Aditya Birla Activ One (VYTL)

Aditya Birla Activ One (VYTL) is a health insurance plan from Aditya Birla Health Insurance Company Limited, designed to provide comprehensive coverage for individuals and families. It takes care of hospitalization expenses along with pre- and post-hospitalization costs, ensuring financial support during medical emergencies. 

This plan even covers a live-in partner, no matter the gender. It’s built to keep your finances safe from sudden medical expenses while also encouraging a healthier lifestyle with fitness benefits. The coverage is flexible, packed with useful features, and comes with plenty of add-ons to fit the medical needs of you and your loved ones.

This plan is competitively priced compared to similar options and comes with extensive coverage, unique features, useful add-ons, and exciting discounts. It goes beyond just hospitalization expenses by also covering non-medical costs and offering the option to cover certain chronic conditions from day one. On top of that, it provides fitness benefits and mental well-being support to promote overall health.

That said, there are a few downsides. There’s no option to pay premiums on a monthly basis, which might be inconvenient for some. Plus, the insurer has received more complaints than others when it comes to both policy purchase and claim settlement. This suggests that the overall experience, whether buying the policy or making a claim, hasn't been the smoothest for many customers.

What are the benefits offered by Aditya Birla Activ One (VYTL)?

• Inpatient hospitalisation coverage: Inpatient coverage kicks in when a patient is hospitalized for over 24 hours. It takes care of essential expenses like room charges, nursing care, doctor consultations, prescribed medicines, ICU fees, and other necessary medical costs. Hospital bills can be overwhelming, but this plan takes care of those big expenses so the focus stays on getting better. The Aditya Birla Activ One (VYTL) plan covers inpatient hospitalization costs without capping ICU or room rent charges. That means no worrying about limits, just the freedom to choose the level of care and comfort that feels right.
• Pre-hospitalisation coverage: Before a hospital stay, there are often medical expenses to take care of, known as pre-hospitalization costs. These usually cover things like doctor visits, lab tests, routine checkups, and medical reports, all adding up before treatment even begins. The expenses will only be covered if they are directly linked to the condition treated and if the main hospitalization claim gets approved. With the Aditya Birla Activ One (VYTL) Plan, pre-hospitalization expenses are also taken care of for up to 90 days, within the sum insured. 
• Post-hospitalisation coverage: Getting discharged from the hospital is just one part of the recovery journey. What comes next, follow-up checkups, medications, and continued care, can add up quickly. That is where post-hospitalization coverage steps in, easing the financial strain. But here is the catch: these expenses are only covered if they are directly tied to your hospital treatment for which the in-patient claim is approved. The Aditya Birla Activ One (VYTL) Plan ensures full coverage for post-hospitalisation expenses, extending up to the sum insured for a period of 180 days after discharge. 
• Daycare treatment coverage: Medical technology has come a long way, making it possible to complete certain treatments and surgeries in less than a day. These are known as daycare procedures, things that once meant long hospital stays but now get done within 24 hours, saving both time and hassle. The Aditya Birla Activ One (VYTL) Plan provides full coverage for all daycare treatments without any financial cap. 
• Domiciliary treatment coverage: Domiciliary treatments involve critical medical care given at home rather than in a hospital. This typically happens when a patient’s condition makes hospital transfer unsafe or when no hospital beds are available nearby. The Aditya Birla Activ One (VYTL) Plan takes care of all costs related to domiciliary treatments, covering them up to the sum insured. 
• Organ donor coverage: The Aditya Birla Activ One (VYTL) Plan steps in to cover organ donor expenses, taking care of the inpatient costs involved in the transplant procedure. It provides financial support up to the sum insured, easing the burden during such a crucial time. 
• Modern treatment coverage: Modern medicine has made incredible strides, providing treatments for conditions that were once considered impossible to cure. Innovations like stem cell therapy, radiosurgery, and robotic-assisted procedures are transforming healthcare, offering highly personalized solutions tailored to each patient’s needs. The Aditya Birla Activ One (VYTL) Plan is designed to keep pace with these medical advancements, covering the costs of modern treatments without any financial restrictions.
• Non-medical expenses coverage: Coverage for non-medical expenses takes care of essential items like vaccinations, gloves, nebulization kits, oxygen masks, medical footwear, urine bags, hospital gowns, and more. This ensures you are not weighed down by these extra costs while focusing on your treatment. The Aditya Birla Activ One (VYTL) Plan gives you peace of mind by covering non-medical expenses without any financial limits, so you can focus on your recovery without worry.
• No Claim Bonus: The No Claim Bonus is a benefit offered by the insurance company as a reward for not filing any claims during the policy term. Under the Aditya Birla Activ One (VYTL) Plan, the No Claim Bonus rewards you with a percentage-based bonus each year. If no claims were made in the previous year, an annual bonus of 50% is added to your coverage. You can accumulate a maximum bonus of 100%, with a limit of up to ₹3 crores. Unlike many policies, this bonus remains intact even if you file a claim, ensuring you continue to benefit from the additional coverage.
• Super No Claim Bonus: The Super No Claim Bonus takes the benefits of the standard No Claim Bonus to the next level, providing even greater rewards for claim-free years. It enhances your coverage more significantly, ensuring you get an even higher bonus without losing its advantages. However, the Aditya Birla Activ One (VYTL) Plan does not provide provisions for the super no-claim bonus.
• Restoration benefit: The restoration benefit is a valuable feature that replenishes your sum insured if you’ve used it all during the policy year due to unexpected medical expenses. Under the Aditya Birla Activ One (VYTL) Plan, the Refill Benefit ensures that your sum insured is reinstated if it gets depleted during the policy year. This benefit can be used unlimited times for subsequent claims in a policy year, provided there has been a partial exhaustion of the sum insured and any accrued No Claim Bonus. It applies to both related and unrelated illnesses, ensuring continued coverage for medical expenses. The reinstatement of the sum insured benefit is available, offering financial security throughout the policy term.

