Aditya Birla Capital Activ Health Platinum Enhanced

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What we love?
Get optional unlimited OPD Cover starting at Rs. 706/member

Cover amount: ₹5 Lakh

Cashless hospitals: 319

Premium:₹592/month (₹7094 paid annually)

Claim Settlement Ratio: 94%

Highlights

94% Claim Settlement Ratio

This is explained as (Number of Claims Settled / Number of Claims) by the Insurance Company.
Source: Public Disclosures (NL25 for 2018-19).

2% Repudiated Due to Waiting Period and Exclusions

Claims Rejected due to Policy Terms and Conditions such as Waiting Periods and Exclusions as provided by the Insurer.

96% Effective Ratio

Number of Claims Settled / Number of claims valid as per Policy Terms and Conditions (C = A+ B).

Free Chronic Cover

You get upgraded to chronic management program automatically if you develop a chronic condition like Asthma, high BP, high Cholesterol, and Diabetes after buying the policy. The benefits include Day 1 cover, Doctor Consultation, Diagnostic Tests, and access to expert Health Coaches.

Why is it Important

Chronic illnesses require continuous monitoring and therefore the chronic management program is essential as it includes diagnostic tests, access to health coaches, and doctor consultations as well. This is available at no additional cost under this plan.

No Room Rent Capping

You are eligible for all Room categories up to Single AC room.

Why is it Important

No Room rent capping means you will not have to pay from your own pocket ever for a Single AC Room in any hospital.

Double your Sum Insured in just 2 years

Your health cover increases by 50% for every claim free year which means your sum insured doubles in just 2 years. If Claim is taken, then Bonus will reduce by 50%.

Why is it Important

This ensures that you have higher coverage to meet any future medical emergency

Earn up to 100% discount on renewal

Discount on renewal premium on the basis of health assessment and number of steps taken ;

Complete 325 Active Dayz a year and get 100% Health Returns ;
Complete 275 Active Dayz a year and get 50% Health Returns;
Complete 156 Active Dayz a year and get 30% Health Returns.
To gain the above HealthReturns, 13 Activ Dayz every month is essential ,
1 Activ Dayz = 10,000 steps or 300 calories burned

Why is it Important

Daily walking helps you keep fit and help in giving you a monetary discount under this plan.

You can start earning Health Returns in 3 simple steps –
Step 1 – Download the Activ Health App
Step 2 – Schedule your Health Assessment and get your Healthy Heart Score
Step 3 – Your daily steps will be measured using the app and will help earn Activ Dayz

Optional discount in premium with Essential Variant

You have an option to select the Essential variant of this product which is available at a discounted price.

Why is it Important

Essential variant is a value for money offering of Activ Health product which offers all the essential features at an affordable price

Premium waiver for Critical Illness

You don’t need to pay your policy premium for 1 year if you are detected with a listed critical illness.

Why is it Important

Critical illnesses usually require longer treatment and recovery time which may lead to financial burden. This feature ensures you don’t need to worry about your health insurance premium as the same is waived off for 1 year

Features

What’s covered

Covid-19 Coverage

Hospitalization due to omicron and all other variants of covid-19 are covered

Why is it Important

Most people infected with the virus will experience mild to moderate respiratory illness and recover without requiring special treatment. However, some will become seriously ill and require medical attention

ProTip: Protect yourself and others from infection by staying at least 1 metre apart from others, wearing a properly fitted mask, and washing your hands or using an alcohol-based rub frequently

Room rent limit

Up to single private A/C room permissible for hospitalization in this plan

Why is it Important

Always opt for rooms within your rent eligibility, In case you opt for a room above this cap, you will have to bear the additional expenses

ProTip: A lower cap is better as room rent eats into the claim amount which should be spent on treatment cost.

Restoration of cover

Full reinstatement of Sum Insured for a non-related illness if the original sum insured exhausted

Why is it Important

It helps at the time of second hospitalization in the same year

ProTip: The restoration amount varies, please check the plan T&C for when restoration is allowed.

