I-Protect shall also be provided to the Family Floater Policy.

Can we accept high risk case with Loading?
Answer: Based on Our discretion, upon the disclosure of the health status of the persons proposed for insurance and declarations made in the Proposal or Insurance Summary Sheet, we may apply a risk loading on the premium payable (excluding statutory levies and taxes) or Special Conditions on the Policy.

Who can avail health checkup benefit and what is the frequency?
Any adult Insured Person on the commencement of that Policy can avail health checkup from very 1st day of the policy; he/she needs not to wait till first renewal. Health check is not available for policy with less than 3 lacs sum insured.

Is it mandatory to undergo listed health checkup only?
Answer: No, for policy with sum insured of 5 lacs and above, instead of availing Health Checkup (i.e. defined list of tests) and if allowed and specified in the Policy Schedule, any Insured Person may undergo the Diagnostic Tests of his/her own choice at any diagnostic center of his/her choice and get the expenses reimbursed or avail this benefit on Cashless Facility up to the amount as specified in the Policy Schedule. This benefit can also be availed by children covered under the policy. This benefit is named as Diagnostic Tests and only be availed in lieu of Health Checkup. Hence, only one of the two benefits i.e. Health Checkup or Diagnostics can be availed under a Policy.

What is the specified amount for diagnostic tests in lieu of health checkup?

SI	5 Lacs	7.5 Lacs	10 Lacs	15 Lacs	25 Lacs
Limits for 1AXC policy	Rs.1000	Rs.1500			Rs.2500
Limits for 2AXC policy	Rs.2000	Rs.3000			Rs.5000

Can utilization of diagnostic tests be done by adults insured only?
The utilization can be done by any of the insured persons including dependent child.

How many OPD consultations are available annually in Go Active?

SI	3 Lacs	4 Lacs	5 Lacs	7.5 Lacs	10 Lacs	15 Lacs	25 Lacs
OPD Consultation (For 1A, 1A+1C, 1A+2C: Consultations limits per policy, per policy year)	2	3	4	4	6	6	6
OPD Consultation (For 2A and more: Consultations limits per policy, per policy year)	4	5	6	8	10	10	10

Is there any discount available if Go Active policy is purchased in young age?
Yes, there will be a discount of 10% in the First Policy Year Base Premium and all subsequent Renewal Base Premium, if Age of the eldest Insured Person at the time of inception of the First Policy with Us is less than or equal to 35 years.

Will refill trigger on subsequent claim even if sum insured in partially exhausted due to claim?
Yes, even if Base Sum Insured and Increased Sum Insured under I-Protect (if any) has been partially exhausted due to claims made and paid or claims made and accepted as payable for any Illness / Injury during the Policy Year, then We will provide a Re-fill amount of maximum up to 100% of the Base Sum Insured which may be utilized for claims arising in that Policy Year for different/unrelated illness.

What is the maximum limit for a single claim after applying Re-fill benefit?
The maximum liability for a single claim after applying Re-fill benefit shall not be more than Base Sum Insured and Increased Sum Insured under I-Protect (if any).

What are the optional benefits available in GoActive?

I-Protect
Health Coach
Personal Accident Cover
Claim cost sharing option – Annual Aggregate Deductible

What is Behavioral Assistance Program in Go Active?
Under Behavioral Assistance Program benefit, we cover the counseling sessions through telephonic mode to provide support on pre-marital counseling, nutrition, stress, child and parenting taken by the Insured Person during the Policy Period.

This benefit is available for policy with sum insured of 3 lacs and above.

What is Second Medical Opinion in Go Active?
If the Insured Person is diagnosed with a Specified Illness as defined under policy schedule or is planning to undergo a planned Surgery or a Surgical Procedure for any Illness or Injury, the Insured Person can, at the Insured Person’s sole direction, obtain a Second Medical Opinion during the Policy Period.

Who can avail optional benefit of health coach in Go Active?
This benefit is available either to the Primary Insured Person or Primary Insured Person along with his/her spouse.

