Fast-paced lifestyles, unhealthy eating habits, and an increasingly polluted environment are some of the most important reasons why more and more people are falling prey to illness or developing life-threatening medical conditions. To help you live your healthiest, Aditya Birla has launched their health insurance product, known as Aditya Birla Health Insurance. One of the newer entrants in the Indian health insurance space, Aditya Birla Health Insurance aims to provide customers with which go beyond just health insurance. The company was formed following an alliance between the Aditya Birla Group of India, with the Africa-based leading health insurance provider known as MMI Holdings. the company currently offers a variety of health insurance plans, as well as an integrated wellness program, all designed with the objective to help their customers lead healthier lives.
Features & Benefits of Aditya Birla Health Insurance:
With a strong focus on providing smart, hassle-free health insurance solutions, Aditya Birla has crafted its various health insurance plans after thorough research of customer requirements and needs. They offer a number of health insurance plans not only for individuals, but also for families, and groups. Some of the notable features of these health insurance plans are:
- Longer plan terms – Health insurance plans by Aditya Birla offer longer plan terms ranging from 1 year to 3 years, thereby ridding you of the hassle of renewing your health plan every year.
- High sum assured – To help you take care of rising medical expenses, these health insurance plans come with a high sum assured amount which ranges from Rs.10 lakh, up to Rs.2 crore for comprehensive plans.
- Cover for pre/post hospitalization expenses – Aditya Birla health insurance plans provide cover for pre-hospitalisation charges, and post-hospitalisation for durations which vary according to the plan which has been chosen.
- Cover for additional expenses – These plans also provide cover for a range of other treatment expenses like in-patient treatments which includes ICU charges, room rent, ICU charges, operation room charges, specialist’s fee, medicines, etc.
- No minimum 24-hour hospitalisation clause – Several of these plans provide cover for a number of listed day-care surgeries and procedures which do not require hospitalisation for over 24 hours.
- Cover for domiciliary hospitalisation – Many Aditya Birla health insurance plans also provide cover for domiciliary hospitalisation where the insured has taken treatment at home and not a hospital or nursing clinic due to medical constraints. Coverage for such treatments will be provided as per plan terms.
- Choice of hospital room category – The insured is free to choose the hospital room category for their hospitalisation. If the insured has chosen a lower room category, they will be eligible to file for the reimbursement of the same at the time of raising a claim.
- Recovery Benefit – Depending on the terms of the plan chosen, policyholders are eligible towards a Recovery Benefit under their plan.
- Tax benefits – in addition to getting health insurance coverage, these plans also offer attractive tax relief benefits to policyholders under provisions of Section 80D of the Income Tax Act, 1961.
- Reload of sum assured – To continue receiving coverage after filling a claim, policyholders can opt to reload their complete sum assured amount for a particular illness. This is independent of other claims which may have been filed under the policy during the same term.
- Additional value-added services – in addition to the above features, customers can avail a number of value-added benefits under these plans as well. These include the option to get second e-opinion for a critical illness, participate in a Chronic Management Program to manage chronic illnesses, be eligible for Health Returns rewards, and avail the services of Wellness Coach.
- Cumulative bonus – Depending on the plan that you have chosen, you will be eligible for a Cumulative Bonus of 10% to 20% which is provided for each claim-free policy year.
- Free health check-up – Every insured policyholder above the age of 18 is eligible to avail a free health check-up annually.
Plans Offered By Aditya Birla Health Insurance:
Aditya Birla offers 4 health insurance plans under individual and group health insurance plans. These include Activ Health, Activ Secure, Activ Assure, and group health insurance plans. Let us find out more about these plans below.
Activ Health Plans:
Activ Health – Essential:
- The Essential plan option offers sum assured in the range of Rs.50,000 to Rs.10 lakh.
- Provides cover for pre-hospitalisation and post-hospitalisation expenses for a period of 30 days and 60 days respectively.
