Aditya Birla Activ Health Platinum Plan

Let’s Know The Plan Better!

Aditya Birla Activ Health Platinum Plan is a health insurance policy provided by Aditya Birla Health Insurance Company Limited. The Aditya Birla Activ Health Platinum Plan is designed to provide comprehensive coverage and flexibility to meet your specific healthcare needs. With this policy, you have the freedom to customise your coverage based on your individual requirements. This plan offers a range of variants to choose from. Two popular variants are 'Enhanced' and 'Premiere'.

Are You Eligible?

Minimum Entry Age

• Adults: 18 years
• Dependent Children: 91 days. Dependent children aged 91 days to 5 years will be covered if at least one adult is enrolled under the policy.

Maximum Entry Age

• Premiere Plan: The maximum age of entry is 65 years.
• Enhanced Plan: No maximum age of entry.
   

An Overview Of The Plan’s Benefits & Limits

The Aditya Birla Activ Health Platinum Plan provides coverage for expenses related to inpatient hospitalisation. This means the costs incurred while admitted in a hospital for more than 24 hours, such as room boarding and nursing charges, medical practitioner's fees, the cost of prescribed medicines and drugs, ICU charges, and other related expenses will be taken care of.

Besides that, the Aditya Birla Activ Health Platinum Plan also covers various other expenses, such as -

• Pre & Post Hospitalisation Expenses
  If your doctor determines that you need to undergo several diagnostic or other tests before or after being admitted to the hospital, the insurer will ensure that you have the necessary coverage. The plan will take care of the expenses for these tests up to the sum insured specified in your policy for a reasonable duration under both variants - 60 days prior to your hospital admission and 180 days following your discharge.
  It is important to note that Aditya Birla Activ Health Platinum Plan will only cover these costs if they are directly associated with the medical condition that necessitated your hospitalisation, and if your claim is approved as part of your inpatient coverage.
   
• Daycare Treatment Coverage
  Certain treatments used to necessitate extended hospital stays years back, but now, thanks to technological advancements in the medical field, they can be completed in just 24 hours. These are called daycare treatments. Under the Aditya Birla Activ Health Platinum Plan, 586 daycare procedures are covered under both variants up to the sum insured.
   
• Organ Donor Coverage
  The Aditya Birla Activ Health Platinum Plan (Enhanced & Premiere Plan) provides coverage for organ donor expenses where you are the recipient. It will cover the costs associated with harvesting the organ in the event of organ transplantation up to the sum insured you choose under your policy.
   
• Modern Treatment Coverage
  The healthcare sector is currently experiencing a swift revolution thanks to technological advancements. As a result, previously inconceivable modern treatments and advanced technological methods have become a reality. The Aditya Birla Activ Health Platinum Plan (Enhanced and Premiere Plan) has been meticulously crafted to keep pace with these advancements, offering comprehensive coverage for these cutting-edge treatments up to the sum insured.
   
• Cumulative Bonus
  The Cumulative Bonus benefit allows you to earn a bonus if you do not make any claims throughout the policy year. Under the Enhanced & Premiere Plan, your sum insured will increase by 50% for each claim-free year. A maximum of up to 100% of your base sum insured or up to Rs 1 crore can be accumulated. However, if you make a claim in the future, the accrued cumulative bonus will be reduced in the same proportion.
   
• Reload the Sum Insured
  Once the sum insured is exhausted within a policy year, this benefit kicks in and ensures that it is completely replenished to its original amount. If your sum insured and no claim bonus is not enough due to claims made, your sum insured will be reloaded. The restore benefit is activated when a portion or the entire basic sum insured or no claim bonus (if any) is used up. It can be used for subsequent claims within the policy year.

• Enhanced Plan: This benefit can be used once per policy year for life, as long as you keep renewing your policy, for unrelated illnesses.
   
• Premiere Plan: In a policy year, your sum insured is restored an unlimited number of times for both related and unrelated illnesses.
   