What are we covering in Personal Accident Cover in Go Active?

Accident Death within 365 days of accident
Accidental Permanent Total Disability(PTD)
Accidental Permanent Partial Disability(PPD)

What is Pharmacy and Diagnostic Services in Go Active?
Policy holder may purchase medicines and diagnostic services from Our Empaneled Service Provider through Our mobile application or website. The cost for the purchase of the medicines or diagnostic services shall be borne by policyholder.

If child is included in family floater plan, when child has to take separate policy?
Answer: If any Insured Person who is a child and has completed Age 22 years at the time of Renewal, then such Insured Person will have to take a separate policy.

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All You Need To Know

Healthy living is happy living. To ensure you lead a healthy life, we bring you GoActive, a comprehensive health insurance cover that ensures overall wellness and complete happiness for you and your family.

GoActive goes beyond the coverage of your hospitalisation expenses as it takes care of your overall health. It gives you the flexibility to choose the perfect cover for your needs, gives you the option to choose from a varied list of benefits and what’s more, it rewards you for being healthy!

Go Active not only cares for your health but your wealth too. It is a pocket-friendly health insurance plan that is designed keeping you and your family (your spouse and up to 4 children) in mind. Some of the key benefits include OPD Consultations, I-Protect, Health Coach and more.

Coverage

Individual & Family floater sum Insured Options:
Rs 4 Lacs, 5 Lacs, 7.5 Lacs, 10 Lacs, 15 Lacs and 25 Lacs

Features

In-patient Care (Hospitalisation)
We cover cost of medical treatment when you or your insured family members are hospitalised for treatment.
Hospital Accommodation
We cover cost of all types of hospital accommodation (except suite or above room category) without any capping on room rent charges (for Sum Insured of Rs.5 lacs and above).
Pre & Post Hospitalisation Medical Expenses
We reimburse pre & post hospitalisation medical expenses incurred due to illness/injury. The period of the treatment covered is 90 days before you get admitted to the hospital and 180 days after you get discharged from the hospital. This is subject to Niva Bupa accepting the In-patient Care hospitalisation, Day Care or Domiciliary hospitalisation claim.
Day care treatments covered
We cover day care treatments under the product. Please refer to Annexure VI of the policy document to know the day care procedures covered under the product..
Home Health Care Services
Home Health Care is a range of health care services and medically necessary treatment that can be given at home for an illness or injury. These shall include services such as nursing care, investigations, medication (including oral and intravenous), chemotherapy, dialysis, transfusions, physiotherapy and postsurgical care.

The Home Health Care Services are covered only if we have accepted an In-patient Care hospitalisation claim and Home Health Care Services are availed immediately after that hospitalisation. The Home Health Care Services are provided through empanelled service provider in selected cities only. Please contact us for updated list of cities where Home Health Care Services are provided.
Domiciliary Hospitalisation
In case a bed in the hospital is unavailable or on advice of the attending medical practitioner, treatment is administered at home; we pay for medical treatment taken at home, which would otherwise have required hospitalisation. Such treatment should continue for at least 3 consecutive days and confirmation from treating medical practitioner/insured that insured person could not be transferred to the hospital or hospital bed was unavailable, as the case may be.
Organ Transplant
Medical expenses for an organ donor’s In-patient treatment for the harvesting of the organ donated is also covered provided the organ is for the use of the insured person.
Emergency Ambulance
We also cover the ambulance expenses to transfer the insured following an emergency to the nearest hospital. These expenses are paid up to Rs 3,000 per hospitalisation only if we have accepted the In-patient claim.
Health Checkup / Diagnostic Tests
You can avail health Checkup for yourself and your spouse (if insured under the policy) annually so that you live a healthier and happier life. You can undergo a Health Checkup through service provider on cashless basis. There shall be a pre-defined list of tests basis the Sum Insured chosen as specified in Annexure III of Policy terms and conditions.

