Today there are several service providers providing health insurance policies to protect individuals from the financial shock associated with sudden illness and hospitalisation. Each insurer also offers a wide array of plans to choose from. This blog details some features of Aditya Birla’s Activ Assure Diamond Plan, a health insurance plan that offers coverage ranging from INR 2 lakhs-2 crores. The premium is dependent on the age of entry as well as the sum insured. Apart from in-patient and domiciliary hospitalisation expenses, the plan offers coverage of over 586 day-care procedures up to the sum insured (SI).
Scope of Coverage
Hospitalisation Cover: This plan offers cover for in-patient hospitalisation as well pre and post-hospitalisation expenses of thirty and sixty days, respectively.
Domiciliary Treatment: Medical expenses for domiciliary treatment or home care is covered up to 10% of the sum insured.
Organ Donor Expenses: In case the insured requires an organ transplant, the expenses of the donor are also covered up to 100% of the SI.
Alternative Medicine Hospitalisation Treatment: This policy also offers coverage of treatment availed in Unani, Ayurvedic, Homeopathic, Naturopathy, Yoga and Siddha streams of medicine facilities. The coverage provided however ranges from INR 15,000/- for a SI up to INR 4 lakhs to INR 50,000/- in case of SI of INR 1 crore or more.
Ambulance Expenses: The policy offers reimbursement of ambulance expenses in case of domestic and international emergencies and includes air ambulance cover. For road ambulances, the cover ranges from INR 1500/- to INR 5000/- depending on the SI.
Cashless Coverage: Activ Assure Diamond Plan comes with cashless coverage at Aditya Birla’s 10,000+ network hospitals.
Vaccination Cover: If the sum insured is INR 1 crore or more, coverage of up to INR 10,000/- is provided against vaccination expenses.
Exclusions
As with most health insurance policies, the Activ Assure Diamond Plan comes with some exclusions. Some are permanent while others are linked to a waiting period.
Permanent Exclusions: Hospitalisation due to war, attempted suicide or self-inflicted injury, and claims related to the use of drugs and alcohol all come under the permanent exclusion category. Plastic surgery forms part of the exclusions unless it was carried out due to medically necessary treatment. Other such exclusions include psychiatric and mental disorders, dental treatment, hearing aids, spectacles, etc.
Temporary Exclusions: Coverage of certain ailments or conditions come with a waiting period. Pre-existing diseases come with a waiting period of up to 48 months, much like most other health insurance policies. Others like cataracts, hernia, sinusitis, joint replacement and others come with a 24-month waiting period. All other treatments, except that in the case of accidents, mandate a 30-day initial waiting period, i.e. no claims can be made within 30 days of the start of the policy, except for accident-related treatment.
Other Features
Mandatory Co-payment
While there is no maximum age limit for entry, the policy mandates a co-payment for a 20% co-payment in case the age of entry of the person covered is 61 years and above.
Health Returns
The policy offers up to a 30% discount on the following year’s premium for maintaining a healthy lifestyle. This healthy lifestyle quotient depends on the number of active days a month or the results of a fitness test every six months. This former is dependent on the number of steps taken per day, the daily calorie count or the number of gym sessions a week. Thirteen active days can earn up to a 30% discount on the following year’s premium. Health Returns can also be used to purchase medicines or pay for diagnostic tests as well. Four active days per month could earn up to a 6% discount on premiums.
Sessions with Health Coach
This is available for persons with asthma, hypertension, hyperlipidemia or diabetes above 18 years of age. Two sessions may be availed every policy year.
Optional covers Available
Activ Assure Diamond Plan has three optional covers – reload of Sum Insured (SI) up to 150% subject to a maximum limit of INR 50 lakhs, no-claim bonus (NCB) of 50% up to a maximum of 100% of SI; and any room upgrades if the SI is INR 500,000/- or more.
Long-term Discounts
Aditya Birla’s Activ Assure Diamond Plan offers a discount of up to 7.5% if one purchases a two-year policy and 10% if one purchases a three-year policy.
Family Discounts
A discount of 5% is offered if 2 to 3 members of the same family opt for the multi-individual policy under this plan. This goes up to 10% if more than four members opt for the plan. A total of six members are allowed coverage under the family floater policy.
Maximum Age of Entry
Unlike most other standard health insurance plans, there is no maximum age limit for entry.
Conclusion
With a coverage of INR 2 Lakhs to INR 2 crores, several features such as Ayush coverage, pre and post hospitalisation, health returns in addition to NCB, this plan merits consideration. However, do check the fine print and ensure that the plan suits the needs of those covered, whether it may require an add-on plan, or, whether there is another standalone plan that offers you better value for money.