Please note that these benefits, along with their limitations and conditions, are applicable for a sum insured of Rs 10 lakhs.

Aditya Birla Activ One (VYTL): Financial Limits

• Room rent limit: The room rent limit is the highest amount your insurance will cover for hospital room expenses. As long as you stay within this limit, you won’t have to pay anything extra. But if you choose a more expensive room, your insurer will apply a proportionate deduction to your claim. The Aditya Birla Activ One (VYTL) Plan gives you the freedom to choose any hospital room without any limitations. 
• ICU rent limit: The ICU rent limit decides how much of your hospital’s intensive care unit charges your insurance plan will cover. With the Aditya Birla Activ One (VYTL) Plan, there’s no cap on ICU expenses. No restrictions, no worrying about extra costs, just full coverage.
• Copayment: Copayment, or copay, is the part of the approved claim that you need to pay from your pocket. Once you cover your share, the insurer takes care of the rest. The Aditya Birla Activ One (VYTL) Plan comes with zero copayment, meaning you don’t have to pay a share of the claim amount.
• Deductible: The deductible is the portion of medical expenses you need to pay from your own pocket before your insurance starts covering the rest. Under the Aditya Birla Activ One (VYTL) Plan, the deductible options available are Rs 15,000 or Rs 25,000, depending on your choice.   
• Limits on surgeries/treatments: When going through your health insurance policy, it’s crucial to check the coverage limits for surgeries and treatments. These limits define the maximum amount your insurer will pay for specific medical procedures. While some plans set fixed limits on certain procedures, others offer more flexibility. The Aditya Birla Activ One (VYTL) Plan covers joint replacement surgeries and cataract treatment up to the full sum insured. 

Please keep in mind that the financial limits mentioned earlier are based on a 30-year-old individual selecting a sum insured of Rs. 10 Lakhs.

Aditya Birla Activ One (VYTL): Waiting Periods & Exclusions

👉Waiting period

The waiting period is the time after buying a policy when specific illnesses and medical conditions aren’t covered. You can only file claims for these conditions once this period is over. The duration of the waiting period isn’t the same for every insurer. It varies depending on the policy and provider. The different types of waiting periods include:

• Initial waiting period: A 30-day waiting period applies to all medical conditions except accidents. During this time, you can’t file a claim for hospitalization unless it results from an accident. 
• Waiting period for pre-existing conditions: A pre-existing medical condition refers to any health issue or illness you’ve had in the 36 months before buying a health insurance policy. For the Aditya Birla Activ One (VYTL) Plan, the waiting period for pre-existing diseases is 36 months as an add-on. 
• Waiting period for specific diseases: In addition to pre-existing conditions, insurers have a separate list of medical conditions that come with their own waiting periods. These apply no matter what your medical history looks like. Even if you're in perfect health, you’ll still need to wait before making a claim for these specific illnesses. The length of these waiting periods is set by the insurer and doesn’t change based on your current health status. The Aditya Birla Activ One (VYTL) Plan also includes a 24-month waiting period for certain specific diseases.

👉Exclusions

Exclusions in health insurance refer to specific medical conditions or situations that the policy doesn’t cover. Here are some common examples of these exclusions:

• Standard Permanent Exclusions: Every insurance company must adhere to the 'standard permanent exclusions' outlined by IRDAI. These exclusions include:

