Aditya Birla Activ Health Platinum Enhanced plan represents a significant advancement in healthcare coverage. It has been crafted to ensure wellness maintenance and comprehensive financial protection. This plan introduces a suite of distinctive features to address various needs of individuals seeking robust healthcare support.
At its core, the plan represents a commitment to holistic health management, combining preventive measures with responsive coverage. One of its noteworthy features is the innovative HealthReturns program, incentivizing proactive health management through rewards. Additionally, the provision for reload of the sum insured ensures uninterrupted coverage during exigencies, fostering peace of mind amidst uncertainties.
Moreover, it has a Chronic Management Program that highlights the plan’s proactive approach towards addressing long-term health concerns, offering tailored support and resources for managing chronic conditions effectively.
This guide will take you through various sides of Aditya Birla Activ Health Platinum Enhanced plan.
Key Features of Aditya Birla Activ Health Platinum Enhanced Plan
- Policy Flexibility
This plan offers individual and family floater policies, catering to diverse coverage needs and preferences.
- Annual Health Check-Up
Insured individuals benefit from an annual health check-up facility, facilitating proactive health monitoring and early detection of potential issues.
- Health Returns
You can earn up to 100% of the premium as health returns, which can subsequently be utilized towards paying renewal premiums, fostering a cycle of incentivized health management.
- Comprehensive Coverage from Day 1
You will get immediate coverage for essential healthcare needs, including medicines, diagnostic tests, consultations with physicians etc. under the Chronic Management Program.
- Premium Waiver for Critical Illness
In the unfortunate event of diagnosis with a critical illness listed within the policy terms, beneficiaries can benefit from a premium waiver for one year, alleviating financial burdens during times of medical crisis.
- Sum Insured Restoration
The policy ensures 100% restoration of the sum insured, subject to certain conditions. Notably, this restoration can be activated if an unrelated illness or accident occurs after the initial claim, provided the sum insured is not fully exhausted in the preceding year.
These salient features collectively underscore the comprehensive nature of the Aditya Birla Activ Health Platinum Enhanced plan.
Also Read: All About Aditya Birla Health Insurance
Inclusions of Aditya Birla Activ Health Platinum Enhanced Plan
The coverage provided by the Aditya Birla Activ Health Platinum Enhanced plan encompasses a comprehensive array of healthcare expenses. Key elements of the coverage include:
- In-patient hospitalization covering room rent, nursing expenses, doctor’s fees, OT charges, medication costs, and consultation fees during hospital stays
- Pre-hospitalization medical expenses covering medical expenses incurred in the 60 days preceding hospitalization
- Post-hospitalization medical expenses covering expenses incurred in the 180 days following hospital discharge
- Daycare treatment coverage for specific treatments not requiring 24-hour hospitalization, such as dialysis, cataract surgery, chemotherapy, and tonsillectomy
- Domiciliary hospitalization to reimburse the cost of treatment administered at home when hospitalization is impractical
- Road ambulance cover to reimburse actual expenses for road ambulance services within network hospitals and up to Rs 5000 per hospitalization for non-network hospitals
- Organ donor expenses covering expenses associated with organ harvesting during transplant procedures
- AYUSH cover including treatment costs under Ayurveda, Yoga, Unani, Siddha, and Homeopathy systems
- Mental illness hospitalization to cover medical expenses for the treatment of mental illnesses
- Obesity treatment for reimbursement of expenses for medical treatment related to obesity
- Home treatment to cover necessary treatment expenses at home post-discharge
- Emergency assistance services including air ambulance services, both domestically and internationally, during emergencies
- OPD cover offering coverage for outpatient consultations, up to Rs 1000, for policies with a sum insured of Rs 15 lakh or above
- Second e-opinion for major illnesses to provide coverage for seeking a second opinion from qualified specialists for major illnesses like cancer etc.
Exclusions of Aditya Birla Activ Health Platinum Enhanced Plan
- Treatment expenses related to venereal diseases
- Expenses incurred for the treatment of external congenital anomalies
- Treatment costs associated with sexually transmitted diseases
- Expenses resulting from the abuse of intoxicants such as drugs or alcohol
- Treatment expenses arising from intentional self-injury
- Costs related to maternity, including childbirth and related medical care
- Treatment expenses for injuries resulting from acts of war and nuclear perils
These exclusions delineate the specific treatment expenses that fall outside the scope of coverage under the Aditya Birla Activ Health Platinum Enhanced plan.
Recommended Read: Types of Health Insurance in India
Eligibility Criteria for Aditya Birla Activ Health Platinum Enhanced Plan
Aditya Birla Activ Health Platinum Enhanced Plan Eligibility Criteria:
- Minimum Entry Age: 5 years (for individual policy) and 91 days (floater policy)
- Maximum Entry Age: No bar; individuals of any age can enroll in the plan
- Children below 25 years of age can be added under the family health insurance option
- Flexible tenure options to choose from durations of 1, 2, or 3 years
How to Buy Aditya Birla Activ Health Platinum Enhanced Plan?
Steps to Purchase Aditya Birla Activ Health Platinum Enhanced Plan
- Access the official website of Aditya Birla Health Insurance or a reliable insurance aggregator.
