Care Joy vs Niva Bupa Health Premia Gold

Covers a Single Private Room with AC. A higher room category means room, boarding, nursing, OT and doctor/surgeon fees are reduced in proportion to the difference in room rent.

Covered up to Sum Insured, any room except Suite or above (all Gold variants incl. Family First). Proportionate deduction applies if a higher room than eligible is taken

ICU charges (ICU bed, monitoring devices, critical care nursing and intensivist charges) are payable as part of in-patient hospitalisation up to the sum insured. There is no separate ICU sublimit.

Covered up to Sum Insured as part of In-patient Care; no separate ICU cap stated

20% of each admissible claim applies if the insured's entry age (eldest member for a floater) is 60 years or above. No co-payment applies for entry ages below 60.

No mandatory co-payment with Zone 1 pricing. With Zone 2 pricing, 20% co-pay applies to treatment in Mumbai (incl. Navi Mumbai & Thane), Delhi NCR, Kolkata and Gujarat. OPD claims under International Coverage have 20% co-pay

No disease-specific caps apply to general hospitalisation, which is payable up to the sum insured. Fixed limits apply to maternity (₹35,000/₹50,000), newborn baby (₹30,000/₹50,000) and ambulance (₹1,000 per claim).

No sublimits on common conditions like cataract or joint replacement. Sublimits apply to: robotic surgeries (₹1 Lakh, with exceptions), specified mental disorders (₹50,000), HIV/AIDS (₹50,000 per year), LASER surgery (up to ₹50,000), non-network road ambulance (₹2,000 per event)

Cashless treatment is available at 11,400+ Care network hospitals across India. Pre-authorisation is required, and the network list can change, so check the hospital list before admission.

Cashless treatment at Niva Bupa network hospitals across India; 10,000+ network hospitals (approximate, per Platinum brochure and Annual Report FY 2024-25; subject to change). Pre-authorisation target of 30 minutes

Not available. Once the sum insured is used, it is not restored within the same policy year. The optional No Claim Bonanza is a bonus for claim-free years, not a restoration benefit.

Re-fill Benefit: up to 100% of Base Sum Insured once per policy year, for the same or a different illness, after the Sum Insured is partly or fully used. Not available under the Family First variant

Optional "No Claim Bonanza", available for an additional premium. After three consecutive claim-free policy years, the sum insured increases by 100% of the expiring sum insured. The accrued bonus cannot exceed 100% of the sum insured in the renewed policy. If a claim is made, the accrued bonus is not carried to the next renewal, but the base sum insured is never reduced. The bonus is lost if the policy is not renewed within the grace period.

Loyalty Additions of 10% of expiring Base Sum Insured every policy year, up to 100%, even if you claim. Optional Enhanced Loyalty Addition: 20% per year, up to 200%

Covers a long list of procedures that need less than 24 hours of hospitalisation (for example cataract, dialysis, chemotherapy and radiotherapy, lithotripsy, tonsillectomy and arthroscopy). Cover is up to the sum insured and subject to waiting periods.

All listed day care procedures (Annexure III) covered up to Sum Insured

Not covered. Non-medical items (for example gloves, masks, diapers, kits, belts, surcharges and similar items in the policy's non-payable list) are excluded. Some items, such as admission and registration charges, are treated as part of room or procedure charges and are not paid separately.

Allowable consumables paid within hospital bills; IRDAI non-payable items are not covered in the base plan. Covered with the optional Safeguard (List I) or Safeguard+ (Lists I-IV) add-on (Add-on UIN NBHHLIA24109V022324)

Not offered as a standard benefit. Treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy, and other non-allopathic treatment, is excluded.

In-patient Ayurveda, Unani, Siddha and Homeopathy treatment in an AYUSH hospital covered up to Sum Insured, with 90/180 days pre/post-hospitalisation

30 days

30 days (not for accidents or renewals)

24 months of continuous coverage for listed conditions and procedures. These include arthritis and spinal disorders, joint replacement, benign ENT disorders, benign prostatic hypertrophy, cataract, piles/fissure/fistula, hernia and hydrocele, hysterectomy for fibroids, kidney or gall bladder stones, and varicose veins. Accident-related claims are exempt. Prior continuous coverage can reduce the waiting period. If a listed condition is also pre-existing, the longer waiting period applies.

