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Cashless claims let you get treatment at network hospitals without paying upfront, while reimbursement claims require you to pay first and get refunded later.

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How do co-payment clauses impact health insurance premiums and claim settlements?

Co-payment means you share a part of the claim cost. Opting for co-pay lowers your premium but increases your out-of-pocket expenses.

Which health insurance plan offers the best coverage for critical illnesses and pre-existing diseases?

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Can I compare waiting periods and sub-limits for hospitalisation expenses on OneAssure?

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What are room rent limits in health insurance, and how do they affect claims?

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Super Mediclaim Vs Health Premia Platinum

Insurance Plans Comparison

Care Super Mediclaim vs Niva Bupa Health Premia Platinum

Make an informed decision with our detailed side-by-side comparison of top health insurance policies. Compare coverage, benefits, and premiums to find the perfect plan for your needs.

Make an informed decision with our detailed side-by-side comparison of top health insurance policies. Compare...

Super Mediclaim

Care Super Mediclaim offers health insurance options focused on specified critical illnesses, cancer, heart conditions and surgical procedures, subject to the selected variant and policy terms.

What Makes It Special:

Care Super Mediclaim is a health insurance product with four specialised variants: Critical Mediclaim, Cancer Mediclaim, Heart Mediclaim and Operation Mediclaim. Each variant is designed around defined medical conditions or procedures and may include hospitalisation, daycare, pre- and post-hospitalisation and other eligible benefits.

Best For:

Customers comparing specialised health coverage options alongside their existing health insurance.
Individuals seeking insurance for defined surgical procedures.
People looking for cover for specified heart-related conditions.
Customers seeking financial protection for eligible cancer treatment.
Individuals looking for cover focused on specified critical illnesses.

Health Premia Platinum

Health Premia Platinum offers ₹1-3 Crore cover with any room, OPD cover, ₹2 Lakh maternity, multi-trip travel cover and specified illness treatment abroad.

What Makes It Special:

Health Premia Platinum is Niva Bupa’s top Health Premia plan, combining ₹1-3 Crore cover with no room category limit, OPD, ₹10,000 annual health check-up, worldwide second opinion, child vaccination, specified illness treatment abroad and annual multi-trip international cover up to ₹1 Crore.

Best For:

Buyers who want treatment abroad for major specified illnesses like cancer and heart attack
People who want OPD, health check-up and child vaccination covered
Couples planning a family who want ₹2 Lakh maternity cover worldwide (excl. USA/Canada)
Frequent international travellers who want annual multi-trip medical cover
Families wanting very high cover of ₹1-3 Crore

Insurance Plans Comparison

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Our insurance experts are here to help you make the right choice. Get personalized recommendations based on your specific needs and budget.

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Quick Decision Guide

Care Super Mediclaim

Assess your overall coverage: Consider whether specialised cover complements your existing health insurance and financial needs.
Compare limits and exclusions: Review room eligibility, co-payments, deductibles and variant-specific restrictions.
Understand waiting periods: Initial, specified-illness and pre-existing disease waiting periods can affect when benefits become available.
Review the covered conditions: Check whether the treatment or diagnosis you want protection for is included.
Choose the right variant: Each option covers a different set of illnesses, conditions or procedures.

Niva Bupa Health Premia Platinum

Reasons to Consider: Loyalty Additions grow cover by 10% of Base Sum Insured every year up to 100%, even if you claim.
Reasons to Consider: A 100% Re-fill of Base Sum Insured is available once a year for any illness.
Reasons to Consider: Pre- and post-hospitalisation are covered for 90 and 180 days.
Reasons to Consider: PED waiting period is 24 months and specific disease waiting period is 12 months.
Reasons to Consider: Any room category, OPD cover and annual multi-trip international cover are built in.
Things to Consider: Maternity cover is only for Family Floater / Family First policies after 24 months of continuous cover.
Things to Consider: Zone 2 pricing means a 20% co-payment for treatment in Mumbai, Delhi NCR, Kolkata and Gujarat.
Things to Consider: Non-payable items such as gloves need the paid Safeguard add-on.
Things to Consider: Robotic surgery, some mental disorders and HIV/AIDS have sub-limits; mental illness has a 36-month wait.
Things to Consider: Premium is higher because of ₹1-3 Crore cover and the built-in extras.

