Aditya Birla Activ Fit (Plus)

Aditya Birla Activ Fit (Plus) is a health insurance policy offered by Aditya Birla Health Insurance Company Limited. 

This plan is a perfect choice if you're looking for a well-balanced combination of affordable pricing, great features, and valuable benefits. It offers extensive coverage, including hospitalisation and related costs, as well as other expenses like consumable items and OPD expenses i.e. day-to-day medical expenses such as costs related to medicines, tests, consultations, etc. Additionally, the plan provides various options for premium discounts.

On the other hand, you don't have the option to pay the premiums on a monthly basis with this plan. Additionally, our research shows that the insurer has received a higher number of complaints related to claim settlements and policy purchases, suggesting a poor track record in terms of both purchase and claim services.

What are the benefits offered by the Aditya Birla Activ Fit (Plus)?

• Inpatient hospitalisation coverage: Aditya Birla Activ Health Fit (Plus) plan provides coverage for the expenses related to inpatient hospitalisation. These expenses refer to the costs that arise when you are admitted to a hospital for a duration exceeding 24 hours such as the costs of your hospital room, nursing care, consultations, prescription medications, ICU charges, and any other relevant expenses.
• Pre-hospitalisation coverage: Before you are admitted to the hospital, you may incur certain medical expenses. These costs, called pre-hospitalisation charges, include fees for consultations, laboratory tests, checkups, and medical reports, among other things. Please note that the insurance company will only cover your expenses if they are directly related to the medical condition that leads to your hospitalisation and the claim is approved as part of your inpatient hospitalisation expenses. With the Aditya Birla Activ Fit (Plus) plan, you can be confident that your pre-hospitalisation expenses will be covered for a period of 90 days before your hospitalisation up to the sum insured.
• Post-hospitalisation coverage: After your discharge from the hospital, you may incur certain medical costs known as post-hospitalisation expenses. These costs include consultation expenses, check-up expenses, medical tests expenses, etc. To ensure your expenses are covered, they need to be directly related to your hospital stay and approved as part of your inpatient hospitalisation coverage. With the Aditya Birla Activ Health Fit (Plus), you get comprehensive coverage for post-hospitalisation expenses up to the sum insured for 180 days after your hospitalisation.
• Daycare treatment coverage: A daycare treatment is a medical procedure or surgery that traditionally requires an extended hospital stay but can now be completed within 24 hours due to advancements in medical technology.  With the Aditya Birla Activ Fit (Plus) plan, you can enjoy comprehensive coverage for all the daycare treatments without any limit up to the sum insured.
• Domiciliary treatment coverage: Domiciliary treatments refer to medical treatments for illnesses or injuries that require immediate attention in a hospital but are administered at home because the patient is very ill or injured and cannot be transported safely to a hospital, or because there are no hospital beds available in the patient's immediate vicinity.  With the Aditya Birla Activ Fit (Plus) plan, all expenses related to domiciliary treatments are fully covered up to the sum insured.
• Organ donor coverage: The Aditya Birla Activ Fit (Plus) plan also provides coverage for organ donor expenses. It covers the costs associated with harvesting the organ, up to the sum insured where you are the recipient.
• Modern treatment coverage: The relentless progress in medical technology has granted access to groundbreaking treatments that were once unimaginable. Treatments like stem cell therapy, radio surgery, etc. are now available, offering targeted solutions for conditions that were previously deemed untreatable. The Aditya Birla Activ Fit (Plus) plan is tailored to keep up with these developments and covers the expenses associated with these modern treatments up to the sum insured without any limit.
• Non-medical expenses coverage: The Aditya Birla Activ Fit (Plus) plan also covers non-medical expenses if you opt for an add-on up to the sum insured. These non-medical expenses refer to the cost of consumables, such as gloves, nebulization kits, oxygen masks, and other items necessary for treatment. 
• No Claim Bonus: No-Claim Bonus is a reward given by the insurance company if no claim is made during the policy period.  The Aditya Birla Activ Fit (Plus) plan offers 10% of the sum insured as a No-Claim Bonus, subject to a maximum of 100% of your sum insured. It's important to remember, though, that if you do make a claim during the policy period, the bonus will reduce at the same rate it increased.
• Super No-Claim Bonus: The Super No Claim Bonus is an upgraded version of the No Claim Bonus, and it operates in a similar manner. Of the very few plans that do provide this, Aditya Birla Active Fit( Plus) Plan is one of them. It is available as an add-on. You’ll receive a  Super No Claim Bonus of 50% of the sum insured every year. However, if you do make claims, there will be a reduction in the accumulated bonus. You have the opportunity to accumulate a maximum bonus of up to 100% of the sum insured.
• Restoration benefit: The restoration benefit is a feature that restores your sum insured after you have used it up during a policy year. With the Aditya Birla Activ Fit (Plus) plan, you can enjoy this benefit for both related illnesses and unrelated illnesses(including complications). This feature is activated when both your sum insured and no claim bonus have been partially used up. The best part is that you can enjoy this benefit unlimited times in a policy year from the first paid claim.

