Choosing a health insurance plan is an exercise that requires careful consideration. There are several service providers in the market, with each offering several different plans. A wise planner will weigh the merits and offering of each plan as well as the premium, against the potential health and hospitalization needs of those she or he seeks to cover under the plan. In this article some of the key features and attractions of the Activ Health Platinum Enhanced Plan offered by Aditya Birla Health Insurance Co. Ltd. are discussed.
Scope of Coverage
Hospitalization Cover: Apart from inpatient hospitalization coverage, this health insurance plan of the Aditya Birla Group offers pre-hospitalization coverage of 60 days and post hospitalization expense coverage up to 180 days, including coverage of physiotherapy expenses.
Domiciliary Treatment: The plan also covers domiciliary treatment on a cashless basis if availed through a network or empaneled service provider. Treatment for dengue, gastroenteritis, chemotherapy, etc. are some of the treatments covered.
Day Care Procedures: More than 575 day care procedures are covered under this health insurance plan.
Cashless Coverage: The Activ Health Platinum Enhanced Plan offers cashless coverage at 6,000 plus network hospitals.
Chronic Illness Cover: Coverage of hospitalization due to conditions related to chronic illnesses such as high blood pressure, diabetes, asthma and cholesterol do not mandate a waiting period under this plan, unless considered a pre-existing disease. In addition, tests and diagnostics related to these are also covered.
Dental Consultation and Investigation: Another unique feature of the plan is the coverage offered for one comprehensive dental consultation, one dental cleaning and one dental x-ray during the plan period.
Obesity Treatment: If bariatric surgery is medically prescribed as necessary, the plan offers coverage of the same. This however requires prior approval from Aditya Birla Health Insurance Co. Ltd.
Organ Donor Expenses: These are covered under this Platinum Enhanced Plan,while not covered under Aditya Birla’s Essential Health Plan
Treatment under Alternative Medicine Therapies: Hospitalization expenses under non-allopathic streams such as Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy are also covered under this policy.
Ambulance Cover: In case there is a necessity for an air ambulance because of the remoteness of the location the insured is in, the plan provides coverage of ambulance charges including domestic air ambulance expenses up to a limit of INR 5000/- per hospitalization.
Exclusions
Permanent Exclusions: Hospitalisation due to war, attempted suicide or self-inflicted injury, and claims related to use of drugs and alcohol all come under the permanent exclusion category. These will not be covered under this health insurance plan. Plastic surgery forms part of the exclusions unless it was diagnosed as a medically necessary treatment. Other such exclusions include psychiatric and mental disorders, dental treatment, hearing aids, spectacles, etc.
Temporary Exclusions: There is a minimum 30-day waiting period before any claim may be made against the plan, except in the case of an accident. Pre-existing disease conditions invite a waiting period of 36 months.
Other Features
Reload of Sum Insured: If a claim is made during the policy period, this policy offers a reload of 100% of the sum insured. However, this will not be available for use against hospitalization for the same illness.
Health Returns: The health return feature challenges the insured to earn 100% return on premiums through staying healthy and fit. In order to be eligible for health returns one must complete the health assessment,and exercise regularly. It also allows you to double the sum insured if you have two claim free years.
Premium Waiver: In a unique offer, the plan provides for a premium waiver if the insured is detected with a critical illness. However, this waiver can only be availed once during the lifetime of the policy. The plan also offers to provide a second e-opinion if so desired through a consortium of international specialists.
Cumulative Bonus: The insured can get a 50% increase in the sum insured during the year following a no-claim year. This bonus is capped at 100% of the sum insured (SI) or a maximum of INR 1 crore, whichever is less.
Personal Accident Optional Cover: This is an optional cover which provides protection against permanent and total disablement and accidental death. The pay-out in such cases is equal to the SI.
International Coverage of Major Illnesses Optional Cover: Should treatment be required form outside India, the plan offers to cover the cost in the case of 16 major illnesses. However, the base SI should be INR 10 lakhs or above and the optional cover should have a SI of INR 3 crores.
Critical Illness Optional Cover: This optional cover is available for 20 critical illnesses, but only after a waiting period of 90 days. In addition, the cover is only available after completion of a survival period of at least 15 days after detection of the critical illness.
Health Coaching: Experts are available for nutritional counseling as well as for medical fitness related issues. Mental wellness coaching and teleconsultation on homeopathy is also available.
Free Health Checkup: This is provided once in a policy year.
Age of Entry: Like the Activ Assure Diamond Plan, there is no maximum age-limit for entry. Under the family floater policy, children can be admitted at a minimum age of 91 days. For individual policies the minimum age of entry is 5 years.
Conclusion
The Activ Health Enhanced Plan offered by Aditya Birla Insurance Co. Ltd. has several attractive features such as coverage of chronic illness related conditions from Day 1 and premium waiver if detected with a critical illness. This health insurance plan has no maximum age of entry. The maximum sum insured is INR 2 crore.
