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ADITYA BIRLA HEALTH INSURANCE

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Aditya Birla Health Insurance

Overview
Aditya Birla Health Insurance Co. Ltd (ABHICL) is a joint venture between Aditya Birla Group and MMI Holdings Limited. MMI Holdings Limited is a South Africa-based company that provides financial services. ABHICL is Focused on leveraging MMI Holdings industry capabilities and Aditya Birla Group’s strategic strengths in India to tap India’s health insurance market which currently covers on 5% of India’s population.

Aditya Birla Health Insurance at a Glance
  • ActivHealth Essential and Enhanced are the star health insurance product
  • Nine branches across the top seven tier-1 cities
  • Multi-channel distribution model across agency, broking, bancassurance, direct marketing, online channel and more.
  • Cashless hospital network of 3000+ pan India and counting.
  • ABHICL reported a preliminary income of INR 3, 86,137 as first operational year.
Awards & Recognitions
  • Nominated for The Digital Insurer Asian Insurance Innovation Award.
Documents needed to apply for Aditya Birla Health Insurance
  • Age proof - (Any One)
    Driving License, Passport, Voter ID Card, Birth Certificate, etc
  • Identity proof – (Any One)
    Driving License, Passport, Voter ID card, PAN Card, Aadhar Card, or any document which proves citizenship
  • Income proof
  • Address proof – (Any One)
    Driving License, Passport and Utility Bill should clearly mention the permanent address
  • Income proof – (Any One)
    Salary Slip, Form 16, ITR
  • Recent passport size photograph
Why Aditya Birla Health Insurance?
Here are some reasons why Aditya Birla is the right insurance provider for you:

Sum Insured Sum insured ranging from Rs. 50,000 to Rs. 2 Cr available.
Cashless hospitalisation Aditya Birla provides cashless access to over 3000+ network hospitals across India where you can avail cashless facility.
Claim process AABHICL needs to be intimated via call, fax or email 7 days prior to hospitalization/accident/diagnosis of critical illness. Specific information include policy number, name of policy holder need to be provided during such intimation.

Types of Aditya Birla Health Insurance Plans
Aditya Birla offers insurance coverage in three variations: Individual Plans and Group Health Insurance Plans.

1: Aditya Birla Activ Health Essential Plan – This plan provides comprehensive coverage for the insured person against hospitalisation and chronic diseases with sum insured uptoRs. 2 crores and reload of sum insured, among other benefits.

2: Aditya Birla Activ Health Enhanced Plan– Provides a customizable cover against hospitalisation, chronic diseases and broad range of optional covers at a value-for-money premium.

3: Aditya Birla Activ Secure Personal Accident Plan– Coverage against partial or permanent disablement or death from accident. The plan also provides protection against EMI and loan instruments.

4: Aditya Birla Activ Secure Critical Illness Plan – A specialised cover that helps insured person gain coverage against all major critical illnesses. There are three plan options with various benefits to suit individual needs.

5: Aditya Birla Activ Secure Hospital Cash Plan– This plan helps the insured protect themselves against the financial burden of hospitalisation with daily cash benefit. The policy also provides flexibility to choose maximum number of days for coverage in a year.

6: Aditya Birla Activ Secure Cancer Secure Plan– Provides coverage against cancer with staged payouts, cumulative bonus and low survival period requirement.

Aditya Birla Health Insurance Plans

1: Aditya Birla Activ Health Essential Plan
Entry age 91 days; no maximum entry age limit. Children upto 25 years can be covered in floater.
Type of Plan Individual / Floater
Sum Insured Rs. 50,000-10 lacs
Coverage for Upto 20 relationships in a family are covered in this plan, in addition to the person insured.
Policy term 1-3 years