- Click on ‘Health Insurance’ to proceed with your purchase.
- Enter your contact details, including your mobile number, to initiate the purchase process.
- Fill in the required personal information, such as age, medical history, and any other relevant details as requested.
- Review the plan and premium.
- Proceed to make the premium payment securely, either online or offline.
- Upon successful payment, the policy will be issued instantly. You will receive a confirmation email containing a downloadable copy of the policy document to your registered email address.
You can also buy the plan offline through an insurance agent.
Aditya Birla Activ Health Platinum Enhanced Insurance Claim Process
Steps to File a Cashless Claim:
- Visit the nearest network hospital affiliated with Aditya Birla Health Insurance Company Limited.
- Present your Aditya Birla health card along with a valid ID proof at the hospital help desk.
- Complete a cashless hospitalization request form and submit the pre-authorization letter to the Third Party Administrator (TPA).
- The TPA will forward the application to the insurance provider for review.
- The insurer will communicate approval or rejection of the cashless request based on specified criteria.
- Upon approval, avail cashless services at the network hospital, with expenses settled directly by the insurer post-hospital discharge.
Note: You need to notify the insurer at least 48 hours in advance for planned hospitalizations and within 24 hours for emergency admissions.
Steps to File a Reimbursement Claim:
- Notify the insurer and register a claim through their 24×7 helpline or official email.
- Gather all relevant documents, including original medical bills, receipts, discharge summary detailing the illness or accident.
- Submit the completed claim form along with the necessary documents to Aditya Birla Health Insurance. You can send the documents via post or upload them online through the insurer’s portal.
- After document verification, the insurer will reimburse expenses up to the admissible amount, considering deductibles specified in the policy terms.
Docs Required to Buy Aditya Birla Activ Health Platinum Enhanced Plan
- Valid age proof documents such as Birth Certificate, Voter’s ID, PAN Card, Passport, Driving License, or School/College Certificate verifying the applicant’s age
- Acceptable forms of identification including Aadhaar Card, Driving License, Passport, Voter’s ID, or PAN Card
- Address proof confirming residential address, such as utility bills, Passport, Bank Statement, or Voter’s ID
- Evidence of income including six months’ salary slips, Employer’s Certificate, Form 16, or any other relevant documents verifying financial status
- Recent passport-sized photographs of the applicant(s) as per specified guidelines
- Medical health check-up depending on the insurer’s requirements or policy terms
Docs Required for Claim Settlement Under Aditya Birla Activ Health Platinum Enhanced Plan
- Duly filled and signed claim form with accurate information
- Medical certificate from the treating doctor, providing details of the illness or diagnosis as per the treating physician’s assessment
- Proof of medical and pharmacy bills including original medical and pharmacy bills along with receipts as evidence of expenses incurred for treatment
- Hospital discharge summary to provide the hospital discharge summary detailing the course of treatment and post-hospitalization instructions
- Death certificate in the unfortunate event of a claim related to demise
- Original diagnostic reports such as laboratory tests, imaging studies, or other relevant medical investigations
- KYC Documents if requested by Aditya Birla Health Insurance Company, ensuring compliance with regulatory norms
Policyholders can expedite the claim settlement process under the Aditya Birla Activ Health Platinum Enhanced plan by furnishing these requisite documents promptly and accurately.
Renewal Process for Aditya Birla Activ Health Platinum Enhanced Plan
Renewing your Aditya Birla Activ Health Platinum Enhanced policy is crucial to ensure continuous coverage and avail ongoing benefits. Online renewal offers a convenient and preferred method for policyholders. Here’s a step-by-step guide to renewing your policy online:
- Access the official website of Aditya Birla Health Insurance or an insurance aggregator.
- Go to the ‘Renew Your Policy’ option.
- Log in by providing your policy number or registered mobile number to access your policy details.
- Once logged in, review the details of your Aditya Birla Activ Health Platinum Enhanced policy.
- Verify the accuracy of the policy details to ensure completeness and correctness.
- Click ‘Renew’ to proceed with the payment process.
- Upon successful payment, you will receive a transaction confirmation to your registered contact number and email address.
- You will then receive a renewed policy document along with a receipt for the payment made, ensuring continuity of coverage.
FAQs
Can I add my family members to my Aditya Birla Activ Health Platinum Enhanced plan?
Yes, you can include your family members under the family floater option. Children below 25 years of age can also be added to the family health insurance. For more details, contact the insurer.
What is the Health Returns feature mentioned in the plan?
Health Returns is an innovative feature that rewards policyholders for maintaining good health habits. You can earn up to 100% of the premium as health returns, which can be utilized for paying renewal premiums.
How do I avail cashless hospitalization under the plan?
To avail of cashless hospitalization, visit any network hospital affiliated with Aditya Birla Health Insurance Company Limited, present your health card and ID proof, fill out a cashless hospitalization request form, and await approval from the insurer.
Is there a waiting period for pre-existing illnesses under the plan?
Yes, like most health insurance plans, there is a waiting period for pre-existing illnesses. However, specific waiting periods may vary based on the policy terms and conditions.
Can I renew my Aditya Birla Activ Health Platinum Enhanced policy offline?
Yes, you have the option to renew your policy offline. It is up to you to decide how you want to renew the policy.