Aditya Birla Activ One (NXT)

Let’s Get To Know Everything About The Plan -

The Aditya Birla Activ One (NXT) Plan is a health insurance plan offered by Aditya Birla Health Insurance Company Limited. This plan offers a range of benefits and features to address both your and your family's healthcare requirements comprehensively. With the Activ One (NXT) Plan, you can enjoy the assurance that necessary medical care will be accessible for you and your loved ones, relieving you of financial concerns.

Eligibility Criteria For The Aditya Birla Activ One (NXT) Plan

• Minimum Age Of Entry: For adults, the policy can be purchased from 18 years onwards. If you have dependent children, they can join as young as 1 year old. For multi-individual policies, the minimum age for dependent children is 5 years.

• Maximum Age Of Entry: Adults can enter the policy until they reach 99 years old, while dependent children can join at most 25 years old.

Benefits and Coverage Overview of The Aditya Birla Activ One (NXT) Plan?

The Aditya Birla Activ One (NXT) Plan provides coverage for inpatient hospitalisation expenses. These are costs incurred while staying in the hospital for over 24 hours, such as room and board, nursing charges, prescribed medicines and drugs, medical practitioner's fees, ICU charges, and other related expenses. Let’s take a look at some of the other expenses covered by the plan –

• Pre & Post Hospitalisation Expenses
  With the Aditya Birla Activ One (NXT) Plan, you do not have to stress about the medical tests before or after your hospital stay. The policy takes care of these expenses for a reasonable period – 90 days before you are admitted and 180 days after you get discharged from the hospital. It is important to note that these expenses are covered only if they are typically related to the condition/disease that led to your hospitalisation and the claim is approved as part of your inpatient hospitalisation coverage.
   
• Daycare Treatment Coverage
  A daycare treatment is a medical procedure or surgery that used to need a long period of hospitalisation but can now be done in just 24 hours because of medical advancements. The Aditya Birla Activ One (NXT) Plan covers all daycare procedures up to the sum insured without any cap.
   
• Domiciliary Treatment Coverage
  These refer to treatments for illnesses or injuries that need urgent hospital attention but are done at home because the patient is too unwell or injured for transportation, or no nearby hospital beds are available. The Aditya Birla Activ One (NXT) Plan covers domiciliary treatment expenses, and the coverage is up to the sum insured.
   
• Organ Donor Coverage
  With the Aditya Birla Activ One (NXT) Plan, you will be covered for organ donor expenses if you are the recipient. The plan takes care of inpatient costs related to the procedure of organ transplantation, up to the sum insured. It is important to note that this plan does not cover pre and post-hospitalization expenses of the organ donor.
   
• Modern Treatment Coverage
  Healthcare is evolving fast with new technologies, bringing about treatments that were once thought impossible. The Aditya Birla Activ One (NXT) Plan provides coverage in a way to adapt to these changes and covers the costs of modern treatments up to the sum insured.
   
• Claim Protect (Non-Medical Expenses)
  Non-medical expenses are costs related to consumables such as gloves, oxygen masks, nebulization kits, and other needed items during treatments or surgeries. These items can be expensive and have an impact on your finances. With the Aditya Birla Activ One (NXT) plan, you get coverage for these costs up to the sum insured to help ease your financial strain if you opt for an add-on.
   
• Super Credit (No Claim Bonus)
  The Super Credit (No Claim Bonus) is a valuable feature designed to assist you in managing the impact of increasing inflation. With this optional benefit, your sum insured will get enhanced. Each time you renew your policy, regardless of whether you make a claim or not, 100% of the base sum insured is added. You have the flexibility to enhance your coverage through this feature, with the possibility of reaching up to a maximum of 500% of the base sum insured, and is limited to Rs. 3 Crores. Also, you should know that the accumulated bonus will not reduce even in the case of making a claim in the future.
   
• Super Reload
  The Super Reload is a unique restoration benefit that ensures your sum insured is replenished when it is exhausted in a policy year. With the Activ One (NXT) Plan, your base sum insured is restored from the very first paid claim. This benefit kicks in whether you have partially or completely used up your base sum insured and super credit (if applicable). This benefit is applicable an unlimited number of times in each policy year for both related and unrelated illnesses.
   
