Aditya Birla Activ One (NXT)

Aditya Birla Activ One Nxt is a health insurance policy offered by Aditya Birla Health Insurance Company Limited.

Aditya Birla Activ One Nxt plan is a cost-effective choice with a wide range of features and benefits. It covers more than just hospitalisation expenses, including mental health, obesity, and consumables like gloves, masks, etc. It also offers a super credit feature that increases the sum insured by 100% upon renewal, up to a maximum of 500% of the sum insured, regardless of previous claims. This plan provides coverage for seven chronic conditions like asthma, diabetes, etc, from the very first day. 

However, it doesn't offer a monthly premium payment option. Our research indicates that the insurer has received a significant number of complaints regarding claim settlements and policy purchases. This suggests that their track record in terms of customer service for both purchasing and claims is poor.

What are the benefits offered by the Aditya Birla Activ One Nxt?

• Inpatient hospitalisation coverage: Similar to other health insurance plans, the Aditya Birla Activ One Nxt plan offers comprehensive coverage for the expenses incurred during inpatient hospitalisation. This includes the costs of your hospital room, nursing care, consultations, prescription medications, ICU charges, and any other relevant expenses incurred for hospitalisation exceeding 24 hours. Ambulance transport on the road, plastic surgery for injuries, dental treatment for injury or disease, mental health care, and treatment for obesity are all included in hospitalisation costs.
• Pre-hospitalisation coverage: Before you are admitted to the hospital, you may incur certain medical expenses. These costs, referred to as pre-hospitalisation charges, include fees for consultations, laboratory tests, checkups, medical reports and others. It is worth noting that the insurance company will only provide coverage for expenses that are directly related to the medical condition that leads to your hospitalisation. Additionally, the claim must be approved as part of your inpatient hospitalisation coverage. With the Aditya Birla Activ One Nxt plan, you can have peace of mind knowing that your pre-hospitalisation expenses will be covered for a generous period of 90 days before your hospitalisation.
• Post-hospitalisation coverage: After being discharged from the hospital, you may incur certain  medical expenses known as post-hospitalisation costs. These costs can include consultations, medical checkups, rehabilitation programs, physical therapy, etc. To ensure coverage for these expenses, these should be directly related to your initial hospital stay and approved as part of your inpatient hospitalisation coverage. The Aditya Birla Activ One Nxt plan offers extensive coverage for post-hospitalisation costs up to the sum insured  for a period of 180 days after your hospital stay.
• Daycare treatment coverage: Daycare treatment are medical procedures or treatments that once required extended hospital stays, but can now be conveniently completed within just 24 hours, all thanks to incredible advancements in medical technology. With the Aditya Birla Activ One Nxt plan, you can enjoy extensive coverage for all daycare treatments up to the sum insured.
• Domiciliary treatment coverage: Domiciliary treatments encompass medical procedures and therapies that can be conveniently administered in the comfort of your own home. This becomes especially beneficial when accessing a hospital proves challenging due to the severity of your condition or the limited availability of hospital beds nearby. The Aditya Birla Activ One Nxt plan covers all expenses associated with domiciliary treatments up to the sum insured.
• Organ donor coverage: The Aditya Birla Activ One Nxt plan provides extensive coverage for organ donor expenses up to the sum insured. This inclusive coverage encompasses all inpatient expenses related to organ transplantation surgery when you are  the recipient. The donor's expenses incurred before and after hospitalisation will not be included.
• Modern treatment coverage: With the continuous progress of medical technology, remarkable and previously inconceivable innovative treatments have now become a tangible reality. Procedures like stem cell therapy,radio surgeries, etc. have been specifically designed to address medical conditions that were once deemed untreatable. The Aditya Birla Activ One Nxt plan is meticulously crafted to stay abreast of these groundbreaking advancements. It offers comprehensive coverage for expenses related to these modern  treatments up to the sum insured without any limit.
• Non-medical expenses coverage: The Aditya Birla Activ One Nxt plan goes the extra mile by offering coverage for non-medical expenses. This includes costs related to consumables like gloves, nebulisation kits, oxygen masks, etc. Non-medical expense coverage can be conveniently included as an add-on to the plan.
• No claim bonus: Aditya Birla Activ One Nxt plan presents a valuable benefit known as the No Claim Bonus. This special reward is granted by the insurer to those who abstain from making any claims within a policy year. By choosing this plan, you can enjoy a substantial 100% of your sum insured as a No Claim Bonus, subject to a maximum of up to 500% of the sum insured. The best part is that it will remain intact even if a claim is made during the policy period. Please note this benefit is available as an add-on.
• Super No Claim Bonus: The Super No Claim Bonus functions in a similar way to the regular No Claim Bonus, but is an upgraded version of it. It's important to keep in mind that the Aditya Birla Activ One Nxt plan does not include the Super No Claim Bonus feature.
• Restoration benefit: The Aditya Birla Activ One Nxt plan offers a unique feature called the restoration benefit. With this feature, you can have your sum insured replenished even after it has been used up within a policy year. This refill benefit comes into effect once you have partially exhausted your sum insured and any No Claim bonus. The best part is that you can take advantage of this benefit an unlimited number of times throughout the policy year and is available with the first paid claim for both related and unrelated illnesses.

Please note that the limits and conditions mentioned in the above benefits and features are for Rs. 10 Lakhs sum insured.

