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Aditya Birla Activ Health Enhanced
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Aditya Birla Activ Health Enhanced

Every individual is required to look after his/her health to lead a healthy and free-from-disease life. Although, caring for your body is very important, it is not enough. The future is unpredictable and any kind of medical emergency may come up anytime.

Hence, it is a wise decision to have a medical insurance policy to tackle unforeseen or unfortunate medical contingencies.            

Aditya Birla Capital, also known as ABC, is an India-based MNC (Multinational Company) that provides plenty of health insurance plans to choose from, to suit one’s financial needs on medical grounds.

The most sought after insurance policy offered by ABC is Aditya Birla Activ Health Enhanced.

What is Aditya Birla Activ Health Enhanced?

Aditya Birla Activ Health Enhanced is a health insurance plan offered by Aditya Birla Capital that provides financial coverage for the expenses incurred by the policyholder for different medical treatments and procedures.

It is one of the premium versions of insurance plans under the brand "Activ Health" provided by ABC. As its name suggests, the Aditya Birla Activ Health Enhanced plan offers enhanced and wide coverage. The plan offers Sum Insured for an amount up to INR 2 Crore.

This plan can be classified into 4 variants – 2 based on premium amounts and 2 based on the number of individuals it covers. Speaking of the variants based on premium amounts, the 2 variants are low and high depending on the amount of premium to be paid. Based on the coverage width of the policy, the 1st variant is for single individuals, while the 2nd is for families.

The Aditya Birla Activ Health Enhanced policy is a great choice for those who want high financial coverage for medical expenses without exhausting their Base Sum insured.

Some of the details regarding the policy are as follows:

S. No

Category

Particulars

1

Sum Insured (SI) options

Min – INR 2 Lakhs

Max – INR 2 Crores

2

Pre-hospitalization expenses

For 60 days

3

Post-hospitalization expenses

For 180 days

4

Hospitalization and In-patient care and accommodation

Fees for consulting doctor/attending physician; the cost of drugs, medicines, and consumables; hospital room rent; etc. are covered

5

Domiciliary hospitalization or treatment

Covered

6

Day Care treatments

Illnesses like a tonsillectomy, dialysis, chemotherapy, cataract treatment or surgery, etc. that don't require hospitalization for more than 24 hours are covered

7

Ambulance Services

Actual amount in network hospitals and up to INR 5,000 in non-network

8

Initial Waiting Period

30 days

9

Auto Recharge of SI

Available, 100% of BSI (Base Sum Insured

10

Second opinion

Expenses incurred for opting for the second opinion in case of illnesses like kidney failure, cancer, heart attack, etc. will be covered

11

Hospital Cash

Available

12

Health Check-up

Available, once per policy year

13

No claim Bonus

20% of Base Sum Insured for every claim-free policy year

14

Waiting Period for Specified illnesses and ailments

2 years

15

Organ Donor/Organ transplantation expenses

Covered


Salient Features of Aditya Birla Activ Health Enhanced plan

The salient features of Aditya Birla Activ Health Enhanced Plan are as follows:

Health Returns:

Health Return is a form of in-policy reward points used towards a reduction in premium amounts or an increase in coverage. This is available for Activ Health plans offered by ABC. One can earn an amount of up to 30% of his/her annual policy premium as Health Returns reward points.

Choice of rooms:

The Aditya Birla Activ Health Enhance policy offers flexibility in the choice of hospital rooms during hospitalisation of the insured. This option is available once per every policy year.

Full-Day 1 coverage:

The plan covers full day 1 expense such as doctor's consultation fees, cost of various diagnostic tests or medicines, etc. in case the insured is suffering from chronic illness like hypertension, diabetes, high cholesterol and asthma.

Hospitalization expenses:

It covers all expenses towards hospitalisation of the policyholder, which includes the hospital room rent, various treatments, nursing, and doctor’s fees, etc.

Pre and post hospitalisation expenses:

All pre-hospitalisation expenses, up to 60 days, and post-hospitalisation expenses, up to 180 days, are covered under this plan.

Adding children to existing policy:

Aditya Birla Activ Health Enhance plan offers the option to add children under the age of 25 years to an existing policy. This is helpful for single parents who have a policy and want their children to enjoy medical coverage too.

No 24-hour hospitalization clause:

The 24-hour hospitalization clause for specific illnesses is not applicable for this policy, that is one can enjoy coverage for treatments for specific illnesses that do not require hospitalization for more than 24 hours.

Core Benefits of Aditya Birla Activ Health Enhanced Plans:

Some of the key benefits of Aditya Birla Activ Health Enhanced Plan are as follows:

Tax benefits

The policyholder is liable to avail tax deductions and exemptions under this policy as lay out by Section 80 C and 10 D of the Indian Income Tax Act, 1961.

Auto Recharge

This refers to the auto restoration of the Base Sum Insured, in case the policyholder exhausts the current SI through a claim. This can go up to an amount of 100% of the BSI.

No claim bonus

The Aditya Birla Activ Health Enhance policy offers No claim bonus, as a reduction in the premium amount, for every claim-free policy year.

This policy covers day Care treatments

Most of the day-care treatments do not require more than 24-hour hospitalisation. As the 24-hour hospitalisation clause is not applicable here, expenses incurred after 24 hours are also covered.

Domiciliary treatments or hospitalisation

This plan provides financial coverage for expenses incurred by the policyholder in case he/she is required to receive domiciliary/home treatments or hospitalization.