Insurance Plans Comparison

Detailed Features Comparison

Compare the key features of different health insurance plans

Super Mediclaim

Health Insurance Plan

Health Premia Platinum

Health Insurance Plan

Brochure

Policy Wording

Room Rent
Super Mediclaim Room eligibility depends on the sum insured and applicable variant. The official overview lists a single private room for certain sum insured levels and all room categories for higher eligible sum insured levels. Check the current policy schedule for the precise entitlement.	Health Premia Platinum Covered up to Sum Insured, no room category restriction (Any Room, incl. suite)

ICU Charges
Super Mediclaim ICU expenses are covered subject to the sum insured and applicable policy terms. The official product overview lists ICU charges without a separate limit for the displayed variants.	Health Premia Platinum Covered up to Sum Insured as part of In-patient Care; no separate ICU cap stated

Co-payment
Super Mediclaim A co-payment option may be available, and the applicable percentage depends on the policy selected. Check the current policy schedule for any mandatory or optional co-payment.	Health Premia Platinum 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

Disease-wise sublimits
Super Mediclaim Variant-specific conditions, procedures and benefits may have limits. Critical Mediclaim covers specified critical illnesses, Cancer Mediclaim covers eligible cancer-related treatment, Heart Mediclaim covers specified heart conditions, and Operation Mediclaim covers defined surgical procedures.	Health Premia Platinum No sublimits on common conditions like cataract or joint replacement. Sublimits apply to: robotic surgeries (₹1 Lakh, with exceptions), specified mental disorders (₹1,00,000), HIV/AIDS (₹50,000 per year), LASER surgery (up to ₹1,00,000), non-network road ambulance (₹2,000 per event)

Cashless Healthcare Providers
Super Mediclaim Cashless treatment is available at eligible network hospitals, subject to network status, pre-authorisation and policy conditions. The network may change over time.	Health Premia Platinum 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

Restoration Benefit
Super Mediclaim Automatic recharge may be available as an optional benefit under applicable product versions. It should not be described as a standard or unlimited benefit unless confirmed in the current policy schedule.	Health Premia Platinum 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

Cumulative Bonus
Super Mediclaim No-claim bonus can increase the sum insured by up to 100% over three consecutive claim-free policy years, subject to the applicable variant’s bonus schedule and claim conditions.	Health Premia Platinum 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%

Daycare Treatment
Super Mediclaim Eligible daycare procedures are covered up to the applicable sum insured, subject to the variant’s covered-procedure list and policy terms.	Health Premia Platinum All listed day care procedures (Annexure III) covered up to Sum Insured

Consumable Cover
Super Mediclaim Separate comprehensive coverage for non-medical consumables is not established as a standard benefit in the reviewed product overview. Eligible hospital expenses remain subject to policy terms.	Health Premia Platinum 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)

AYUSH Treatment
Super Mediclaim Eligible AYUSH treatment is covered under applicable variants and policy conditions. The historical brochure identifies variant-specific restrictions, including limits for certain treatments.	Health Premia Platinum In-patient Ayurveda, Unani, Siddha and Homeopathy treatment in an AYUSH hospital covered up to Sum Insured, with 90/180 days pre/post-hospitalisation

Initial Waiting Period
Super Mediclaim Generally 30 days for illnesses from policy inception, except eligible claims arising from accidents, subject to policy terms.	Health Premia Platinum 30 days (not for accidents or renewals)

Specific Waiting Period
Super Mediclaim A 24-month waiting period applies to specified illnesses or procedures where listed in the applicable policy wording. The applicable list depends on the variant.	Health Premia Platinum 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

PED Waiting Period
Super Mediclaim The historical product information lists a 36-month waiting period for pre-existing diseases. Any available reduction option and the applicable current waiting period must be checked against the selected policy version.	Health Premia Platinum 24 months of continuous cover

Modern Treatment
Super Mediclaim Coverage depends on the selected variant and applicable policy terms. Refer to the current variant wording for the eligible advanced procedures and limits.	Health Premia Platinum 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

Annual Health Checkup
Super Mediclaim Annual health check-ups are available from the second policy year after continuous coverage, subject to the applicable policy conditions.	Health Premia Platinum Annual from Day 1: tests up to ₹10,000 per insured (Family First Platinum: ₹5,000)

Pre-Hospitalisation
Super Mediclaim Eligible medical expenses incurred during the 30 days immediately before hospitalisation are covered, subject to policy terms.	Health Premia Platinum Up to 90 days before admission, covered up to Sum Insured

Post-Hospitalisation
Super Mediclaim Eligible post-hospitalisation medical expenses are covered for up to 60 days after discharge, subject to the policy terms and claim admissibility.	Health Premia Platinum Up to 180 days after discharge, covered up to Sum Insured

Outpatient Department Cover (OPD Expense)
Super Mediclaim OPD benefits may be available for eligible covered conditions under the applicable variant and policy limits. Under the historical product information, OPD expenses are linked to an admissible hospitalisation claim for the same illness.	Health Premia Platinum Covered up to ₹50,000 per policy per year (Family First: ₹35,000) for consultations, diagnostics and prescribed medicines; 80% of unused amount carried forward, total capped at 2.5x the annual limit. Unlimited e-consultations included in all plans