1. Investigation and evaluation: Hospital stays meant only for evaluation and observation, without any active medical treatment, are not covered.
2. Rest, rehabilitation, and respite care: Services focused on rest, rehabilitation, or long-term care, rather than active treatment or surgery, are excluded.
3. Obesity/weight control: Any procedures or treatments aimed at weight loss or obesity control, including bariatric surgery, are not covered.
4. Gender reassignment: Medical treatments or surgeries related to gender reassignment or altering gender identity are excluded.
5. Plastic/Cosmetic surgery: Any plastic or cosmetic surgeries performed solely for enhancing appearance, unless medically necessary, are not covered.
6. Profession in adventure or hazardous sports: Medical expenses for injuries sustained while professionally engaging in adventure or extreme sports like river rafting, mountaineering, or scuba diving are not covered.
7. Breach of law: Treatment costs for injuries or health issues arising from involvement in criminal activities or unlawful acts are excluded.
8. Excluded providers: Expenses for medical treatments received from doctors or hospitals that are not recognized under the insurance policy will not be reimbursed.
9. Narcotics: Costs related to the treatment of addiction or health issues caused by alcohol, drugs, or other controlled substances are not covered.
10. Treatments in establishments arranged for domestic purposes: Medical expenses for treatments in nursing homes or similar establishments meant primarily for long-term domestic care rather than active medical treatment are excluded.
11. Dietary Supplements: Expenses for vitamins, minerals, and other over-the-counter supplements that are not medically prescribed are not covered.
12. Refractive error: Costs for treating refractive errors up to 7.5 diopters, such as LASIK or other corrective procedures, are excluded.
13. Unproven treatments: Any medical procedures, surgeries, or therapies lacking scientific validation or proven effectiveness are not covered.
14. Expenses related to sterility, birth control, and infertility: Expenses related to contraception, sterilization, artificial insemination, and assisted reproductive techniques like IVF, GIFT, ZIFT, ICSI, and surrogacy are excluded.
15. Maternity expenses: Hospitalization expenses for childbirth, including prenatal and postnatal care, as well as delivery costs, are not covered under the policy.

• Additional permanent exclusions: Insurance companies can impose extra exclusions for certain health conditions or situations beyond the standard permanent exclusions. If an insurer views a particular illness or serious medical condition as too high-risk, they may decide to exclude it from your policy permanently. 

Health insurers must follow the guidelines set by the Insurance Regulatory and Development Authority of India (IRDAI), which outlines specific illnesses eligible for permanent exclusions. They cannot permanently exclude any medical condition that isn’t on this approved list. 

• Non-standard exclusions (Specific exclusions): Non-standard exclusions are extra conditions that insurers choose to leave out, apart from the standard permanent ones set by IRDAI. They aren’t the same for every policy; each insurer has its own rules, and what’s excluded depends entirely on the terms they’ve set. Here are the most important specific exclusions listed under the Aditya Birla Activ One (VYTL) Plan -

1. Circumcision is not covered unless it is medically necessary to treat a disease or injury.
2. Expenses for preventive care, vaccinations, immunizations, and routine physical, psychiatric, or psychological check-ups are excluded, except when required for post-animal bite treatment.
3. Hospitalization costs for nutritional and electrolyte supplements are not covered unless the attending doctor certifies they are essential due to a covered medical condition.
4. Medical expenses related to external birth defects, diseases, or anomalies are not included in the policy coverage.
5. Costs associated with stem cell therapy are excluded, except for bone marrow transplants or hormone replacement therapy.
6. Expenses for AYUSH treatments or any non-allopathic/alternative therapies, except for Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy, are not covered.
7. Expenses for prosthetics and external medical equipment used for diagnosis or treatment are excluded unless required due to an accident.
8. Specific advanced medical treatments and surgeries, such as KTP laser surgeries, CyberKnife treatment, Femto laser surgeries, and similar procedures, are not covered.

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

• Speed of claims settlement: Aditya Birla Health Insurance Company Limited has ensured a prompt and effective claim payment process by settling 94.59% of its claims within 30 days. 
• Claim-related complaints: Based on our research, Aditya Birla Health Insurance Company Limited has a claims complaint rate of 0.22%, which is higher compared to other insurers. 
• Claims incurred ratio: The claims incurred ratio reflects an insurer's financial stability by measuring the percentage of claims paid against the total premiums collected in a given year. Aditya Birla Health Insurance Company Limited has a claims incurred ratio of 68.31%. 
• Claim settlement ratio: Aditya Birla Health Insurance Company Limited has a claim settlement ratio of 94.51%, indicating the percentage of claims successfully processed out of the total received in a given financial year.
• Network hospitals: With a network of over 11,000 hospitals, Aditya Birla Health Insurance Company Limited makes cashless treatment easily accessible. This wide coverage allows you to get the medical care they need without the burden of upfront payments.

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

• Policy purchase-related complaints: Our research indicates that only 0.03% of complaints have been reported regarding Aditya Birla Health Insurance Company Limited's after-sales service.
• Response on Toll-Free: In comparison to other insurers, our study indicates that Aditya Birla Health Insurance Company Limited's toll-free number response time is slow.    
• Response on Twitter(X): Our research shows that Aditya Birla Health Insurance Company Limited has an average response time on Twitter (X) when compared to other companies. 

About Aditya Birla Health Insurance Company Limited

Aditya Birla Health Insurance Company Limited (ABHICL), a part of Aditya Birla Capital Ltd. (ABCL), is a joint venture between the Aditya Birla Group and South Africa’s MMI Holdings. Launched in 2015 and based in Mumbai, Maharashtra, ABHICL provides distinctive products like Chronic Care and Incentivized Wellness. The company operates under the leadership of Mr. Mayank Bathwal, its CEO and Managing Director. As of now, ABHICL has issued over 36 lakh policies and processed more than 13 lakh claims, with a Gross Written Premium turnover of 3458.46 Crores.