• Room Rent Limit
  The room rent limit is the maximum amount covered by your insurer for your hospital room. If you choose a room within this limit, you won't have to pay anything extra. However, if you pick a room that exceeds the limit, you'll be responsible for paying a proportionate amount of the total bill, not just the difference in room rent. With Aditya Birla Activ Health Platinum Plan - Premiere variant you can choose any room you want without any restrictions - be it shared room, single room, suite, or any other available option. However, there are certain room-related restrictions for the Enhanced Plan.

Noteworthy Features You Should Be Aware Of

• Chronic Management Program (OPD)
  The Chronic Management Program (OPD) is a healthcare initiative under Aditya Birla Activ Health Platinum Plan. It offers comprehensive care for people with chronic health conditions like diabetes, hypertension, asthma, high cholesterol, etc. The plan is intended to cover expenses related to these conditions and encourage you to control them and stay healthy. Under this benefit, you'll have access to consultations with medical practitioners and diagnostic tests.

Note: Certain terms and conditions may apply.

• Mental Illness Hospitalisation
  Mental illness hospitalisation refers to the admission of individuals with severe mental health conditions to specialised hospitals or dedicated mental health units within regular hospitals. Under Premiere & Enhanced Plans, the benefit covers the costs associated with inpatient hospitalisation for mental illnesses up to the sum insured.
  Note: Certain terms and conditions may apply.
   
• Obesity Treatment
  Aditya Birla Activ Health Platinum Plan - Enhanced and Premiere variants cover expenses for bariatric surgery - a type of weight loss surgery for people with severe obesity up to the sum insured.
  Note: Certain terms and conditions may apply.

Understanding Waiting Periods

After you buy a health insurance policy, there is a certain period of time during which specific illnesses or medical conditions will not be covered. This duration is called a waiting period. Once the waiting period is completed, you can make claims for these conditions.

Waiting periods are of the following types -

• Initial Waiting Period: After purchasing your policy, there is an initial waiting period of 30 days before you can make a claim for any medical condition, except accidents. This means that during the first 30 days, you won't be able to claim for any hospitalisation unless it's due to an accident.

• Waiting Period For Pre-Existing Diseases: A pre-existing disease refers to any medical condition or illness you had in the 48 months before getting your health insurance policy. Under the Aditya Birla Activ Health Platinum Plan, there are waiting periods for pre-existing diseases. For both Enhanced and Premiere variants, the waiting period is 36 months. During this time, any expenses related to your pre-existing diseases will not be covered by the policy.

• Waiting Period For Specific Diseases: Insurers generally levy a waiting period for certain medical conditions or illnesses besides pre-existing conditions. This waiting period is determined by the insurer and is not influenced by your current health. For the Aditya Birla Activ Health Platinum Plan, there is a waiting period of 24 months for specific diseases and 48 months for genetic diseases for both Enhanced and Premiere variants.

What The Plan Does Not Cover?
Exclusions are certain situations that your health insurance policy does not cover. Some exclusions are as follows -

1. Standard Permanent Exclusions:
   It's important for you to know that the IRDAI has put in place a list of 'standard permanent exclusions' that all insurance companies must follow. Some of these include -

• Unproven treatments: Surgeries/medical procedures/treatments that have not been proven to be effective.
   
• Expenses related to birth control, sterility, infertility: Some treatments like contraception methods, sterilisation procedures, artificial insemination techniques, etc. as well as advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
   
• Treatments in establishments arranged for domestic purposes:  Treatment received at health spas, nursing homes, or similar establishments that were arranged completely or partially for domestic reasons.
   
• Excluded providers: Treatment from a medical practitioner or hospital excluded by the insurer.
   
• Breach of law: Expenses associated with treating injuries of someone who has committed or attempted to commit a crime violating the law.
   
• Rest, cure, rehabilitation, & respite care: Admission to a medical facility just for bed rest, without any active treatment taking place.
   
• Refractive error: Expenses related to correcting refractive errors of up to 7.5 diopters to improve your eyesight.
   
• Maternity expenses: Pre/post-natal costs, expenses related to childbirth hospitalisation, etc. are excluded.
   
• Dietary supplements, substances purchased without prescription: Vitamins, minerals, or other supplements that haven’t been prescribed by a medical practitioner.
   