Inclusions, Benefits and Features
  • In-Patient Hospitalisation- general/economy ward, shared room and single room covered.
  • Pre-Hospitalisation - Any medical expenses that have been incurred 30 days prior to the hospitalisation for the same illness will also be covered.
  • Post-Hospitalisation– Similarly, medical expenses incurred 60 days after being released from the hospital and for the same illness will also be covered.
  • Day-Care Procedures– Treatments or procedures like dialysis which may not warrant a 24-hour hospitalisation with also be covered.
  • Domiciliary Treatment– Illnesses which have been treated at home, but needed hospitalisation, will be covered.
  • Benefit for Hospital Room Choice – Provides the option to choose the hospital room type of choice before entering into coverage. Premium will be adjusted in accordance to room tariff.
  • Daily Cash for Choosing Shared Accommodation– The policy entitles the insured person to lump sum amount for choosing shared accommodation at a hospital.
  • Hospital Cash Benefit – For each day the insured person remains hospitalized, he/she shall be eligible for cash allowance between Rs. 500-5000.
  • Road Ambulance– Expenses incurred for ambulance service to transfer insured person to a hospital will be covered upto Rs. 2000.
  • Second E-Opinion on Critical Illness– This benefit allows the insured person to take a second opinion from a panel of qualified medical specialists as decided by ABHICL.
  • Cumulative Bonus– For each claim free year, the sum insured is increased by 10%. There is no claw-back in case a claim has been made in subsequent years. Max upto 100%.
  • Health Check-up – A free health check-up for each adult covered in the plan is made available by ABHICL in this plan.
  • Chronic Management Program – A team of doctors and specialists will help you stay above chronic illnesses like hypertension, diabetes, high cholesterol to ensure that proper diet and medication is undertaken.
  • Health Returns – ABHICL allows insured persons to accumulate returns by staying fit and healthy and later on these returns/points can be redeemed for treatment or pharmacy bills for illnesses which aren’t covered in the plan.
  • Wellness Coach – A personalised wellness coach is provided to each policy holder to provide reminders about their schedule, diet and fitness regime.
  • Deductible – Deductible option available on all policy claims for the year. Option to select deductible among – Rs. 25,000 – Rs. 2 lacs.
Basic Sum insured per insured person per policy year(Rs. in Lakhs) Rs. 50,000- 10lacs
Inpatient treatment Available
Pre-hospitalisation 30 days
Post hospitalisation 60 days
Day Care procedures Available
Domiciliary treatment Available
Hospital Cash Benefit Rs 500-5000
Road Ambulance Upto Rs. 2000 per hospitalisation
Second E-opinion Covered
Benefit of Hospital Room Choice Choose your preferred hospital room type and adjust tariff accordingly
Deductible Get discount on premium for choosing deductible on every claim during policy period
Health Check-up Once a year
Cumulative bonus 10% increase of sum insured for each claim-free year. Limit upto 100%

2: Aditya Birla Activ Health Enhanced Plan
Entry age 91 days; no maximum entry age limit. Children upto 25 years can be covered in floater.
Type of Plan Individual / Floater
Sum Insured Rs. 2-200 Lacs
Coverage for Upto 20 relationships in a family are covered in this plan, in addition to the person insured.
Policy term 1-3 years

Inclusions, Benefits and Features
  • In-Patient Hospitalisation- Any room is covered for greater than Rs. 7 Lacs.
  • Pre-Hospitalisation - Any medical expenses that have been incurred 60 days prior to the hospitalisation for the same illness will also be covered.
  • Post-Hospitalisation–Similarly, medical expenses incurred 180 days after being released from the hospital and for the same illness will also be covered.
  • Day-Care Procedures
  • Domiciliary Treatment
  • Benefit for Hospital Room Choice
  • Hospital Cash Benefit
  • Road Ambulance–Expenses incurred for ambulance service to transfer insured person to a hospital will be covered up to Rs. 5000.
  • Organ Donor – Treatment required for donating an organ is covered in this policy.
  • Second E-Opinion on Critical Illness
  • Cumulative Bonus – For each claim free year, the sum insured is increased by 20%. There is no claw-back in case a claim has been made in subsequent years.Max up to 100%
  • Health Check-up
  • Chronic Management Program
  • Health Returns
  • Wellness Coach
  • Deductible – Deductible option available on all policy claims for the year. Option to select deductible among – Rs. 25,000 – Rs. 5 Lacs.
  • Reload of Sum Insured – In case the sum insured is exhausted within the policy period (inclusive of cumulative bonus) the same will be reinstated.
Basic Sum insured per insured person per policy year(Rs. in Lakhs) Rs. 2-200 Lacs
Inpatient treatment Available
Pre-hospitalisation 60 days
Post hospitalisation 180 days
Day Care procedures Available
Domiciliary treatment Available
Hospital Cash Benefit Rs 500-5000
Road Ambulance Upto Rs. 5000 per hospitalisation
Organ Donor expenses Available
Second E-opinion Covered
Reload of sum insured Available
Benefit of Hospital Room Choice Choose your preferred hospital room type and adjust tariff accordingly
Deductible Get discount on premium for choosing deductible on every claim during policy period
Health Check-up Once a year
Cumulative bonus 10% increase of sum insured for each claim-free year