Deductible Option
Super Mediclaim A deductible option may be available to reduce the premium. Availability, deductible amount and application conditions depend on the selected variant and policy schedule.	Health Premia Platinum Not available (the policy wording has no deductible option for Health Premia)

Coverage Options
Super Mediclaim Available variants include Critical Mediclaim for specified critical illnesses, Cancer Mediclaim for cancer, Heart Mediclaim for specified heart-related conditions and Operation Mediclaim for defined surgical procedures.	Health Premia Platinum Individual / Family Floater: ₹1 Crore, ₹2 Crore or ₹3 Crore Base Sum Insured. Family First variant: Base Individual SI ₹10-15 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

Coverage Options

Super Mediclaim

Available variants include Critical Mediclaim for specified critical illnesses, Cancer Mediclaim for cancer, Heart Mediclaim for specified heart-related conditions and Operation Mediclaim for defined surgical procedures.

Health Premia Platinum

Individual / Family Floater: ₹1 Crore, ₹2 Crore or ₹3 Crore Base Sum Insured. Family First variant: Base Individual SI ₹10-15 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

Claim Settlement Ratio
Super Mediclaim Use Care Health Insurance’s insurer-level claim settlement ratio for the relevant financial year. Do not represent it as a product-specific ratio or a guarantee of claim approval.	Health Premia Platinum 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)

Maternity Cover
Super Mediclaim Maternity cover is not identified as a standard benefit in the reviewed Super Mediclaim product overview.	Health Premia Platinum Covered only under Family Floater / Family First (not Individual), after 24 months continuous cover, up to 2 pregnancies/terminations: up to ₹2,00,000 worldwide excl. USA & Canada (Family First Platinum ₹1,00,000). USA/Canada extension available as optional add-on. New born covered up to SI till end of policy year; newborn vaccination in first year

Insurance Plans Comparison

Detailed Features Comparison

Compare the key features of different health insurance plans

Super Mediclaim

Health Insurance Plan

Health Premia Platinum

Health Insurance Plan

Brochure

Policy Wording

Room Rent
Super Mediclaim Room eligibility depends on the sum insured and applicable variant. The official overview lists a single private room for certain sum insured levels and all room categories for higher eligible sum insured levels. Check the current policy schedule for the precise entitlement.
VS VS
Health Premia Platinum Covered up to Sum Insured, no room category restriction (Any Room, incl. suite)

ICU Charges
Super Mediclaim ICU expenses are covered subject to the sum insured and applicable policy terms. The official product overview lists ICU charges without a separate limit for the displayed variants.
VS VS
Health Premia Platinum Covered up to Sum Insured as part of In-patient Care; no separate ICU cap stated

Co-payment
Super Mediclaim A co-payment option may be available, and the applicable percentage depends on the policy selected. Check the current policy schedule for any mandatory or optional co-payment.
VS VS
Health Premia Platinum 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

Disease-wise sublimits
Super Mediclaim Variant-specific conditions, procedures and benefits may have limits. Critical Mediclaim covers specified critical illnesses, Cancer Mediclaim covers eligible cancer-related treatment, Heart Mediclaim covers specified heart conditions, and Operation Mediclaim covers defined surgical procedures.
VS VS
Health Premia Platinum No sublimits on common conditions like cataract or joint replacement. Sublimits apply to: robotic surgeries (₹1 Lakh, with exceptions), specified mental disorders (₹1,00,000), HIV/AIDS (₹50,000 per year), LASER surgery (up to ₹1,00,000), non-network road ambulance (₹2,000 per event)

Cashless Healthcare Providers
Super Mediclaim Cashless treatment is available at eligible network hospitals, subject to network status, pre-authorisation and policy conditions. The network may change over time.
VS VS
Health Premia Platinum 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

Restoration Benefit
Super Mediclaim Automatic recharge may be available as an optional benefit under applicable product versions. It should not be described as a standard or unlimited benefit unless confirmed in the current policy schedule.
VS VS
Health Premia Platinum 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

Cumulative Bonus
Super Mediclaim No-claim bonus can increase the sum insured by up to 100% over three consecutive claim-free policy years, subject to the applicable variant’s bonus schedule and claim conditions.
VS VS
Health Premia Platinum 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%

Daycare Treatment
Super Mediclaim Eligible daycare procedures are covered up to the applicable sum insured, subject to the variant’s covered-procedure list and policy terms.
VS VS
Health Premia Platinum All listed day care procedures (Annexure III) covered up to Sum Insured

Consumable Cover
Super Mediclaim Separate comprehensive coverage for non-medical consumables is not established as a standard benefit in the reviewed product overview. Eligible hospital expenses remain subject to policy terms.
VS VS
Health Premia Platinum 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)

