Aditya Birla Activ Fit (Preferred) is a health insurance policy provided by Aditya Birla Health Insurance Company Limited.
With competitive pricing and a range of benefits, this plan is an unbeatable choice for health insurance. It covers various expenses including hospitalisation and related expenses, maternity expenses, consumable items, and day-to-day expenses for medicines, tests, consultations, etc. Besides this, there are multiple options for getting discounts on premiums.
However, the plan is not available on an individual basis, and the monthly premium payment option is not available. The insurer has also received a greater number of complaints regarding claim settlement and policy purchase, according to our research. This implies that you may not have a satisfactory experience with the company.
What are the benefits offered by Aditya Birla Activ Fit (Preferred)?
- Inpatient hospitalisation coverage: Expenses incurred when you are admitted to a hospital for more than 24 hours including room boarding and nursing charges, medical practitioner’s fees, cost of prescribed medicines and drugs, ICU charges, and other related expenses are inpatient hospitalisation expenses. These expenses are covered by Aditya Birla Activ Fit (Preferred).
- Pre-hospitalisation coverage: Pre-hospitalisation charges are medical expenses you incur before getting admitted to the hospital. These expenses include consultations, tests, checkups, lab reports, etc. Insurers will cover these expenses only if they are related to the medical condition for which you are hospitalised, and your claim must be approved as part of the inpatient hospitalisation benefit. The Aditya Birla Activ Fit (Preferred) policy covers pre-hospitalisation expenses up to the sum insured for a period of 90 days before hospitalisation.
- Post-hospitalisation coverage: You may incur certain expenses after you are discharged from the hospital. These expenses may include follow-up consultations with your doctor, medical check-ups, rehabilitation sessions, physiotherapy, and more, which are called post-hospitalisation expenses. In order to qualify for coverage, your post-hospitalisation expenses must be related to the condition you were hospitalised for, and your claim must be approved under inpatient hospitalisation. Aditya Birla Activ Fit (Preferred) covers post-hospitalisation expenses up to 180 days after hospitalisation - up to the sum insured.
- Daycare treatment coverage: Medical advancements have enabled some treatments to be completed within 24 hours without the need for prolonged hospital stays. These are known as ‘daycare treatments’. Thus, patients do not have to take an extended break from their everyday lives to receive the necessary medical care. All daycare procedures are covered by the Aditya Birla Activ Fit plan (Preferred). Daycare expenses are covered up to the sum insured.
- Domiciliary treatment coverage: The term "domiciliary treatment" refers to medical treatments administered at home if a patient is too ill or injured to be transported to a hospital, or if there are no beds available in hospitals nearby. Such treatments can provide crucial medical care to the patients - allowing them to receive the care they need in the comfort of their own home. Aditya Birla Activ Fit (Preferred) will cover domiciliary treatment costs up to the sum insured.
- Organ donor coverage: The Aditya Birla Activ Fit (Preferred) also covers organ donor expenses. The policy covers the costs associated with harvesting the organ where the insured is the recipient, up to the sum insured.
- Modern treatment coverage: Technological advancements have accelerated the development of modern treatments previously thought to be unachievable in the healthcare field. This allows healthcare providers to more effectively address and manage medical conditions, ultimately leading to improved patient outcomes. These modern treatments including balloon sinuplasty, stem cell therapy, etc. can cure ailments that were once believed to be incurable. With Aditya Birla Activ Fit (Preferred), you are covered for the costs associated with modern treatments up to the sum insured.
- Non-medical expenses coverage: Aditya Birla Activ Fit (Preferred) provides coverage for non-medical costs up to the sum insured, but if you purchase the same as an add-on for an extra fee. Non-medical expenses include consumables such as gloves, nebulization kits, oxygen masks, and other items necessary for treatment.
- No Claim Bonus: In the event that there are no claims during the policy period, the insurance company gives you a No-Claim Bonus. If you do not make any claims during your previous policy year, you can get a 10% bonus on the sum insured with Aditya Birla Activ Fit (Preferred). This bonus can be availed when you renew your policy with Aditya Birla Activ Fit (Preferred), providing you with financial benefits. It is possible to accumulate a bonus of 100% of the sum insured under this plan. Any claim you make during the policy period will reduce the accumulated bonus.
- Super No Claim Bonus: Essentially, this is an enhanced form of the No Claim Bonus. If you do not make any claims during the previous policy year, you will be eligible for a super no claim bonus of 50% of the sum insured with Aditya Birla Activ Fit (Preferred). It is available as an add-on that you can purchase by paying an additional premium. It is possible to accumulate a bonus up to 100% of the sum insured. If you make a claim during the policy period, the accumulated bonus amount will be reduced.