No claim bonus

Up to Rs 2.5 Lac added for every claim-free year up to a cumulative maximum of Rs 5 Lacs. In case a claim is made, your no claim bonus will reduced by ₹2.5 lakh

Why is it Important

Since the medical expenses are rising every year, this benefit ensures you have sufficient funds for any medical emergency.

Free health checkup

Health checkup permissible annually, in designated network

Why is it Important

Health checks ensure you are treated before your medical condition gets serious.

ProTip: Look for the type, cost and number of tests your insurer allows.

Co-pay

Full claim paid by Insurer

Existing Illness cover

There is a waiting period of 3 years for coverage on conditions declared and existing at the time of first purchase

Why is it Important

The shorter waiting period, the better as the cost of your current illness can be expensive

Covid-19 Patient Eligibility

After 1 month of covid negative report date

Why is it Important

Protect yourself and others from infection by staying at least 1 metre apart from others, wearing a properly fitted mask, and washing your hands or using an alcohol-based rub frequently

ProTip: Most people infected with the virus will experience mild to moderate respiratory illness and recover without requiring special treatment. However, some will become seriously ill and require medical attention

Cashless hospitals

8500+ Network hospitals

Why is it Important

The higher the number of network hospitals the better as you can avail cashless treatment at more places.

ProTip: Check if the hospital of your choice or those near you are part of the network.

Pre-hospitalization coverage

Medical expenses that are incurred in 60 days before hospitalisation are covered

Why is it Important

Typically there is a period of OPD and diagnostics before one is discharged. Longer the Pre-Hospitalisation cover period, better it is

ProTip: Make sure you claim the medical expenses for the same illness for which you got admitted later on.

Post-hospitalization coverage

Medical expenses that are incurred in 180 days post hospitalisation are covered

Why is it Important

There are usually expenses on medicines and treatments even after hospitalization. This benefit helps to cover the same.

ProTip: More the number of days covered, the better it is

Day care treatment

586 listed day care treatments covered

Why is it Important

The number of day care treatments are increasing every day and it is important that your insurance covers the same.

ProTip: Look for plans which cover maximum Day Care procedures

Hospitalization at home

Treatments done at home due to patient condition or unavailability of hospital bed are covered upto Sum Insured

Why is it Important

The higher the cover amount, the better as sometimes — especially during seasonal outbreaks like dengue — hospitals may not have accomodation.

ProTip: Look out for the cover amount and the number of days at home treatment is covered.

Alternate medicine (AYUSH)

Upto SI for utilizing ayurveda, unani or other alternate medicine methods s

Why is it Important

This benefit covers you for alternative treatment options which are becoming more and more popular.

ProTip: Don’t forget to check if your insurance plan covers AYUSH treatment

Ambulance charges

Covered up to Actual expenses per event in case of Network Providers,Reimbursed up to Rs 5000 per Hospitalization for Non-Network Providers

ProTip: Check if your insurance plan covers the Ambulance cost and how much

Worldwide coverage

Emergency treatments for issues when outside India are covered once per year, upto full sum insured(including Air Ambulance)

ProTip: The higher the coverage the better as medical treatments abroad are expensive.

Domestic evacuation

Coverage upto SI to utilize any emergency services for evacuation within India including air ambulance

E-consultation

Expert Health coach provided for medical,nutritional, Mental & fitness counselling

Why is it Important

It is a value-added service and you get a convenient second opinion.

Discount on Renewal

Earned basis of Health Assesment & Active days_up to 100% premium back

Cover for organ donor

Medical expenses of organ donor are covered Upto SI

Why is it Important

It ensures that expenses of the donor are covered, and the insured gets the organ that is required in time

ProTip: Make sure the cover amount is high as the organ transplant is expensive.

What’s not covered

Maternity cover

Not covered

Why is it Important

Higher the maternity cover and a shorter waiting period is better. This allows you to avail the best hospitals and doctors for your new born.

ProTip: Check the waiting period after which you can claim for maternity.

Daily cash allowance

Not covered

Why is it Important

The money can be used for meeting additional expenses that are not covered by health insurance

ProTip: The higher the daily cash allowance the better as these additional costs do add up during hospitalization.

Out patient consultation benefits

Not covered

Why is it Important

The higher the coverage the better as most treatments do not require hospitalization.