AYUSH Treatment
Super Mediclaim Eligible AYUSH treatment is covered under applicable variants and policy conditions. The historical brochure identifies variant-specific restrictions, including limits for certain treatments.
VS VS
Health Premia Platinum In-patient Ayurveda, Unani, Siddha and Homeopathy treatment in an AYUSH hospital covered up to Sum Insured, with 90/180 days pre/post-hospitalisation

Initial Waiting Period
Super Mediclaim Generally 30 days for illnesses from policy inception, except eligible claims arising from accidents, subject to policy terms.
VS VS
Health Premia Platinum 30 days (not for accidents or renewals)

Specific Waiting Period
Super Mediclaim A 24-month waiting period applies to specified illnesses or procedures where listed in the applicable policy wording. The applicable list depends on the variant.
VS VS
Health Premia Platinum 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

PED Waiting Period
Super Mediclaim The historical product information lists a 36-month waiting period for pre-existing diseases. Any available reduction option and the applicable current waiting period must be checked against the selected policy version.
VS VS
Health Premia Platinum 24 months of continuous cover

Modern Treatment
Super Mediclaim Coverage depends on the selected variant and applicable policy terms. Refer to the current variant wording for the eligible advanced procedures and limits.
VS VS
Health Premia Platinum 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

Annual Health Checkup
Super Mediclaim Annual health check-ups are available from the second policy year after continuous coverage, subject to the applicable policy conditions.
VS VS
Health Premia Platinum Annual from Day 1: tests up to ₹10,000 per insured (Family First Platinum: ₹5,000)

Pre-Hospitalisation
Super Mediclaim Eligible medical expenses incurred during the 30 days immediately before hospitalisation are covered, subject to policy terms.
VS VS
Health Premia Platinum Up to 90 days before admission, covered up to Sum Insured

Post-Hospitalisation
Super Mediclaim Eligible post-hospitalisation medical expenses are covered for up to 60 days after discharge, subject to the policy terms and claim admissibility.
VS VS
Health Premia Platinum Up to 180 days after discharge, covered up to Sum Insured

Outpatient Department Cover (OPD Expense)
Super Mediclaim OPD benefits may be available for eligible covered conditions under the applicable variant and policy limits. Under the historical product information, OPD expenses are linked to an admissible hospitalisation claim for the same illness.
VS VS
Health Premia Platinum Covered up to ₹50,000 per policy per year (Family First: ₹35,000) for consultations, diagnostics and prescribed medicines; 80% of unused amount carried forward, total capped at 2.5x the annual limit. Unlimited e-consultations included in all plans

Deductible Option
Super Mediclaim A deductible option may be available to reduce the premium. Availability, deductible amount and application conditions depend on the selected variant and policy schedule.
VS VS
Health Premia Platinum Not available (the policy wording has no deductible option for Health Premia)

Coverage Options
Super Mediclaim Available variants include Critical Mediclaim for specified critical illnesses, Cancer Mediclaim for cancer, Heart Mediclaim for specified heart-related conditions and Operation Mediclaim for defined surgical procedures.
VS VS
Health Premia Platinum Individual / Family Floater: ₹1 Crore, ₹2 Crore or ₹3 Crore Base Sum Insured. Family First variant: Base Individual SI ₹10-15 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

Claim Settlement Ratio
Super Mediclaim Use Care Health Insurance’s insurer-level claim settlement ratio for the relevant financial year. Do not represent it as a product-specific ratio or a guarantee of claim approval.
VS VS
Health Premia Platinum 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)

Maternity Cover
Super Mediclaim Maternity cover is not identified as a standard benefit in the reviewed Super Mediclaim product overview.
VS VS
Health Premia Platinum Covered only under Family Floater / Family First (not Individual), after 24 months continuous cover, up to 2 pregnancies/terminations: up to ₹2,00,000 worldwide excl. USA & Canada (Family First Platinum ₹1,00,000). USA/Canada extension available as optional add-on. New born covered up to SI till end of policy year; newborn vaccination in first year

Insurance Plans Comparison

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Senior Citizen Health Plan

Secure against age-related medical costs
Tailored for seniors healthcare needs

Family Health Plan

One policy covers the entire family
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Maternity Health Plan

Covers delivery, newborn care, and maternity expenses
Reduces financial stress of childbirth costs

Senior Citizen Health Plan

Secure against age-related medical costs
Tailored for seniors healthcare needs

Family Health Plan

One policy covers the entire family
High sum insured with cashless care
Multiple coverage options based on your family needs

Maternity Health Plan

Covers delivery, newborn care, and maternity expenses
Reduces financial stress of childbirth costs

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