• Room Rent Limit
  The room rent limit is the maximum amount your health insurance policy covers for the room during your hospital stay. If you choose a room within this limit, you will not have to pay any extra costs. But if you exceed this limit, you will be responsible for paying a proportionate share of the total bill and not just the room cost difference. Aditya Birla Activ One (NXT) lets you freely choose any room – whether it is a shared, single, deluxe, or any other type of room – with no restrictions on room rent.
   

Other Important Features Of The Aditya Birla Activ One (NXT) Plan

• Chronic Care
  The Aditya Birla Activ One (NXT) Plan offers immediate coverage for seven chronic diseases, including asthma, diabetes, hypertension, obesity, etc. With this add-on, there is no initial waiting period or pre-existing condition clause for these specific conditions. The coverage extends to inpatient costs related to these chronic conditions up to the sum insured. It is important to note that certain terms and conditions apply to this coverage.

• Critical Illness Cover
  It is an optional feature that pays a lump sum if you are diagnosed with serious conditions such as severe cancer, stroke, kidney failure, etc., listed in the policy document during the policy term. You get to decide the benefit amount that ranges from Rs. 10 lakhs to 25 lakhs, based on your medical needs. This sum can assist in compensating for lost income during illness and recovery, as well as covering extra expenses like lifestyle changes, etc. You should, however, keep in mind that there is a waiting period of 60 days and a survival period of 15 days for this coverage. Additionally, there may be other conditions related to the coverage.
   
• Cancer Booster
  With the cancer booster feature, you can receive additional funds of up to 100% of the base sum insured to help you with medical costs related to cancer. This coverage not only takes care of hospitalisation expenses before admission and after discharge but also includes day care treatments (surgeries that are done within 24 hours due to advancements in medical technology). However, keep in mind that there are specific terms and conditions associated with this coverage.
   
• Health Management Program (In-Built)
  The Health Management Program (In-built) is a fantastic initiative by the Aditya Birla Activ One (NXT) Plan to encourage you and your covered family members to stay healthy. By following a regular health routine, you can receive back a percentage of your renewal premiums up to 100%, based on your earned wellness points (health returns). You get to earn these points when you participate in engaging health activities like yoga, marathons, calorie-burning exercises, walking, etc. You can also accumulate points by completing a health questionnaire or undergoing a health checkup at least once per policy year. Your risk levels, as determined by these assessments, will then be used to calculate the percentage of the premium to be returned to you.
   

Waiting Periods

When you buy a health insurance policy, there is a certain time frame called the waiting period, during which some illnesses and diseases may not be covered. Once this period is over, you can start claiming for these conditions. Waiting periods come in different types, and each one serves a specific purpose –

• Initial Waiting Period: This waiting period refers to all medical conditions except accidents, for an initial period of 30 days. During this time, you will not be able to claim for hospitalisation expenses, but accident cases are an exception.
   
• Waiting Period For Pre-Existing Diseases: This pre-existing disease is any health condition you had in the 48 months before getting your health insurance policy. With the Aditya Birla Activ One (NXT) Plan, there is a 48-month waiting period for pre-existing diseases. During this period, the policy will not cover any expenses related to your pre-existing conditions.
   
• Waiting Period For Specific Diseases: Apart from your pre-existing conditions, insurers may have a list of specific medical conditions with a waiting period. It does not matter if you had these diseases before or not; the waiting period is set by the insurance company and is not influenced by your current health. The Aditya Birla Activ One (NXT) Plan has a 24-month waiting period for specific diseases.
   

Exclusions

Exclusions are situations not covered by your health insurance policy. These may include –

• Standard Permanent Exclusions: The IRDAI has set certain 'standard permanent exclusions' that every insurance company must adhere to. Some of them include –
  • Observation And Evaluation: Hospital admission purely for monitoring purposes or observation.
  • Rest, Rehabilitation, and Respite: Admission for bed rest without active treatment.
  • Weight Management: Treatment or surgery for weight control or obesity.
  • Gender Change Treatment: Procedures for altering the body to the opposite sex's characteristics.
  • Plastic/Cosmetic Procedures: Surgery to modify appearance or body characteristics.
  • Professional Adventure Sports: Treatment costs for participating in activities like rafting, mountaineering, scuba diving, horse racing, etc.
  • Legal Violations: Expenses for treating someone who committed or attempted a criminal act.
  • Excluded Providers: Treatment from medical practitioners or hospitals not covered by the insurance company.
  • Addiction Treatment: Addressing conditions like alcohol or drug addiction.
  • Domestic Treatment Facilities: Costs for treatment in health spas, nursing homes, or similar places for personal reasons.
  • Non-Prescribed Supplements: Vitamins, minerals, etc., not prescribed by a doctor.
  • Refractive Error Correction: Expenses for correcting refractive errors up to 7.5 diopters for better eyesight.
  • Unproven Treatments: Surgeries, medical procedures, or treatments not proven effective.
  • Birth Control and Infertility: Costs related to contraception, sterilisation, artificial insemination, IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
  • Maternity Costs: Expenses for pre/post-natal care, hospitalisation during childbirth, etc.
     