- Restoration Benefit: It restores your sum insured when it gets depleted within a policy year. It helps ensure that your finances remain secure and protected, even if you exhaust your sum insured. The restoration/refill benefit is available under Aditya Birla Activ Fit (Preferred) for related and unrelated illnesses (including complications). It will be activated after a partial exhaustion of the sum insured and No Claim Bonus. Moreover, the refill is applicable from the first paid claim and can be utilised infinite times in the policy year. This ensures that you are always covered in case of medical emergencies.
Please note that the limits and conditions mentioned in the above benefits and features are for Rs. 10 Lakhs sum insured.
Aditya Birla Activ Fit (Preferred): Financial Limits
- Room rent limit: The room rent limit refers to the maximum amount that your insurance company will cover for your hospital room. If you choose a room that falls within your plan's room rent limit, you can be assured that you will not be responsible for any additional costs. It is important to note, however, that you will be subject to a proportionate deduction if you choose a room with a higher rent than your eligibility. You will have to pay a proportionate share of the entire bill, not just the difference in room rent. Aditya Birla Activ Fit (Preferred) does not impose any room rent limit. So, you can choose the room type you want.
- ICU rent limit: It refers to the maximum amount an insurance policy will cover in the event of a stay in a hospital's intensive care unit (ICU). There is no ICU rent limit in the Aditya Birla Activ Fit (Preferred). Essentially, this means that the insurance covers the full cost of an ICU stay.
- Copayment: Copayment is a portion of the approved claim amount you must pay from your end. The insurer covers the remainder. Aditya Birla Activ Fit (Preferred) does not have a copayment limit.
- Deductible: A deductible is the amount of money that you must pay from your end before your health insurance coverage begins to pay. Aditya Birla Activ Fit (Preferred) does not have a deductible limit.
- Limits on surgeries/treatments: It refers to the maximum amount that a health insurance plan will pay for medical procedures or treatments. This limit can help control healthcare costs, but it can also make accessing certain treatments more difficult and expensive for patients. In some policies, there may be limits on the amount they will cover for certain procedures, while in others, there may be no such limits. As part of Aditya Birla Activ Fit (Preferred), important surgeries and treatments like cataract surgery and joint replacement surgery are not subject to a limit. This means that the policy provides comprehensive coverage for these surgeries, ensuring members have full financial protection in times of need.
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 (Preferred): Waiting Periods & Exclusions
Health insurance policies may not cover certain illnesses and diseases for a certain period of time, known as the waiting period. These conditions will be eligible for a claim once this period ends. There are various types of waiting periods, including:
- Initial waiting period: Except for accidents, all medical conditions have an initial waiting period of 30 days.
- Waiting period for pre-existing diseases: Pre-existing conditions are any illnesses or medical conditions that you have been diagnosed or contracted in the last 48 months before applying for health insurance. They are subject to a 48-month waiting period under Aditya Birla Activ Fit (Preferred). You will not be covered for any pre-existing disease-related expenses during this time period.
- Waiting period for specific diseases: Some insurers apply waiting periods for specific diseases other than pre-existing conditions, whether or not you had them before. Aditya Birla Activ Fit (Preferred) has a waiting period of 24 months for specific diseases and 48 months for genetic disorders. This means that treatment for these diseases will not be covered until after the specified waiting period has elapsed.
The terms "exclusions" refer to situations that won't be covered by your health insurance. They include-
- Standard permanent exclusions: All insurance companies must comply with the list of 'standard permanent exclusions' established by the IRDAI. Here are some of them -
- Evaluation and investigation: Admission solely for the purpose of observation or monitoring.
- Change of gender treatment: A procedure intended to change an individual's body characteristics to that of the opposite sex.
- Plastic/cosmetic surgery: Surgery or treatment to alter the appearance or characteristics of the body.
- Dietary supplements, substances purchased without prescription: Supplements such as vitamins, minerals, etc. that are not prescribed by a physician.
- Profession in hazardous or adventure sports: Treatments for injuries sustained while engaging as a professional in adventure activities like mountaineering, river rafting, scuba diving, horse racing, etc.
- Rehabilitation, rest cure, and respite care: Bed rest without active treatment at a medical facility.
- Weight control/obesity : Treatment or surgery to control weight or obesity.