ProTip: If you stand to lose your NCB, it is advisable not to claim OPD expenses.

Animal bite vaccination

No coverage provided for vaccination against animal bites

Why is it Important

This add-on is beneficial as stray animals are everywhere and you can’t predict when one might bite you.

About Aditya Birla

Aditya Birla Capital Limited (ABCL) is the holding company for all the financial service businesses of the Aditya Birla Group. With a strong presence across the life insurance, asset management, private equity, corporate lending, structured finance, general insurance broking, wealth management, equity, currency and commodity broking, online personal finance management, housing finance, pension fund management and health insurance business, ABCL is committed to serve the end-to-end financial services needs of its retail and corporate customers. Aditya Birla Capital Limited is a part of the Aditya Birla Group, a USD 40 billion Indian multinational in the league of Fortune 500. Anchored by an extraordinary force of over 120,000 employees, belonging to 42 nationalities, the Aditya Birla Group operates in 36 countries across the globe. About 50 per cent of its revenues flow from its overseas operations.

Most Asked Question For Your Profile

Are PPE kits and other consumable items covered in Health Insurance policies?
Mostly policies don’t cover it by default, however you can buy some very low cost riders and get consumables like PPE kits covered. These include riders such as Care Shield with Care Health Products, or Safeguard with Max Bupa products.

Is HomeCare treatment covered in my Health Insurance policy?
Many Comprehensive health plans provide Home Care treatment where Hospitalisation was required, but patients couldn’t be hospitalised because beds weren’t available. This will include the cost of treatment, diagnosis, medication, oxygen, etc. Check with your advisor for options where HomeCare for Covid-19 is also covered

Will my Health policies cover Black Fungus or any other complications of Covid-19?
Absolutely, Health Insurance covers Covid-19 and all its related complications such as Black Fungus.

Claim Process

Cashless Process

In cashless process the hospital expenses are settled directly between the insurance company and the network hospital. No cash has to be paid by the insurance policy holder.

- Step 1: Find network hospital
  
  Click here to view the list of Cashless Hospitals
- Step 2: Inform the insurer
  
  There can be 2 types of hospitalisation.
  - Planned Hospitalization – Kindly intimate insurer 48 hours prior to your admission by calling on 1800-270-7000 or writing at [email protected]
  - Emergency Hospitalization – In case of an emergency hospitalization, call and inform at 1800-270-7000 within 24 hours of your admission.

Step 3: Preauthorization
- - Approach Hospital’s Insurance / TPA desk for Pre-Authorization Emergency Hospitalization.
  - Show your insurance policy and provide valid photo id proof.
  - Hospital will send the cashless request to insurer and coordinate for authorization.
Step 4: Discharge

Hospital will share all the necessary documents with insurer / TPA for approval.
Step 5: Claim settlement

Insurer will scrutinize the shared documents and give the authorization on the final bill amount in case of approved transactions.Any inadmissible expenses,copayments,deductions will have to be paid by you.

Pro Tip – Once your cashless claim is approved, you can also reimburse your pre and post hospitalization expenses through the reimbursement process.

Re-imbursement Process

In case of hospitalization in non calshless network hospital you can still take an advantage of your health insurance policy by making a Reimbursement claim where you can pay the medical bills directly to the hospital and then gets expenses reimbursed from the insurance company.

Step 1: Inform the insurer (Claim Intimation)

There can be 2 types of hospitalisation.
- Planned Hospitalization – Kindly intimate insurer 48 hours prior to your admission by calling on 1800-270-7000 or writing at [email protected]
- Emergency Hospitalization – In case of an emergency hospitalization, call and inform at 1800-270-7000 within 24 hours of your admission.
The insurer needs to provide complete details including hospital name, diagnostic and treatment details, date of admission, etc.

The insurer will provide a reference ID for all future communication pertaining to the claim request.
Step 2: Claim registration

The completed and duly filled claim form has to be sent along with the document checklist.
Step 3: Claim settlement

Insurer will scrutinize the shared documents and give the authorization on the final bill amount in case of approved transactions.Any inadmissible expenses,copayments,deductions will have to be paid by you.

Aditya Birla Capital Activ Health Platinum Enhanced