- Plan available for a policy term of 1, 2, or 3 years.
- Policyholders have the flexibility to choose benefits for hospital room choice.
- Plan provides cover for in-patient hospitalisation, day-care treatments, domiciliary hospitalisation, road ambulance cover.
- Provision of Hospital Cash Benefit offered under the plan.
- Additional benefits offered under the plan include a Cumulative Bonus, second e-opinion on critical illnesses, worldwide emergency assistance services, and a yearly free of cost health check-up.
- Optional covers available under this plan include cover for OPD expenses, maternity expenses, deductible, and waiver of the compulsory co-payment clause.
- Value added benefits offered under the plan include HealthReturns, services of a Wellness Coach, and option to be a part of the Chronic Management Program.
- Health Returns come with benefits such as coverage of diagnostic tests, cost of medicines, and consultation fees of doctors.
- There is no limit on the maximum age of entry into this plan.
- The waiting period for coverage of pre-existing diseases is 48 months.
Activ Health – Enhanced:
- This plan can be taken for a policy term of 1, 2, or 3 years.
- The sum insured options available under this plan range from Rs.2 lakh to Rs.200 lakh.
- Waiting period for coverage of pre-existing diseases is 36 months.
- This plan covers pre and post-hospitalisation expenses for a relatively longer duration of 60 days and 180 days respectively.
- In-patient hospitalisation expenses covered a range of room option, depending on sum assured chosen.
- This plan option also provides cover for expenses like domiciliary treatments, day-care treatments, Road Ambulance cover, organ donor expenses, etc.
- Policyholders can get a 100% reload of their sum assured if they contract another illness within the same policy year. In case of an accident, the sum assured will be reloaded by the company after the first claim.
- Under additional benefits available under this plan, policyholders are eligible for a Cumulative Bonus, Recovery Benefit, second e-opinion on a critical illness, worldwide emergency assistance services, and an annual free health check-up.
- There is no restriction on the maximum entry age for this plan.
- This plan option does not include a mandatory co-payment requirement.
- Policyholders can avail benefits for hospital room choice in Zone I, II, and III cities.
- Under value added benefits which are offered under this plan, policyholders can choose to be a part of the Chronic Management Program, HealthReturns, or avail the services of a Wellness Coach.
Activ Secure Plans:
Activ Secure – Personal Accident:
- The Activ Secure Personal Accident plan provides a number of basic covers which include Accident Death Cover, Permanent Partial Disablement, and Permanent Total Disablement where 100% of sum assured provided if insured is left permanently, and totally/partially disabled due to an accident, or dies due to an accident.
- This plan also provides benefits such as (i) Education Benefit – 10% of sum assured paid one-time in lump sum for a surviving dependent child; (ii)Orphan Benefit - If parents pass away due to an accident, 10% of sum assured, up to max. Rs.15 lakh, provided regardless of number of dependent children; (iii) Modification benefit – Entitled to Rs.1 lakh for making suitable improvements to vehicle/residence after a disablement.
- In addition to this, the plan also provides Emergency Road Ambulance cover for up to Rs.10,000, and cover for Funeral Expenses for 1% of sum assured (max. Rs.50,000).
- Cover worth Rs.50,000 is provided for repatriation of the insured’s mortal remains from the place of demise to their place of residence or cremation ground.
- The policy also covers expenses for a relative’s compassionate visit to the insured’s place of hospitalisation. For domestic travel, expenses worth Rs.10,000 will be covered, while for international travel, expenses worth Rs.25,000 will be covered.
- Policyholders are entitled to a Cumulative Bonus of up to 5% (max. 50% of the sum assured) for every claim-free policy year.
- This plan also offers a number of optional covers such as worldwide emergency assistance services, accidental in-patient hospitalisation cover, temporary total disablement, broken bones benefit, coma benefit, burn benefit, accidental medical expenses, adventure sports cover, EMI protect, loan protect, and a wellness coach.