3: Aditya Birla Activ SecurePersonal Accident Plan
Inclusions, Benefits and Features
  • Accidental Death Cover – 100% of sum insured awarded in case of accidental death
  • Permanent Total Disablement – 100% of sum insured awarded in case of PTD.
  • Permanent Partial Disablement– 100% of sum insured awarded in case of PPD, depending upon nature of disability.
  • Education Benefit – Surviving child gets 10% of sum insured as lump sum.
  • Road Ambulance Cover
  • Funeral Expenses – 1% of sum insured awarded for funeral expenses, limit upto Rs. 50,000.
  • Repatriation of Remains – Rs. 50,000 provided for transportation of mortal remains from place of death or cremation ground or residence.
  • Orphan Benefit – In case of accidental death of parents, surviving children to receive 10% of sum insured, limit up to Rs. 15 lacs.
  • Modification Benefit – Rs. 1 lac benefit provided for modification of residence or vehicle, following disablement.
  • Compassionate Visit – Travel expenses of a relative to visit insured person’s place of hospitalisation is covered upto Rs. 10,000 for domestic travel and Rs. 25,000 for international travel.
  • P.A. Cumulative Bonus – 5% bonus provided in case of claim-free year, with maximum upto 50%.
4: Aditya Birla Activ Secure Critical Illness Plan
Inclusions, Benefits and Features
  • Plan 1 – Coverage for 20 critical illnesses and 100% payout upon diagnosis of any of the covered critical illness.
  • Plan 2 -Coverage for 50 critical illnesses and 100% payout upon diagnosis of any of the covered critical illness.
  • Plan 3 -Coverage for 64 critical illnesses (50 from List A and 14 from List B) and receive 150% maximum payout upon diagnosis for the same illness (100% for List A and 50% for List B illness).
Optional Covers
  • Wellness Coach
  • Second opinion
5: Aditya Birla Activ Secure Hospital Cash Plan
Inclusions, Benefits and Features
  • Daily Cash Benefit– Insured person is paid cash daily for each completed 24 hours of hospitalisation.
  • Deductible – A one day deductible is applicable in this policy.
  • Double Benefit Cover– Double the daily cash benefit is available in case of admission in ICU.
  • Convalescence Cash – Benefit of 1 Daily Cash Benefit provided for hospitalisation of more than 7 days.
  • Parent Accommodation - Daily Cash amount for parent’s accommodation in case the insured is 12 years or less and hospitalised for 72 hours or more.
6: Aditya Birla Activ Secure Cancer Secure Plan
Inclusions, Benefits and Features
  • Minor – Upto 50% of sum insured for being diagnosed with minor stage cancer
  • Major – 100% of sum insured paid out upon diagnosis of major stage cancer
  • Advanced - 150% of sum insured paid out upon diagnosis of major stage cancer
Aditya Birla Exclusions:
While exact nature of exclusions varies for every health insurance policy offered by Aditya Birla health insurance here are some common exclusions in all health insurance plans.

  • Any pre-existing condition covered only after a waiting period as per policy terms and conditions from the date of policy inception.
  • Any critical illness signs/symptoms of which first occurred prior to or within the waiting period (90 days)
  • AIDS, HIV infection or sexually transmitted condition, congenital anomalies or complications, pregnancy or child birth related treatments
  • Medical expenses as a result of alcohol and/or drug abuse, addiction or overdose as well as intentional self injury
  • War, civil war, invasion, hostilities, and nuclear weapon induced hospitalization, professional sports, and hazardous activities
  • Elective, cosmetic or plastic surgery, except as a result of an Injury caused by a covered Accident while the policy is in force;
Aditya Birla Login:
Aditya Birla Heath Insurance offers a single online platform which allows all users to seek extensive details of all their health insurance plans. Users can create a login id and access the customer portal at https://adityabirlacapital.com/healthinsurance/#!/login as a single platform for all policy purchase, renewals and claims filing requests.