Aditya Birla Activ  One Nxt plan : Financial Limits

• Room rent limit: The room rent limit is the maximum amount covered by your insurance provider for your hospital room expenses. Staying within this limit ensures that you won't have to pay any additional charges. However, if you choose a room that exceeds this limit, you will be responsible for a proportionate share of the entire hospital bill instead of just the room rent difference. With the Aditya Birla Activ One Nxt plan, you have the freedom to select any room without any restrictions.
• ICU rent limit: It is the maximum amount covered by your health insurance policy for your ICU stay in the hospital. The Aditya Birla Activ One Nxt plan offers comprehensive coverage for ICU rent without any restrictions. This means that the plan will cover the full cost up to the sum insured.
• Copayment: A copayment refers to a certain percentage of the claim amount you need to contribute from your own funds. Once this payment is made, the insurer will cover the remaining expenses. However, the Aditya Birla Activ One Nxt plan does not have copayment.
• Deductible: A deductible is the amount you need to pay out of pocket before your insurance coverage kicks in to cover your medical expenses. However, with the Aditya Birla Activ One Nxt plan there is no deductible.
• Limits on surgeries/treatments: It is the maximum coverage offered by your health insurance for specific medical procedures. Some plans have set limits for certain treatments, while others do not. With the Aditya Birla Activ One Nxt plan, you can benefit from unlimited coverage for cataract treatment and joint replacement surgeries up to the sum insured.

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

Aditya Birla Activ One Nxt plan: Waiting Periods & Exclusions

👉Waiting period

A waiting period pertains to a certain time frame during which particular illnesses and medical conditions are not immediately covered after acquiring health insurance. Claims for these specific conditions can only be submitted once the waiting period has passed. Here are some of the different types of waiting periods -

• Initial waiting period: The Aditya Birla Activ One Nxt plan has a 30-day initial waiting period for all medical conditions, except for accidents. This means that during this period, you won't be able to make claims for hospitalisation expenses unless they are related to an accident. Once the initial waiting period is completed, you can make claims for all covered medical conditions.
• Waiting period for pre-existing diseases: A  pre-existing disease refers to a health condition that you had in the 36 months prior to obtaining your health insurance policy. With the Aditya Birla Activ One Nxt plan, there is a waiting period of 36 months for pre-existing conditions. It is important to note that during this waiting period, you will not be eligible to claim for expenses associated with your pre-existing disease.
• Waiting period for specific diseases: In addition to any pre-existing conditions, insurers may have a specific list of medical conditions or illnesses that necessitate a waiting period, regardless of whether you have previously experienced them or not. The duration of this waiting period is determined by the insurer and is not influenced by your present health status. The Aditya Birla Activ One Nxt plan has a waiting period of 24 months for specific diseases. 

👉Exclusions

Health insurance policies include exclusions, which are specific situations or medical conditions that the policy does not cover. Here are some of these exclusions -

• Standard permanent exclusions: All insurance providers are required to stick 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, 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: In addition to the standard permanent exclusions required by the IRDAI, insurance companies have the authority to apply extra exclusions for certain illnesses and circumstances. If a specific illness is considered to be highly risky, insurers may choose to exclude it from coverage permanently. It is worth noting that insurers can only apply permanent exclusions for diseases that are listed in the pre-approved list provided by the IRDAI.
• Non-standard exclusions (specific exclusions): These particular exclusions extend beyond the usual permanent exclusions outlined by the IRDAI. They are decided upon by the insurance company and may vary depending on the terms and conditions of the policy. Under the Aditya Birla Activ One Nxt plan, the specific exclusions are as follows-

1. Injury or illness resulting directly or indirectly from acts of terrorism, nuclear emissions, war, civil war, etc.
2. Intentional self-inflicted injury or attempted suicide, engaging in illegal activities, substance abuse including drug use, alcohol consumption, etc.
3. Circumcision unless deemed medically necessary for treating a disease or injury.
4. Costs associated with preventive care, such as vaccinations, inoculations, and immunisations excluding treatment following an animal bite, as well as physical, psychiatric, or psychological examinations.
5. Coverage for hospitalisation expenses pertaining to nutritional and electrolyte supplements.
6. Expenses related to external birth diseases, defects, or anomalies.
7. Coverage for stem cell therapy expenses (excluding bone marrow transplants or hormone replacement therapy).
8. Costs associated with dentures, preventive care, prosthetic teeth, and other comparable external devices or appliances.
9. Expenses linked to Ayush therapies or non-allopathic or alternative treatments, excluding Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy.
10. Prostheses and durable external equipment are used for diagnosis or treatment, unless required as a result of an accident.
11. Alternative treatments such as KTP Laser Surgeries, cyber knife treatment, femto laser surgeries, and comparable procedures.

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 indicates that you can expect a timely claim settlement.
• Claim-related complaints: From our research, we have found that Aditya Birla Health Insurance Company Limited has a higher complaint rate of 0.22% for claims in comparison to other insurance providers. This indicates that their claim settlement process is unsatisfactory.
• 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 maintains 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 from a diverse range of healthcare providers 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 number 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 other insurers.

About Aditya Birla Health Insurance Company Limited

Aditya Birla Health Insurance Company Limited (ABHICL) is a collaboration between Aditya Birla Group and MMI Holdings of South Africa. The company stands out in the insurance market by offering innovative products such as chronic care and incentivized wellness. Since its establishment in 2015, Aditya Birla Health Insurance Company Limited has been based in Mumbai, Maharashtra. Mr. Mayank Bathwal leads the company as its CEO and MD.