- Violation of law: Costs associated with treating an individual who has broken or attempted to break the law with criminal intent.
- Domestic purposes treatment: The cost of treatment in health spas, nursing homes, or similar facilities arranged exclusively or partially for domestic purposes.
- Excluded providers: Treatment provided by a medical practitioner or hospital excluded by the insurer.
- Narcotics: Addiction treatment for situations like alcoholism or drug abuse.
- Costs associated with birth control and infertility: Contraception: Artificial insemination, advanced reproductive techniques such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
- Maternity expenses: Costs associated with the pre/postnatal period, pregnancy-related hospitalisation expenses, etc.
- Correction of refractive errors : The cost of correcting refractive errors of up to 7.5 diopters in order to improve your vision.
- Unproven treatments: Unproven surgeries, medical procedures, or treatments.
- Additional permanent exclusions: Insurance companies may apply additional exclusions for specific situations or medical conditions. Insurance companies may permanently exclude you from coverage if you suffer from conditions or diseases they consider risky to cover. It is essential to understand that insurers can only exclude permanent coverage for illnesses listed by the Insurance Regulatory and Development Authority of India (IRDAI). It is not possible for them to exclude conditions or illnesses outside of this list.
- Non-standard exclusions (Specific exclusions): These are specific exclusions other than the standard permanent exclusions stipulated by the IRDAI. Depending on the policy terms and conditions, these exclusions may vary across insurers. These are some top specific exclusions under Aditya Birla Activ Fit (Preferred) -
- Injuries caused by terrorism, nuclear emissions, war, or civil war.
- Preventive care, vaccinations, inoculations, and immunizations (except treatment for animal bites), physical, psychiatric, or psychological examinations.
- Intentional self-inflicted injuries, attempted suicide, illegal acts, drug use, alcohol consumption, or any intoxicant-related treatment.
- The practice of circumcision unless necessary for treating a disease or injury.
- A hospital stay for the purpose of supplementing nutrition and electrolytes.
- Any type of prosthesis or external durable equipment used for diagnosis or treatment, except in cases of accidents.
- External birth defects, diseases, or anomalies-related expenses.
- Costs associated with stem cell therapy (other than bone marrow transplants or hormone replacement therapy).
- Treatments such as KTP laser surgery, cyber knife treatment, Femto laser surgery, and other similar treatments.
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 98.05% of claims in less than 30 days. This demonstrates the company's commitment to providing fast and efficient service to its customers.
- Claim-related complaints: Based on our research, Aditya Birla Health Insurance Company Limited received higher complaints related to claims. As such, Aditya Birla Health Insurance Company Limited has established an average reputation for providing quality service.
- Claims incurred ratio: The claims incurred ratio is used to measure an insurance company's financial health. It shows how much insurance claims an insurer paid compared to how much premiums they have collected in a financial year. Aditya Birla Health Insurance Company Limited's claims incurred ratio is 78.36%.
- Claim settlement ratio: It is the ratio of claims settled by an insurer to the total number of claims received by them in a given financial year. Aditya Birla Health Insurance Company Limited has a claim settlement ratio of 92.25%.
- Network hospitals: There are over 10,500+ hospitals in Aditya Birla Health Insurance Company Limited's network. By having access to a large network of hospitals, you can receive cashless healthcare services - without having to worry about out-of-pocket expenses.
How is the customer service of Aditya Birla Health Insurance Company Limited?
- Policy purchase-related complaints: As per our research, Aditya Birla Health Insurance Company Limited has received 0.02% of complaints related to their after-sales service. This is a relatively high complaint rate, suggesting that the company's policy purchase process is not as satisfactory as others.
- Response on Toll-Free: Based on our research, Aditya Birla Health Insurance Company Limited has an ‘average’ response time over the toll-free number.
- Response on Twitter: According to our research, Aditya Birla Health Insurance Company Limited has a slow response rate on Twitter. So, you may not receive timely assistance at times of need.
About Aditya Birla Health Insurance Company Limited
Aditya Birla Health Insurance Company Limited (ABHICL), is a part of Aditya Birla Capital Ltd. (ABCL). It is a joint venture between the Aditya Birla Group and MMI Holdings of South Africa. ABHICL is committed to providing innovative health solutions to create a healthier India, offering its customers a range of products and services tailored to their needs. As part of its current product portfolio, the company offers Chronic Care and Incentived Wellness. The company was founded in 2015 and is based in Mumbai, Maharashtra. The company's CEO and MD is Mayank Bathwal.