Aditya Birla Activ Care Health Plan

Brief Overview

The chances of falling prey to medical problems get higher with old age. And in today’s time along with the unabated growth in the number of lifestyle diseases, COVID-19 cases there has also been a steep rise in the cost of healthcare treatments. Affording a good-quality treatment in a decent hospital can dig deep into your savings. To help you deal with such a crisis, especially in your golden years, Aditya Birla Capital-Health Insurance brings for you the Activ Care Plan. 

When you invest in a good health insurance policy, it not only helps you deal with a medical emergency but also gives you mental peace that in case of hospitalisation and the related expenses, you have the protective cover of a health insurance plan. Let us explain this with an example. 

On his retirement as a bank manager, Mr Anand received a good amount of money. He was happy that he wouldn’t have to worry much about the future and would spend his time relaxing. A few months later, he suffered a heart stroke and had to undergo surgery. As he did not have health insurance, he had to bear all the expenses from his pocket. After this, Mr Anand bought an Activ Care Plan for himself and his wife. Next year, his wife had a bad fall and had to be hospitalised for 4 days. But because Mr Anand had a health cover this time, he did not have to pay for his wife’s treatment. 

Thus, buying a health insurance plan for senior citizens is very important. With a plan such as Activ Care Plan, you can rest assured that a medical urgency will not put you into a financial crisis. 

Best Features of Aditya Birla Activ Care

1. The indemnity based health insurance plan is for people who are between 55 and 80 years of age
2. The plan is available as an individual and family floater health insurance plan (family floater covers the only spouse)
3. The plan is available in 3 variants Standard/ Classic/ Premier
4. There are 586 day-care procedures available
5. Your expenses for hospitalisation due to COVID-19 will also be covered
6. Once a year get a Reload of Sum insured for subsequent claims for an unrelated treatment
7. For every claim-free year enjoy a No Claim Bonus of 10% of the sum insured
8. When you stay fit and healthy, you can earn rewards in form HealthReturns
9. You can avail International/Domestic Emergency Assistance Services
10. Second E-opinion on major illnesses is provided under the plan 

Benefits of Aditya Birla Activ Care

1. Comprehensive Cover
   The plan, under the three variants, offers a lot of choice in coverage benefits:
   1. Standard: with a sum insured from INR 3 lakhs to INR 10 lakhs
   2. Classic: with a sum insured from INR 3 lakhs to INR  to INR 10 lakhs
   3. Premier: with a sum insured from INR 5 lakhs to INR  to INR 25 lakhs
2. Reload of Sum Insured
   Depending upon the plan variant that you select there is a reload of the sum insured that can be from 50% to 100%. In a policy year, if the sum insured is exhausted the reload will help you make subsequent claims for an unrelated illness.
3. In-patient Hospitalisation
   When an insured member is hospitalised for over 24 hours, the expenses such as doctor’s fee, room rent, medicines, ICU and OT charges etc. are covered depending on the policy that you have bought.
4. No Claim Bonus
   In a policy tenure, if you do not make a claim, you will receive 10% of the sum insured as a No Claim Bonus. The maximum limit for the bonus is 50% of the sum insured. 
5. Pre and Post-hospitalisation 
   There are various expenses that are incurred before as well as after the hospitalisation. With the Aditya Birla Activ Care Plan, such costs are covered for a specific number of days.
6. Day-care procedures
   Unlike regular hospitalisation, there are certain treatments that do not require you to be admitted for more than 24 hours. Under the Activ Care Plan, 586 of such day-care procedures are covered. 
7. Organ Donation
   Under the Classic and Premier plan option, you would be covered for organ transplant along with the expenses of organ donation for harvesting the organ.
8. Domiciliary Treatment
   In case you need to get treated at home as you could not get admitted to a hospital, the expenses on the prescribed medical treatment will be covered. 
9. AYUSH Benefits
   Medical expenses incurred towards the hospitalisation under AYUSH treatment is covered under the Classic and Premier plan option.
10. Ambulance Charges
    In case of an emergency, if the insured member makes use of an ambulance to get to the hospital, the ambulance charges will be covered by the company. 
11. Health Check-ups
    Once in a policy year, if you opt for a sum insured over INR 5 lakhs under the Classic and Premier plan option, every insured member will be offered a comprehensive health check-up.
12. Discounts
    Under the plan you can get the following discounts:
    1. 5% discount on buying multi-individual Activ Care plan for 2 members
    2. 7.5% discount when you buy the policy for 2 years 
13. Optional Care Benefits
    There are 4 optional benefits that can be opted for:
    1. Nursing at Home
    2. Advanced Health Checkup
    3. Lifestyle Support Equipment
    4. Portable Medical Equipment 
14. Co-payment
    1. Standard and Classic: 20% co-pay for all in-patient hospitalisation, Domiciliary, Day-Care Treatments, AYUSH claims
    2. Premier: 20% co-pay for all in-patient hospitalisation, Domiciliary, Day-Care Treatments, AYUSH claims. 20% co-payment for listed illnesses

Plan Details of Aditya Birla Activ Care

• Waiting Period
  The waiting period in Aditya Birla Activ Care plan is applicable as follows:
  • Expenses incurred towards the treatment of any sickness within 30 days of policy purchase. Accidental injuries are covered from day 1
  • Expenses on the listed diseases, procedures, conditions will not be covered till the end of 24 months in Classic Plan & Premier Plan
  • Standard Plan: 24 months for a specific illness, 48 months for Joint Replacement Surgery
  • Pre-existing diseases and their related conditions will not be covered till the end of 2 years
  • There is a 15 Days Initial Waiting Period in case the insured members are diagnosed with COVID-19
• Free Look Period
  In the rare case that after you purchase the policy you feel dissatisfied with it, the company gives you a free look period of 15 days. If a claim has not been made then you will be allowed to return the policy.  Notification must be sent to the company from your side along with the reason for the return. You will be refunded with the money that you paid as the health insurance premium, after deducting the proportional risk cover and the stamp duty charges.