Healthcare check-ups and diagnostic tests

Under this policy, the policyholder can claim one session of free healthcare check-ups and diagnostic tests on an annual basis.

WEAS

WEAS stands for Worldwide Emergency Assistance Services. Under this benefit, the insurer will provide medical services and facilities to the policyholder, in case he/she is outside India.

Ancillary expenses

In case the insured is hospitalised for a long period, the policy will cover all the ancillary expenses such as traveling to and from the hospital, attendant expenses, etc.

Add-on Benefits/Riders of Aditya Birla Activ Health Enhanced plan

Some additional benefits or riders of Aditya Birla Activ Health Enhanced plan are as follows:

This policy covers OPD expenses

All expenses incurred by the policyholder for medical tests, check-ups, consultations, medicines, etc. on an OP (out-patient) basis.

Deductible options

Under the deductible option, the deductible amount is applied to the premiums to be paid for every policy year, provided that this is done on the aggregate of all admissible and plausible claims in the said policy year.

Pregnancy and other maternity-related expenses

Under this add-on benefit, Aditya Birla Activ Health Enhance offers coverage against pregnancy and other maternity-related treatments. Also, the amount is deducted from a different version of SI known as the Maternity Sum Insured

Chronic Management Programs

This policy offers ABC-sponsored chronic disease management programs for individuals suffering from chronic diseases like hypertension, asthma, high cholesterol, diabetes, etc.

Optional Benefits of Aditya Birla Activ Health Enhanced plan

Optional benefits of this plan include:

Hospital Cash

This is an optional benefit under which the policyholder is liable to receive cash to use towards various hospitalisation expenses. The maximum amount received is INR 5,000, which is paid in multiples of INR 500.

A second opinion or e-opinion

In case the insured is suffering from specified critical illnesses like heart attack, kidney failure, cancer, etc. then this plan offers coverage against second consultations or second opinion

Wellness Coach

If activated, as per this benefit, the policyholder will receive various pointers, charts, tables, data, etc. related to hygiene, diet, nutrition, and fitness

Exclusions of Aditya Birla Activ Health Enhanced plan

Listed below are not covered by Aditya Birla Activ Health Enhanced Plan:

  • Accidents or injuries caused due to strikes and riots
  • Injuries or diseases due to invasion, war and nuclear weapons
  • Reconstruction or cosmetic surgeries, surgeries, or treatments that are intended for enhancing facial or bodily features such as dental or plastic surgeries, congenital disorder surgeries, treatments or surgeries in case of infertility, etc.
  • Treatments or medical procedures for psychiatric or mental disorders, rehabilitation, etc.
  • Treatments against alcohol or drug or substance abuse
  • Congenital external defects or diseases, growth hormone therapies, general debility, etc.
  • Self-inflicted injury
  • Unnecessary or unjustified hospitalisation, such as hospitalisation for tests like X-Ray, etc.
  • Weight management treatments or programs
  • Treatments against AIDS/HIV
  • Treatment undertaken outside India, which is not covered under WEAS

Eligibility Criteria to apply for Aditya Birla Activ Health Enhanced

The eligibility criteria for the Aditya Birla Activ Health Enhanced plan are based on the following:

Age Criteria for applying

The minimum age for applying for this policy is 91 days, and there is no upper age limit.

Age criteria for getting insured

The policy wordings state that children below the age of 25 years can be added under an existing policy if they do not possess their medical insurance, though after adding that policy will be converted into the family option. People above the age of 25 years are required to get a separate plan.

The claim process for Aditya Birla Activ Health Enhanced plan

There are 2 types of claims – Cashless claims and Reimbursement claims.

Cashless claims

This claim can be either raised by visiting the official website of Aditya Birla Capital or one of its branch offices. The policyholder has to fill-up a claim form and submit it to the insurer along with other details and the required documents. The approval of the claim depends on its plausibility based on different grounds. 

Details/documents required for Cashless claims

    • Health card
    • Policy Number
    • Name and address of the policyholder
    • Medical reports
    • Copy of medical bills
    • Death certificate (if applicable)
    • Claim form 

Reimbursement claims

A reimbursement claim is raised when the policyholder pays all the medical charges for his/her hospitalisation and requests to get reimbursed for the same. The process for this is the same as that for Cashless claim, and it can be done either online or offline.

Details/documents required for Reimbursement claims

    • Policy Number
    • Name and address of the policyholder
    • DOA (Date of Admission) and DOD (Date of Discharge)
    • Medical Reports
    • Copy of Medical bills
    • Death certificate (if applicable)
    • Claim form

Required Documents to apply for Aditya Birla Activ Health Enhanced plan

  • Proof of Identity – KYC or non-KYC documents
  • Proof of Age – Birth certificate
  • Proof of Income – Recent salary slip
  • Proof of Address – Recent utility bills, ID cards with address

How to buy Aditya Birla Activ Health Enhanced?

One can buy Aditya Birla Activ Health Enhanced plan:

Online

Visit the official website of the insurer, go to the health insurance plan section, and buy this policy.

Branch Office

One can also visit the nearest branch office of ABC and request for an application form to buy this plan. The individual is required to duly fill-in the form and submits it with a CRO (Customer Relations Officer) with applicable documents.

Intermediary

One can also take the help of various intermediaries or TPAs (Third Party Administrators) like insurance agents, brokers, etc. to purchase this plan.

Aditya Birla Activ Health Enhanced Plan FAQs

Written By: Paisawiki - Updated: 30 June 2020

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