Instead of undergoing the pre-defined list of tests under health checkup for Sum Insured of Rs5 lacs and above, you can undergo the diagnostic tests of your choice up to a fixed amount depending upon your Sum Insured either on cashless or reimbursement basis. The cashless facility will only be available through empanelled service provider.

Please note that only one of either Health Checkup or Diagnostic Tests can be availed.
Refill Benefit
In case you have exhausted your Base Sum Insured and Increased Sum Insured under I-Protect (if any) partially or completely, you are entitled for an additional sum insured equal to the base sum insured for a subsequent claim in the same year, provided it is for an unrelated illness.
Second Medical Opinion
You can obtain second medical opinion for specified illness / planned surgery / surgical procedure.
OPD Consultation
Avail OPD consultations within a network either on cashless or reimbursement basis. In case of reimbursement, the maximum amount payable per OPD consultation is Rs.600 (for Zone 1) and Rs.500 (for Zone 2). The number of consultations will depend on the Sum Insured chosen.
Behavioral Assistance Program
You can avail consultation/counseling from a psychotherapist/counselor over a call to provide support on pre-marital counseling, nutrition, stress, child, parenting, etc.
Pharmacy and Diagnostic Services
You may purchase medicines and diagnostic services from the empanelled service provider through our mobile application or website. The cost for the purchase of the medicines or diagnostic services shall be borne by you.
AdvantAGE
You will get a discount of 10% in the first policy year Base Premium and all subsequent renewal Base Premiums, if age of the eldest insured person at the time of inception of the first policy is less than or equal to 35 years.
I-Protect (Optional)
Get an increase in Sum Insured by 10% of the Base Sum Insured for every renewal. The benefit will be provided for every policy year as long as the policy is renewed or until you request for opting out of this benefit.
Health Coach (Optional)
You can opt for personalized health coaching services to keep yourself fit and healthy. Based on your health score, a premium discount of maximum up to 20% of the base premium may apply at the time of renewal.
Personal Accident Cover (Optional)
Personal Accident coverage against accident death, permanent total and partialdisability.
Annual Aggregate Deductible (Optional)
Top Up with Annual Aggregate Deductible option of Rs 25,000, Rs 50,000, Rs 1 lac, Rs 2 lacs, Rs 3 lacs, Rs 5 lacs & Rs 10 lacs
Zonal coverage
You can opt for one of the following two zones.

• Zone 1: All India coverage
• Zone 2: All India coverage (Co-payment applicable for Mumbai, Delhi NCR, Kolkata & Gujarat)

If You select Zone 2, then 20% co-payment will apply for Inpatient treatment in Mumbai, Delhi NCR, Kolkata & Gujarat. This Zone-wise co-payment shall not be applicable on OPD Consultation, Emergency Ambulance, Health Checkup / Diagnostic Tests, Second Medical Opinion, Behavioral Assistance Program and Personal Accident Cover.
Tax Benefit
Save tax under Section 80D of the Income Tax Act when you buy a Niva Bupa health insurance policy. Tax benefits are subject to changes in the tax laws, please consult your tax advisor for more details.
Assured Policy Renewal for Life
Once insured with us, you will always remain our customers subject to continued payment of premium. We assure you renewability for life with no extra loadings based on your claim history.
Direct Claim Settlement
We believe you should focus on the treatment of your loved ones rather than running after claim settlement. Therefore, all claims are processed directly by our customer service team.
Cashless Facility
Cashless Facility can be availed only at our Network Providers or Service Providers. Please contact us for more details.
Free Look Period
We endeavor for transparency and complete satisfaction and therefore, our policies are transparent and easy to understand. If you are not satisfied, we provide a 15-day free look period within which you can cancel your plan stating the reason.
Waiting Periods
• Pre-existing Disease waiting period of 36 months since inception of the policy and continuous renewal
•Initial Waiting Period of 30 days unless the treatment needed is the result of an accident.
•Specific Waiting Period of 24 months for some listed illnesses, unless the condition is directly caused by cancer (covered after initial Waiting Period of 30 days) or an accident
covered from day 1)

Please note that Waiting Periods shall not apply to annual health checkup or diagnostic tests, second medical opinion, out-patient consultations, counseling sessions and optional benefits if opted for.