• Additional permanent exclusions: In addition to the regular permanent exclusions we discussed earlier, insurance providers might add more exclusions based on specific medical conditions. If you have severe medical conditions or certain diseases or that insurers consider risky to cover, the insurer may permanently exclude them from your policy. It is worth noting that insurance companies can only enforce permanent exclusions for illnesses that are listed by IRDAI.
   
• Non-Standard Exclusions (Specific Exclusions): Specific exclusions go beyond the permanent exclusions set by the IRDAI.  These exclusions can differ between insurance companies and may be influenced by the terms and conditions of your policy. Let's take a look at some notable specific exclusions under the Aditya Birla Activ One (NXT) Plan –
  • Costs for hearing aids, glasses, or contact lenses, as well as optometric therapy and multifocal lenses.
  • Wigs, toupees, and other such related expenses.
  • Circumcisions, unless it is necessary for medical reasons or part of a treatment plan for an illness or injury.
  • Regular preventive care, vaccinations, and immunizations, except in cases when required for post-bite treatment, any physical, psychiatric, or psychological examinations or testing.
  • Admission for nutritional and electrolyte supplements, unless they are certified by the attending medical practitioner as necessary in a covered claim.
  • Conditions or abnormalities visible at birth, including related diseases or defects.
  • Stem cell therapy, except for hematopoietic stem cells for bone marrow transplant related to haematological conditions. Surgery, growth hormone therapy, and hormone replacement therapy.
  • Dental and oral treatment, including procedures and preventive, diagnostic, restorative, and cosmetic services for natural teeth and gingiva, except in cases when it requires hospitalisation due to an accident.
  • AYUSH treatments, except as mentioned under Section AYUSH treatment.
  • Treatment involving Rotational Field Quantum Magnetic Resonance (RFQMR), External Counter Pulsation (ECP), Enhanced External Counter Pulsation (EECP), hyperbaric oxygen therapy, KTP laser surgeries, cyber knife treatment, femto laser surgeries, bioabsorbable stents, bioabsorbable valves, bioabsorbable implants, and the use of Radio Frequency (RF) probe for ablation.

Summary

Know More About The Aditya Birla Activ One (NXT) Plan

• Brochure: https://www.adityabirlacapital.com/healthinsurance/assets/pdf/active-one/brochure.pdf
   
• Policy Wording: https://www.adityabirlacapital.com/healthinsurance/assets/pdf/active-one/NXT/product-information/policy-document.pdf
   

FAQs

1. Under the Aditya Birla Activ One (NXT) Plan, what is the maximum cover one can opt for?
   With the Aditya Birla Activ One (NXT) Plan, you can secure a health cover of up to Rs. 1 crore.
    
2. Does the Aditya Birla Activ One (NXT) Plan have room rent restrictions?
   No, there are no limits on room rent in this plan. This means that you can freely select any room that suits your comfort without any constraints.
    
3. Are consumables covered under the Aditya Birla Activ One (NXT) Plan?
   Yes, the Aditya Birla Activ One (NXT) Plan not only provides coverage for your medical expenses but also includes covers for costs associated with non-medical expenses or consumables like gloves, masks, syringes, etc., up to the sum insured, in case you opt for an add-on.
    
4. Does the Aditya Birla Activ One (NXT) Plan cover AYUSH treatments?
   Yes, the Aditya Birla Activ One (NXT) Plan covers AYUSH treatments, which include alternative or non-allopathic approaches like Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy. This coverage extends up to the sum insured and is subject to terms and conditions.
    
5. Is the health checkup benefit available under the Aditya Birla Activ One (NXT) Plan?
   With the Activ One (NXT) Plan, you have the option to undergo a thorough health checkup every year. This service is available through the insurance company’s network providers if you opt for an add-on.