Aditya Birla Health Insurance Renewal:
  • Log into the Aditya Birla Health Insurance website with your username or member ID and password.
  • New users can create a login id and access the customer portal at https://adityabirlacapital.com/healthinsurance/#!/login as a single platform for all policy purchase, renewals and claims filing requests. Existing users can logging with their created user ID to access all policy related information and seek renewals.
Aditya Birla Health Insurance Claim Settlement:
Cashless Claim Reimbursement Claim
The insured approaches any of the networked hospital with Aditya Birla health insurance for cashless treatment. The insured collects all hospitalization documents and submit the same with Aditya Birla health insurance.
The TPA helps the customer by verifying customer details and sending the preauthorization form for approval. Aditya Birla health insurance conducts a preliminary scrutiny for claims and verifies policy benefits and requisite documentation.
Once approved/declined the Authorization letter or decline of request is sent to the provider for appropriate action. Once Aditya Birla health insurance receives all the required documents from the Insured and the claim is approved, the claims are appropriately paid out.
Hospital treats the patient without any deposit till discharge once approved.  

Aditya Birla Health Insurance FAQs:
1: What is the difference between individual and floater cover offered by Aditya Birla health insurance?
In the individual plan each person is covered for a separate sum insured as selected at the time of purchase of the health insurance plan. In a family gloater policy all insured members are covered on a floater basis and is the maximum liability for all claims made by all insured members.

2: For how long is my Aditya Birla health insurance policy valid?
Your policy is valid as per the duration mentioned in your policy schedule. You have an option of buying health insurance plans for 1 year, 2 year and even 3 years.

3: Is there any benefit offered by Aditya Birla health insurance for choosing a long term policy?
You can avail of a long term discount of 7.5% and 10% respectively on selection of 2 and 3 years tem for your health insurance.

4: What will be my discounts if i cover 4 family members under the individual type policy?
You will avail a 5% discount on covering 2 family members and a 10% discount on covering 4 family members in an individual type policy of Aditya Birla health insurance.

5: What is a pre existing disease as per Aditya Birla health insurance?
As per Aditya Birla health insurance a pre existing disease means a condition, ailment or injury for which there were signs or symptoms and/or were diagnosed and/or for which medical advice/treatment was received within 48 months prior to the first policy issued by the insurer and renewed thereafter.

6: What is a maximum age to renew Aditya Birla health insurance plans?
All health insurance plans offered by Aditya Birla come with lifetime renewability subject to the payment of appropriate premium and fulfillment of other policy terms and conditions.

7: What are the factors that determine by premium charges for Aditya Birla health insurance?
The key factors that determine the health insurance premium from Aditya Birla include the Sum insured amount, the age of the insured, the number of the members to be insured, details of any pre-existing diseases and whether opting for any optional add-on covers.

8: Who can buy the optional maternity expenses cover offered by Aditya Birla health insurance?
You and your spouse both if covered under the same policy can opt for a maternity expense cover. It can be a floater or individual type policy. The insured female must be between the ages of 18 to 45 years. A waiting period of 24 months is applicable for the benefit under this cover.

9: Are OPD expenses covered under day care treatment?
No, OPD expenses are not covered under day care treatments. You can however get a reimbursement for your OPD cover if you have opted for an optional OPD expenses cover. Alternatively you can also reimburse such expenses from your accrued HealthReturns offered exclusively by Aditya Birla health insurance.

10: What is worldwide emergency assistance service offered by Aditya Birla health insurance?
Aditya Birla health insurance with its worldwide emergency assistance service offers medical assistance to an insured when travelling 150 Kms or more away from his or her residential address as mentioned in the policy schedule. Emergency assistance services are offered for emergency medical evacuation and medical repatriation subject to policy terms and conditions.