Please do read more about the common exclusions in the policy terms & conditions.

Click Here to read the policy wording.

Eligibility Criteria

Entry Age and family coverage
The entry age for adults under this policy can be from 18 to 65 years. The entry age for dependent children is from 91 days to 21 years.

The policy can be taken individually or for the family. The family floater policy is available in any of the following combinations:
• 1 Adult + 1 Child
• 1 Adult + 2 Children
• 2 Adults
• 2 Adults + 1 Child
• 2 Adults + 2 Children
• 2 Adults + 3 Children
• 2 Adults + 4 Children

Permanent Exclusion
• Ancillary hospital charges
• Hazardous activities
• Artificial life maintenance
• Behavioral, Neurodevelopmental and Neurodegenerative Disorders
• Circumcision
• AYUSH treatments, except inpatient treatments taken under Ayurveda, Unani, Sidha and Homeopathy
• Conflict & disaster
• External congenital anomaly
• Convalescence & rehabilitation
• Cosmetic and reconstructive surgery
• Dental/oral treatment
• Eyesight & optical services
• Experimental or unproven treatment
• HIV, AIDS, and related complex
• Hospitalisation not justified
• Inconsistent, irrelevant or incidental diagnostic procedures
• Mental and psychiatric conditions
• Non-medical expenses
• Obesity and weight control programs
• Off- label drug or treatment
• Puberty and menopause related disorders
• Reproductive medicine & other maternity expenses
• Robotic assisted surgery, light amplification by stimulated emission of radiation (LASER) & light based treatment
• Sexually transmitted infections & diseases
• Sleep disorders
• Substance related and addictive disorders:
• Unlawful activity
• Treatment received outside India
• Unrecognized physician or hospital
• Generally, excluded expenses - Any costs or expenses specified in the list of expenses generally excluded at • Annexure II of the Policy Document.
• Permanent Exclusion for Personal Accident Cover (if opted)
We shall not be liable to make any payment under any benefits under the Personal Accident Cover if the claim is attributable to, or based on, or arise out of, or are directly or indirectly connected to any of the following:
a.   Suicide or self-inflicted injury, whether the insured person is medically sane or insane.
b.   Treatment for any injury or illness resulting directly or indirectly from nuclear, radiological emissions, war or war like situations (whether war is declared or not), rebellion (act of armed resistance to an established government or leader), acts of terrorism.
c.   Service in the armed forces, or any police organisation, of any country at war or at peace or service in any force of an international body or participation in any of the naval, military or air force operation during peace time.
d.   Any change of profession after inception of the policy which results in the enhancement of our risk, if not accepted and endorsed by us on the policy schedule.
e.   Committing an assault, a criminal offence or any breach of law with criminal intent.
f.   Taking or absorbing, accidentally or otherwise, any intoxicating liquor, drug, narcotic, medicine, sedative or poison, except as prescribed by a medical practitioner other than the policyholder or an insured person.
g.   Participation in aviation/marine including crew other than as a passenger in an aircraft/water craft that is authorised by the relevant regulations to carry such passengers between established airports or ports.
h.   Engaging in or taking part in professional/adventure sports or any hazardous pursuits, such as speed contest or racing of any kind (other than on foot), bungee jumping, parasailing, ballooning, parachuting, skydiving, paragliding, hang gliding, mountain or rock climbing necessitating the use of guides or ropes, potholing, abseiling, deep sea diving using hard helmet and breathing apparatus, polo, snow, ice sports, hunting, etc.
i.   Body or mental infirmity or any disease except where such condition arises directly as a correspondence of an accident during the policy period. However, this exclusion is not applicable to claims made under the Permanent Partial Disability benefit.

Commission on General Insurance

Niva Bupa GoActive

FAQs

All You Need To Know

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