• Narcotics: Treatments related to addictive conditions such as alcohol addiction, drug usage, etc.
   
• Plastic/cosmetic surgery: Treatment/surgery that aims to alter your body characteristics or appearance.
   
• Profession in hazardous or adventure sports: Expenses incurred as a result of engaging in adventurous activities like mountaineering, parachuting, rafting, etc. as a professional.
   
• Change of gender treatment: Treatments that aim to change your body's characteristics to match those of the opposite sex.
   
• Investigation & evaluation: Admission to a hospital; for just observation/monitoring.

2. Additional Permanent Exclusions: In addition to the standard permanent exclusions we mentioned earlier,  companies may also have exclusions in your policy for certain situations or medical conditions. If you have particular diseases or severe medical conditions that insurers deem risky to cover, they may choose to permanently exclude them from your policy. In India, insurance companies must follow a specific list of illnesses set by the Insurance Regulatory and Development Authority of India (IRDAI). They are not allowed to exclude any illnesses beyond this list.
    
3. Non-Standard Exclusions (Specific Exclusions): The Aditya Birla Activ Health Platinum Plan has specific exclusions that go beyond the usual permanent exclusions set by the IRDAI. It's important to understand that these exclusions may differ between insurance companies and depend on the terms and conditions of your policy.
   
   Here are some of the specific exclusions under Aditya Birla Activ Health Platinum Plan -

• Conditions like Parkinson's, Alzheimer's, general weakness/fatigue, sleep apnea, and stress.
• Experimental/investigational devices and pharmacological treatments.
• Circumcisions unless they are necessary due to illness or injury and are part of the treatment.
• Non-allopathic treatments.
• Convalescence, cure, sanatorium treatment, private duty nursing, long-term nursing care, and custodial care.
• Assistive devices for improving vision and hearing, such as hearing aids, spectacles, contact lenses, optometric therapy, and multifocal lenses.
• The treatment options for alopecia, baldness, wigs, toupees, and any related treatments.
• Medical items, such as elastic stockings, diabetic test strips, and similar products.
• External congenital anomalies, diseases, or defects.
• Deliberate exposure to danger, intentional self-inflicted injury, and participation or involvement in naval, military, or air force operations.
• The use of Radio Frequency (RF) probe for ablation or any other procedure unless it has been specifically approved in writing in advance.
• Dentures and artificial teeth, dental treatment, and surgery of any kind, unless necessitating hospitalisation due to an accident.
   

A Quick Recap Of The Benefits & Limits

Some OG reading Material for your Reference

• Brochure:

?Premiere Plan: https://www.adityabirlacapital.com/healthinsurance/assets/pdf/activ-healthplatinum-premiere.pdf

?Enhanced Plan: https://www.adityabirlacapital.com/healthinsurance/assets/pdf/activ-health-platinum-enhanced.pdf

• Policy Wording: https://www.adityabirlacapital.com/healthinsurance/assets/PDF/20210209T052110.pdf
   

FAQs

1. Within the Aditya Birla Activ Health Platinum Plan, what is the highest coverage amount available?
   The Aditya Birla Activ Health Platinum Plan provides health coverage of up to Rs 2 Crore for Premiere and Enhanced Plans.
    
2. Does the Aditya Birla Activ Health Platinum Plan include coverage for modern treatments?
   Certainly, the Aditya Birla Activ Health Platinum Plan provides coverage for modern treatments up to the sum insured chosen by you.
    
3. Are outpatient department (OPD) expenses included in the coverage of Aditya Birla Activ Health Platinum?
   Certainly! The Enhanced and Premiere options offer coverage for outpatient department (OPD) expenses.
    
4. Does the Aditya Birla Activ Health Platinum policy include coverage for expenses related to mental health treatments?
   Absolutely! Aditya Birla Activ Health Platinum Plan provides coverage for mental health treatment expenses in accordance with the terms and conditions.
    
5. Could you provide information on the waiting period for specific diseases under the Aditya Birla Activ Health Platinum Plan?
   In the Aditya Birla Activ Health Platinum Plan, there is a waiting period of 24 months for specific diseases or procedures. However, genetic disorders have a waiting period of 48 months.