Activ Secure – Critical Illness:
- The Critical Illness plan is designed to offer financial assistance when you have been diagnosed with a major, or minor critical illness.
- This plan is available in 3 options, and each option provides varying degrees of cover.
- Depending on the plan option which you have chosen, you get cover against 20, 50, and 64 critical illnesses.
- Different plan options offer varying amounts of sum assured, the maximum being Rs.1 crore.
- When the policyholder is diagnosed with any listed critical illness, the policy will provide a lump sum payout.
- This plan offers tax benefits under Section 80D of the Income Tax Act, 1961.
- This plan also offers two optional covers which include a wellness coach, and the option of availing a second e-opinion for a critical illness.
Activ Secure – Hospital Cash:
- The Hospital Cash cover is designed to help you take care of the additional expenses that one invariably has to incur along with hospitalisation, which itself can burn a hole in your savings.
- Daily Cash Benefit (DCB) will be paid for every 24 hours that the insured spends under hospitalisation. This benefit can be opted for a duration of 30 days/45 days/60 days during a single policy year.
- This plan offers tax benefits under Section 80D of the Income Tax Act, 1961.
- Under the Double Benefit Cover, the insured is entitled to twice the amount of Daily Cash Benefit if they are admitted to the ICU or are hospitalised following a road accident. This benefit is paid for a maximum duration of 10 days during each policy year.
- Convalescence Benefit, which is equal to 1 day’s Daily Cash Benefit, will be paid if the insured is hospitalised for a duration of under 7 days.
- Parental Accommodation Benefit that is equal to one day’s Daily Cash Benefit will be paid if an insured below 12 years of age has been hospitalised for over 72 continuous hours.
- This plan also offers an options cover of a Wellness Coach who will help and guide you on improving and maintaining your health.
Activ Secure – Cancer Secure:
- The Activ Secure Cancer Secure plan aims at providing you with much needed financial support during any occurrence of cancer, so you can focus on getting better.
- In case the cancer has been detected at an early or minor stage, the policy provides 50% of the sum assured amount.
- In case of a major stage cancer diagnosis, the policy provides 100% of the sum assured amount.
- In case of diagnosis of an advanced stage cancer, the policy will provide 1505 of the sum assured amount.
- Policyholders are eligible to a Cumulative Bonus for every claim-free policy year. Cumulative bonus helps enhance the degree of protection.
- This plan also offers the optional cover of getting a second e-opinion of a specialist.
Activ Assure Diamond:
- Cover for a number of pre, and post-hospitalisation expenses (diagnostic tests, follow-up tests, etc.) for a period of 30 and 60 days respectively.
- If the insured has been hospitalised for over 24 hours following a planned treatment or a sudden emergency, the policy covers expenses like doctor’s fee, room rent, medicines, operation room charges, and other related expenses.
- This plan provides cover for a number of other types of treatments such as 586 day-care procedures, domiciliary hospitalisation, road ambulance cover, organ donor expenses, AYUSH in-patient treatment, and vaccination.
- Policy provides for a 150% (max. up to Rs.50 lakh) reload of sum assured if the original sum assured + No Claim Bonus/Super NCB (optional) are insufficient to cover a fresh claim on an unrelated illness.
- A Daily Allowance of Rs.500/day is provided for a maximum of 5 days per hospitalisation on policies with a sum assured of up to Rs.4 lakh.
- No claim bonus of 10% of sum assured is provided for every claim free policy year. Maximum limit of NCB is 50% of sum assured.
- Additional benefits provided under this policy include an annually held health check-up program for policyholders, domestic/international emergency assistance services, chance to avail HealthReturns rewards for staying fit, and services of a health coach.
- This plan also comes with a number of value-added optional covers such as Any Room Upgrade, Unlimited Reload of Sum Assured, cancer hospitalisation booster, accidental hospitalisation booster, and Reduction in Waiting Period For Pre-Existing Diseases.