12 months for listed conditions (e.g. cataract, hernia, joint/spine disorders, piles). Accidents covered from day 1; cancer after the 30-day wait. Mental illness and LASER surgery: 36 months. HIV/AIDS: 48 months

36 months of continuous coverage from the first policy with Care. Pre-existing conditions must be declared at proposal. If the sum insured is increased, the waiting period applies afresh to the increased amount. Continuous prior coverage with another insurer can reduce the waiting period on porting.

24 months of continuous cover

Covers 12 listed advanced treatments within the sum insured: uterine artery embolization and HIFU, balloon sinuplasty, deep brain stimulation, oral chemotherapy, monoclonal antibody immunotherapy (injection), intravitreal injections, robotic surgeries, stereotactic radio surgeries, bronchial thermoplasty, laser prostate vaporisation (green laser or holmium laser), intra-operative neuro monitoring (IONM), and hematopoietic stem cell therapy for bone marrow transplant in blood disorders. Advanced methods outside this list are not covered.

Covered up to Sum Insured (12 listed procedures, e.g. robotic surgery, oral chemotherapy, immunotherapy, stem cell therapy). Robotic surgeries capped at ₹1 Lakh, except robotic radical prostatectomy, cardiac, partial nephrectomy and cancer surgeries

Not available as a benefit. Depending on age and sum insured, Care may ask for pre-policy medical tests at its own cost. If the proposal is declined or the policy is cancelled in the free-look period, the test cost is deducted from the refund.

Annual from Day 1: tests up to ₹2,500 per insured (₹10-20L SI), ₹5,000 (₹30L), ₹7,500 (₹50L). Family First Gold: ₹2,500

30 days before admission. Expenses must relate to the same illness or injury and the hospitalisation claim must be admissible.

Up to 90 days before admission, covered up to Sum Insured

60 days after discharge. Expenses must relate to the same illness or injury and the main hospitalisation claim must be admissible.

Up to 180 days after discharge, covered up to Sum Insured

Not covered. Routine consultations, tests and pharmacy bills without hospital admission are not payable. Pre- and post-natal expenses are covered only within the maternity limit and as part of the delivery hospitalisation claim.

Domestic OPD: Not available under Gold. (OPD abroad is covered only within the in-built International Coverage, with 20% co-pay). Unlimited e-consultations included in all plans

No deductible applies. This is a base indemnity plan, not a top-up.

Not available (the policy wording has no deductible option for Health Premia)

Sum insured of ₹3 lakh or ₹5 lakh, on an Individual or Family Floater basis. Policy term is 3 years. Entry age is 18 to 65 years for adults, 1 day to 24 years for children, and 1 day to 90 days for newborns. Lifelong renewability. Maternity cover is available only for insured women aged 45 or below.

Individual / Family Floater: ₹10, 15, 20, 30 or 50 Lakh Base Sum Insured. Family First variant: Base Individual SI ₹5-10 Lakh per person with a shared floater layer on top. Policy types: Individual, Family Floater (up to 6 members, max 4 children) and Family First (up to 19 relationships). Entry age: adults 18-65, children 91 days-30 years. 1, 2 or 3-year terms; lifelong renewal

96.74% for FY 2024-25 (insurer-level, based on IRDAI public disclosures). This reflects Care Health Insurance overall, not Care Joy specifically.

93.5% of claims settled (by number) for Health Premia in FY 2025-26. Source: Niva Bupa Public Disclosures FY2025-26 (Form NL-47), https://transactions.nivabupa.com/pages/doc/pub-dis/quarterly-reports/Website-Public-Disclosures-Mar-2026.pdf. Company-level: 94.4% (Niva Bupa Annual Report FY 2025-26)

Covers delivery hospitalisation (normal and C-section) including pre-natal and post-natal expenses: up to ₹35,000 on a ₹3 lakh sum insured and up to ₹50,000 on a ₹5 lakh sum insured. Waiting period is 9 months of continuous coverage. Newborn baby cover applies if the maternity claim is admissible. Voluntary termination of pregnancy in the first 12 weeks and miscarriage (unless caused by an accident) are not covered. Ectopic pregnancy is covered under regular hospitalisation, not the maternity limit.

Covered only under Family Floater / Family First (not Individual), after 24 months continuous cover, up to 2 pregnancies/terminations: ₹70,000 (₹10L), ₹75,000 (₹15L), ₹80,000 (₹20L), ₹1,00,000 (₹30L/₹50L); Family First Gold ₹50,000. New born covered up to SI till end of policy year; newborn vaccination in first year