Bigger Cover, Built-in Travel Protection
92.02%
Claim Settlement Ratio
10,000+
Network Hospitals
1/10
Plan Rating
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Our Verdict
Expert Review: Niva Bupa Health Premia Gold
Final Verdict
About
What Is Health Premia Gold?
Sum Insured options are ₹10 Lakh to ₹50 Lakh, with any room allowed except suite or above. Every year you get a 10% loyalty addition to your cover (up to 100%) regardless of claims, and if your cover runs out, a 100% re-fill is available once a year.
Families can get maternity and newborn cover after 24 months, and every insured person gets an annual health check-up from day 1. This plan also includes LASER surgery cover (₹50,000) and in-built single-trip international cover (₹30 Lakh).
Optional add-ons include Safeguard / Safeguard+ for non-payable items and inflation-linked cover, Personal Accident (up to ₹50 Lakh), Critical Illness (₹10 / 15 / 25 Lakh), Hospital Cash (₹5,000/day (Family First: ₹3,000/day)), Enhanced Loyalty Addition and a Health Coach.
Gold Ratings
Gold
Insurer Rating
7.1
out of 10
Insurance Rating
1
out of 10
No Room Rent Limit
No
Consumables Covered
No
No Co-payment
No
Loyalty Bonus >= 500%
Yes
No Disease Sublimits
No
Unlimited Restoration
No
Additional Benefits (Informational Only — Not part of score)
PED Waiting <= 2 Years
Yes
Maternity Available
Yes
Waiting Period Waiver
No
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Inclusions and Exclusions
Niva Bupa Health Premia Gold Inclusions and Exclusions
Modern Treatment
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
ICU Charges
Covered up to Sum Insured as part of In-patient Care; no separate ICU cap stated
Cumulative Bonus
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%
Consumable Cover
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)
Initial Waiting Period
30 days (not for accidents or renewals)
Specific Waiting Period
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
24 months of continuous cover
Annual Health Checkup
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
Post-Hospitalisation
Up to 180 days after discharge, covered up to Sum Insured
Outpatient Department Cover (OPD Expense)
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
Deductible Option
Not available (the policy wording has no deductible option for Health Premia)
Coverage Options
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
Maternity Cover
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
AYUSH Treatment
In-patient Ayurveda, Unani, Siddha and Homeopathy treatment in an AYUSH hospital covered up to Sum Insured, with 90/180 days pre/post-hospitalisation
Co-payment
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
Pre-Hospitalisation
Up to 90 days before admission, covered up to Sum Insured
Claim Settlement Ratio
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)
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
Cashless Healthcare Providers
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
Daycare Treatment
All listed day care procedures (Annexure III) covered up to Sum Insured
Disease-wise sublimits
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)
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
Exclusions
Pre-existing conditions are not covered until 24 months of continuous coverage have elapsed since the policy's inception.
A 30-day initial waiting period applies, during which no claims are admissible, except for those arising from accidents.
Specific treatments, such as cataract, hernia, and spinal disorders, have a 12-month waiting period.
Mental disorder treatments and LASER surgery coverage have a 36-month waiting period.
HIV/AIDS coverage is subject to a 36-month waiting period.
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About Niva Bupa
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Frequently Asked Questions
This content has been reviewed by Aman Shetty, Senior Insurance Advisor | BQP code: 33905
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