Group Insurance Products:
Group Activ Health:
- Policy offers comprehensive cover against a range of health related ailments.
- Documentation required to apply for the plan is minimal and simple.
- Policy issuance is made quick and easy due to the simple underwriting process.
- Policyholders can avail cashless claim settlement under this policy.
- This plan also offers a number of optional covers which can help you tailor the plan as per your needs and get enhanced protection.
- In addition to this, policyholders can further customize the plan in terms of the features, limits, and waiver of restrictions.
- Premiums paid towards this health insurance plan will make you eligible for tax exemption under Section 80D of the Income Tax Act, 1961.
Group Activ Secure:
- The Group Activ Secure plan is a group plan which offers fixed benefits.
- In case the policyholder suffers from a health issue which is covered under the scope of the plan, they will be entitled to receive a lump sum benefit.
- This plan also offers Group Personal Accident Cover Group Critical Illness cover, and Group Hospital Cash Benefit.
Process For Claim Intimation:
Cashless Claim Process:
- To avail this facility, the policyholder must approach the insurer’s network hospital which offers cashless claim treatments. The list of network hospitals is available on the insurer’s website.
- Once at the network hospital, the insured can either provide their cashless card or give their policy details at the hospital’s insurance helpdesk. They will also be required to provide a proof of identity such as a passport, PAN card, or Voter ID card.
- After their identity has been noted, the insured will be required to fill out the cashless hospitalization request form. For quicker processing of the cashless request, the insured can fill up the form that is available online on the insurer’s website.
- If the cashless claim facility is being availed in the event of an emergency hospitalisation, the cashless request form must be filled and submitted to the insurer within a period of 48 hours of the hospitalisation having commenced. If the hospitalisation is pre-planned, the cashless request form must be filled in and submitted to the insurer in a minimum number of 3 days before hospitalisation commences.
- After the cashless hospitalisation request is received by the insurer, they will take at minimum of 2 hours (when request is submitted during normal business hours) to review the request and come to a decision. The policyholder will be informed of the insurer’s decision as soon as it is taken.
- The settlement of the claim will be done between the insurer and the treating network cashless hospital in accordance of the terms and conditions of the policy, and after all due formalities have been completed.
Reimbursement Claim Process:
- If the policyholder is availing treatment at a non-network hospital, they are eligible to file a reimbursement claim.
- The first thing to do is to inform the insurer about the hospitalisation that has taken place. This can be done by either calling on the insurer’s toll free helpline number, or by dropping an email to the insurer’s customer service team.
- If the hospitalisation has occurred following an emergency, the insurer must be informed at least 48 hours after the hospitalisation has commenced. If the hospitalisation is pre-planned, the insurer must be informed at least 3 days before the insured is admitted to the hospital for treatment.
- To file for a reimbursement claim, the policyholder is required to gather all treatment related documents from the hospital, and submit the same to the insurer within a period of 15 days after being discharged from the hospital.
- The necessary claim supporting documents can be submitted to the insurer either via post, or the same can be uploaded on the insurer’s portal after logging in.
- Once the claim supporting documents have been successfully submitted to the insurer, the claim processing will be done in accordance with the terms and conditions of the policy.
- Policyholders can track their claim status on the insurer’s website by logging into the portal with the help of their username/member ID, and the password.
Incurred Claims Ratio of Aditya Birla Health Insurance for the Year 2017-18
|Net Earned Premium (in Crore)||Net Claims Paid (in Crore)||Incurred Claims Ratio (in %)|
|Rs.151.98 crore||Rs.135.35 crore||89.05%|
Aditya Birla Health Insurance Customer Care:
To deal with the concerns and issues faced by the customers regarding their policy, Aditya Birla has set up a dedicated customer service team. There are multiple channels via which customers can contact the customer care team, which include:
- Toll free number – 1800 270 7000
- Email ID – email@example.com; Senior citizens can write in to firstname.lastname@example.org.