What is not Covered in Aditya Birla Activ Care Plan?

Listed below are the permanent exclusions of the policy, for a detailed list, it is recommended that you refer to the Policy document. The expenses on the following are NOT covered:

1. Optometric therapy, cost of contact lenses, hearing aids, spectacles
2. Treatment for alopecia, wigs, baldness
3. Re-shaping treatments
4. Cosmetic and aesthetic surgeries
5. An illness due to injury/ accident under the influence of intoxicants
6. Intentional self-injury
7. Breach of law
8. War/ uprising/ revolution

Renewal Process of Aditya Birla Activ Care Plan

Renewing the policy on time is very important as it lets you enjoy the benefits and services of the policy. The renewal process is easy, you can either:

• Visit the company website and select the policy, then select the option of “Renew”, given on the top right of the page. When you enter the required details, you will be redirected to a new page. Check your policy details and make the payment via any of the given electronic mediums.
• The policy can also be renewed offline. You need to visit the company office and fill in the renewal form. The policy will be renewed once the payment is made.

Keep in mind:

1. The right of the renewal lies with the company
2. The request for renewal has to reach the company before the policy expires
3. A claim that is made during the 30-day grace period is not accepted
4. After the grace period, the policy will be terminated

Aditya Birla Activ Care Plan - Claim Process

On the occurrence of an injury or discovery of any disease that may give rise to a claim, you need to inform the company as early as possible. The company can be intimated through an email, a phone call with customer care, or online registration. In the case of:

• Planned Hospitalisation -72 hours prior to admission. Also, bear in mind that in case of planned hospitalisation, once you receive the authorisation, the treatment must be taken within a period of 15 days.
• Emergency Hospitalisation - Within 48 hours of admission
• Cashless Claim 
  It is only at a network hospital, that you can avail the facility of cashless treatment. The list of network hospitals is available on the company website and is updated regularly. At the hospital Help Desk, you need to submit your Health Card. You would also have to submit the Pre-Authorisation form, treatment-related documents and your KYC documents. After verification of all the paperwork, when your cashless health insurance claim is accepted, the hospital bill will be settled directly by the company.  
• Reimbursement Claim 
  At a non-network hospital cashless treatment is not available and the payment has to be made upfront. However, you can make a claim for reimbursement of your expenses. There are a few and simple guidelines that you need to follow carefully. Keep in mind that you need to inform the company about the hospitalisation well in time. After your discharge from the hospital, you have to fill in the Claim Form and submit it along with all the other required documents (the list is given below). Once all the documents are ready, send them to:
  
  Aditya Birla Health Insurance Co Limited,Claims Department, 5th floor, Modi Business Centre, Kasarvadavali, Mumbai, Thane West-400 615

Once all your documents are found in order, the company would approve the claim. You would be contacted by the company in case any paperwork is due. Once approved, the due amount will be transferred into your bank account.

• Required Documents
  The list of the documents required is given below: 
  • Claim Form A and B
  • Health Card or Policy Papers
  • Valid Photo ID document
  • KYC documents
  • Doctor’s prescription that advises hospitalisation,  all investigations, tests, medicines, consultations etc
  • Treatment-related bills and receipts
  • Patient’s Discharge Summary
  • Bill of Ambulance Service, if used
  • A Medico-Legal Certificate or an FIR in case of an accidental injury
  • Death Certificate (in case of death)
  • Bank Account details, cancelled cheque

Bear in mind that more documents may be required depending upon the treatment that has been sought by the insured member. 

Aditya Birla Health Insurance- Network Hospitals

If you are trying to locate a network hospital, you can either visit the company website and go through the list or click https://www.adityabirlacapital.com/healthinsurance/#!/hospital-search. 

With a network of over 7,000 well-renowned hospitals, Aditya Birla Capital-Health Insurance offers cashless treatment across to one and all. In case of a medical emergency,  you would need not run around arranging funds for the treatment as the bill is settled by the company. Rather than fretting about the finances, you can concentrate on the treatment. 

Another major advantage of being in a network hospital is that there would be very little paperwork that is required. Most of the procedures are carried out by the representatives of the company. It saves you a lot of time and makes the claim procedure smooth and hassle-free. 

Review of Aditya Birla Activ Care Plan 

Aditya Birla Activ Care Plan is a health insurance plan created especially for people who are in the age group of 55 to 80 years. As most health insurance plans have a maximum entry age of 55/ 60 years, this plan allows you to opt for a medical cover for a much longer time. Very flexible health insurance, Aditya Birla Activ Care Plan lets you customise the benefits as per your insurance needs and also offers you multiple additional benefits. 

While covering the in-patient costs, the plan will also reward you for staying fitter and healthier in the form of HealthReturn rewards. If you or someone you know is looking for a health insurance plan that is suitable for the insurance needs of senior citizens, Aditya Birla Activ Care plan offers various benefits that make it an outstanding choice. 

Aditya Birla Capital Health Insurance Customer Care