Please remember that the limitations and conditions mentioned in the benefits above apply to a sum insured of Rs. 10 lakhs. 

Aditya Birla Activ  Fit (Plus): Financial Limits

• Room rent limit: The room rent limit is the maximum amount that your insurance provider will cover for your hospital room expenses. When you choose a room within this limit, you won't have to pay any extra charges. But if you decide to go for a pricier room, you'll be responsible for a proportionate portion of the total hospital bill, not just the room rent difference. With the Aditya Birla Activ Fit (Plus) plan, you have the freedom to select any room without any restrictions.
• ICU rent limit: It is the maximum amount that your plan will pay for your stay in the intensive care unit at the hospital. In the Aditya Birla Activ Fit (Plus) plan, there is no limit on the ICU rent. This means that the plan will cover the entire cost of your ICU stay, up to the sum insured.
• Co-payment: A copayment, or copay, is a portion of the approved claim amount that you are responsible for paying out of pocket. Once this payment is made, the insurer will cover the remaining expenses. However, there is no co-payment in the Aditya Birla Activ Fit (Plus).
• Deductible: A deductible refers to a specific amount that you need to pay out of pocket before your insurance coverage kicks in to cover the remaining costs. However, it's important to note that there is no deductible in the Aditya Birla Activ Fit (Plus) plan.
• Limits on surgeries/treatments: This refers to the maximum amount that the health insurance policy will cover for specific medical procedures or treatments. Some plans have predetermined limits on the amount they’ll cover for certain procedures, while others do not. With the Aditya Birla Activ Fit (Plus) plan, the cataract treatment and joint replacement surgeries are covered up to the sum insured.

Please note that the above financial limits are taken for a 30-year-old individual opting for a sum insured of Rs. 10 Lakhs.

Aditya Birla Activ Fit (Plus): Waiting Periods & Exclusions

👉Waiting period

A waiting period is a specific time frame during which certain illnesses and medical conditions are not immediately covered after obtaining a health insurance policy. Claims for these specific conditions can only be made once the waiting period has passed. Here are some of the types of waiting periods 

• Initial waiting period: There is an initial waiting period of 30 days for all medical conditions, with the exception of accidents. During this time, you will not be eligible to make a claim for any hospitalisation, except in cases of accidents.
• Waiting period for pre-existing conditions: A pre-existing condition refers to any medical condition or illness you experienced within the 36 months before purchasing a health insurance policy. In the Aditya Birla Activ Fit (Plus) plan, there is a waiting period of 36 months for pre-existing conditions. During this waiting period, you will not be eligible to make any claims for costs associated with your pre-existing disease.
• Waiting period for specific diseases: In addition to pre-existing conditions, insurers maintain a list of particular medical conditions or illnesses which entail waiting periods, regardless of whether you have experienced those diseases previously or not. The waiting period is determined by the insurer and is not dependent on your current state of health. The Activ Fit (Plus) plan has a waiting period of 24 months for specific diseases and 48 months for genetic disorders.

👉Exclusions

Health insurance policies do not provide coverage for specific medical conditions or situations. These are referred to as exclusions. Here are some of the types of exclusions -

• Standard Permanent Exclusions: All insurance providers are required to adhere to the ‘standard permanent exclusions’ established by IRDAI. These include -

1. Investigation and evaluation: Hospital admission for observation or monitoring.
2. Rest, rehabilitation, and respite care: Admission to a facility for bed rest without active treatment. 
3. Obesity/weight control: Treatment or surgery related to weight control or obesity.
4. Gender reassignment: Treatments aimed at altering the body’s characteristics to match the opposite sex. 
5. Plastic/Cosmetic surgery: Treatment or surgery intended to modify body characteristics or appearance.
6. Profession in hazardous or adventure sports: Treatment expenses resulting from participating in adventurous activities such as river rafting, mountaineering, scuba diving, etc. as a professional.  
7. Breach of law: Expenses incurred in treating a person who has committed or attempted to commit a criminal act.
8. Excluded providers: Treatment received from medical practitioners or hospitals excluded by the insurance company.
9. Narcotics: Treating addiction to substances such as alcohol, drugs, etc.
10. Treatments in establishments arranged for domestic purposes: Expenses incurred due to the treatment received in health spas, nursing homes, or similar establishments arranged entirely or partially for domestic reasons. 
11. Dietary supplements, substances purchased without subscription: Vitamins, minerals, etc., that a medical practitioner does not prescribe.
12. Refractive error: Expenses associated with correcting refractive errors of up to 7.5 diopters to improve eyesight.
13. Unproven treatments: Surgeries, medical procedures, or treatments that are not proven to be effective.
14. Expenses related to birth control, sterility, and infertility: Contraception, sterilisation, artificial insemination, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc. 
15. Maternity expenses: Pre/post-natal costs, childbirth-related hospitalisation expenses, etc. 