- Registered address - Customers can send a mail to the insurer’s Customer Services Unit at the registered address i.e. Aditya Birla Health Insurance Company Ltd., 10th Floor, R-Tech Park, Nirlon Compound, Off Western Express Highway, Goregaon East, Mumbai – 400063.
If you have not received a satisfactory reply to your query or complaint from the Customer Services team, you can escalate your complaint by writing to email@example.com.
In case your complaint/issue has still not been satisfactorily resolved, you can write in to the Grievance Redressal Officer at Aditya Birla, the email ID for which is firstname.lastname@example.org.
Aditya Birla Health Insurance FAQs:
How do I port my existing health insurance policy to Aditya Birla?
The process to port your policy to Aditya Birla is very simple. Customers who wish to port their policy to Aditya Birla must fill up the portability form at least 45 days before the renewal date of their existing policy. Following this, Aditya Birla will contact your current insurer and request for your medical and claim history. After the same has been received by ABHI, the insurer will review your application and reach a decision within a period of 15 days starting from the date on which your existing insurer has provided the policy related information.
Can I track my claim status?
Yes, you can track your claim status by going to the Aditya Birla health insurance website, go to the ‘Track Claim’ section, and login to the portal using your username and password. Once you have logged in, look for your claim to check its status.
In case of Reimbursement Claims, how will the payment be made?
In case of a Reimbursement claim, the payment is transferred directly to the policyholder’s bank account. Policyholders also have the option of receiving the payment via NEFT, in which case they must provide their NEFT related details while submitting the Reimbursement Claim Form. The details to be provided include the account holder’s name, account number, IFSC code, branch address, and a cancelled cheque. If the policyholder has not provided these details, the claim settlement amount will be sent to them via a cheque to the policyholder’s registered address.
To whom should the claim be submitted, the insurer or a TPA?
Group insurance customers must submit their reimbursement claims through the TPA, as per the details mentioned in their policy. Retail customers filing reimbursement claims can submit the supporting documents wither at their nearest Aditya Birla Health Insurance branch office, or at the following address:
Aditya Birla Health Insurance Co. Ltd.
13th Floor, R Tech Park,
Off Western Express Highway,
Goregaon (East), Mumbai - 400063
Can the cashless facility be availed for treatment in government-run institutions like AIIMS, TMH, ARMY referral hospitals?
No, the cashless claim facility is currently not provided for treatments taken in government hospitals.
Will I be entitled to a claim that has been raised during the policy’s grace period?
No, the insurer will not be liable to entertain any claim which arises when the policy is in its grace period.
What if the hospitalisation expenses are more than the limit that is provided under the initial cashless authorization request?
In case the hospitalisation expenses exceed the approved cashless claim limit, the treating network hospital will send a request for enhancement of the authorisation limit to the insurer. This includes the details of the treatment and circumstances which have caused the increase in expenses over the authorized limit. Once the details reach the insurer, they will verify the same and review the insured’s eligibility for the enhancement, and make their decision accordingly.
Under the Activ Health Plan, what is the maximum age for policy renewal?
Under the Activ Health plan, the policyholders have the benefit of lifetime renewability, which means that there is no maximum age restriction on policy renewability. Policy renewal will be dependent on payment of premiums, and fulfilment of policy conditions.
Under the Activ Health plan, who is eligible for the optional ‘maternity expenses’ cover?
If the policyholder and their spouse are covered under the same individual or floater policy, they are eligible for the optional maternity expenses cover. The insured woman must be between 18 to 45 years of age. This optional cover comes with a waiting period of 24 months.
For an Activ secure policy taken for a term of 2 or 3 years, is there any discount offered on premiums?
Those who have chosen a single premium Activ secure plan with a policy term of 2 years or 3 years will be eligible to a premium discount of 7.5% and 10% respectively.
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