• Additional permanent exclusions: Insurance providers have the authority to apply additional exclusions for particular medical conditions or circumstances besides the standard permanent exclusions. If you have certain diseases or severe medical conditions that insurers consider risky to cover, they may permanently exclude them from your policy. 

However, you need to note that the health insurers are restricted to a list of illnesses defined by the Insurance Regulatory and Development Authority of India (IRDAI) for which they can apply a permanent exclusion. They cannot impose permanent exclusions to illnesses or diseases beyond this list.

• Non-standard exclusions (Specific exclusions): These are specific exclusions that go beyond the standard permanent exclusions outlined by the IRDAI. These exclusions differ across insurance companies and depend on the policy’s terms and conditions. Here are some of the specific exclusions listed under the Aditya Birla Activ Fit (Plus) plan -

1. Any injury or illness caused directly or indirectly by acts of terrorism, nuclear emissions, war, civil war, etc.
2. Treatment related to intentional self-inflicted injury or attempted suicide, illegal activity, drug use, alcohol consumption, any form of intoxication, etc.
3. Circumcision, unless it is deemed necessary for treating a disease or injury.
4. Expenses associated with preventive care, vaccinations, inoculations, and immunisations (excluding post-animal bite treatment), as well as physical, psychiatric, psychological examinations, etc.
5. Hospitalisation for nutritional and electrolyte supplements
6. Costs associated with external birth conditions, defects,  anomalies, etc.
7. Expenses related to stem cell therapy, excluding bone marrow transplants,  hormone replacement therapy, etc.
8. Prosthetics and durable external equipment are used for diagnosis or treatment unless required due to an accident.
9. Specialised procedures such as KTP laser surgeries, cyber knife treatment, femto laser surgeries, and other comparable treatments and surgeries.

What to expect in terms of claims experience if you buy from Aditya Birla Health Insurance Company Limited?

• Speed of claims: Aditya Birla Health Insurance Company Limited has settled 94.59% of its claims within 30 days.  This assures you of a smooth and timely claim settlement experience. 
• Claim-related complaints: As per our research, we found that Aditya Birla Health Insurance Company Limited has a higher complaint rate as compared to other insurers, accounting for 0.22%.
• Claims incurred ratio: The claims incurred ratio is a measure of an insurer's financial performance. It shows the total claims paid out in relation to the premiums received in a specific fiscal year. Aditya Birla Health Insurance Company Limited has a claims incurred ratio of 68.31%.
• Claim settlement ratio: Aditya Birla Health Insurance Company Limited's claim settlement ratio stands at 94.51%. This figure reflects the proportion of total claims received to those successfully settled by the company in a specific fiscal year.
• Network hospitals: Aditya Birla Health Insurance Company Limited provides access to an extensive network of 11,000++ hospitals. This broad network allows customers to receive cashless treatment without any financial worry.

How is the customer service of Aditya Birla Health Insurance Company Limited?

• Policy purchase-related complaints: Based on our research, Aditya Birla Health Insurance Company Limited has received 0.03% of complaints related to its after-sales service, which is significantly higher than other insurance companies. 
• Response on Toll-Free: Our research suggests that Aditya Birla Health Insurance Company Limited’s response time on their toll-free is average, as compared to other insurers. 
• Response on Twitter: As per our research, Aditya Birla Health Insurance Company Limited has an average response time on Twitter, as compared to others.

About Aditya Birla Health Insurance Company Limited

Aditya Birla Health Insurance Company Limited (ABHICL) is a joint venture between Aditya Birla Group and MMI Holdings of South Africa. It provides innovative offerings such as chronic care and incentivized wellness. Established in 2015, Aditya Birla Health Insurance Company Limited (ABHICL) has its headquarters in Mumbai, Maharashtra led by the CEO and MD Mr Mayank Bathwal.