Aditya Birla Activ Care (Premier)

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

This thoughtfully crafted plan caters specifically to senior citizens, providing extensive coverage and assistance throughout different stages of their health and overall well-being. In addition to hospitalisation and associated costs, it also includes coverage for outpatient expenses like medical consultations, diagnostic tests, and more. However, it is important to note that this plan does not offer the option to make monthly premium payments and may be comparatively higher in cost compared to similar products available in the market.

Moreover, based on our extensive research, it has come to our attention that the insurer has encountered a significant number of complaints regarding claim settlements and policy purchases. This indicates a subpar performance in both customer satisfaction and service experience when it comes to policy purchase and claim settlement processes.

What are the benefits offered by the Aditya Birla Activ Care (Premier)?

• Inpatient hospitalisation coverage: The Aditya Birla Activ Care (Premier) plan offers comprehensive coverage for expenses related to inpatient hospitalisation. Inpatient hospitalisation costs refers to the expenses incurred when you are admitted to a hospital for a duration of more than 24 hours. This includes expenses such as your hospital room, nursing care, consultations, prescription medications, ICU charges, and any other relevant expenses. With this plan, you can have peace of mind knowing that your medical expenses during your hospital stay will be taken care of.
• Pre-hospitalisation coverage: Prior to your admission to the hospital, it is important to be aware of potential medical expenses that may arise. These expenses, known as pre-hospitalisation charges, encompass various fees such as consultations, laboratory tests, checkups, medical reports, etc. It is imperative to note that the insurance company will only provide coverage for these expenses if they are directly linked to the medical condition that ultimately leads to your hospitalisation. Additionally, the approval of your claim as part of your inpatient hospitalisation expenses is a necessary requirement for insurance coverage. With the Aditya Birla Activ Care (Premier) plan, you can have peace of mind knowing that your pre-hospitalisation expenses will be taken care of for a duration of 30 days prior to your hospitalisation, up to the sum insured.
• Post-hospitalisation coverage:  After you are discharged from the hospital, you may encounter specific medical expenses referred to as post-hospitalisation expenses. These expenses include costs associated with consultations, check-ups, medical tests, and more. It is important to note that for these expenses to be covered, they must be directly related to your hospital stay and approved as part of your inpatient hospitalisation coverage. With the Aditya Birla Activ Health Care (Premier) plan, you can enjoy extensive coverage for post-hospitalisation expenses for 60 days after your hospital discharge up to the sum insured.
• Daycare treatment coverage: In essence, a daycare treatment denotes a medical procedure or surgery that used to necessitate a prolonged hospital stay but can now be accomplished within 24 hours, thanks to remarkable advancements in medical technology. By opting for the Aditya Birla Activ Care (Premier) plan, you can benefit from extensive coverage for 586 daycare treatments, up to the sum insured.
• Domiciliary treatment coverage: Domiciliary treatments include medical care for illnesses or injuries that necessitate urgent attention in a hospital setting. However, these treatments are instead provided at home due to the patient's severe condition, making transportation to a hospital unsafe, or due to unavailability of hospital beds nearby. With the Aditya Birla Activ Care (Premier) plan, all costs associated with domiciliary treatments are covered up to the sum insured. However please note there are 15 illnesses which are not covered under this benefit.
• Organ donor coverage: The Aditya Birla Activ Care (Premier) plan also offers coverage for organ donor expenses. It covers the costs associated with harvesting the organ from the donor, up to the sum insured, where you are the organ recipient. Please note that the donor’s pre and post-hospitalisation expenses will not be covered
• Modern treatment coverage:  The remarkable strides made in medical technology have opened doors to innovative treatments that were once beyond our imagination. Stem cell therapy, radio surgery, and other groundbreaking methods are now accessible, providing precise solutions for conditions that were once considered untreatable. The Aditya Birla Activ Care (Premier) plan, ensures that you stay in step with these advancements by covering all expenses associated with these cutting-edge modern treatments up to the sum insured, without any limitations.
• Non-medical expenses coverage: The Aditya Birla Activ Care (Premier) plan goes beyond medical coverage by also including non-medical expenses up to the sum insured. These non-medical expenses include the cost of consumables, such as gloves, oxygen masks, nebulization kits, and other essential items required for treatment. However, this benefit is available as an add-on.
• No claim bonus:  The no claim bonus is an incentive given by the insurance company when you refrain from making any claims during the policy period. With the Aditya Birla Activ Care (Premier) plan, you can enjoy a no claim bonus equivalent to 10% of your sum insured, up to a maximum of 50% of the sum insured. It's worth noting that if you do make a claim, the bonus will decrease at the same rate it initially increased.
• Super no-claim bonus: The super no claim bonus is an enhanced version of the no claim bonus, functioning in a similar way. Unfortunately, Aditya Birla Activ Care (Premier) plan does not offer this benefit.
• Restoration benefit: The restoration benefit is a valuable feature that replenishes your sum insured once it has been fully utilised within a policy year. With the Aditya Birla Activ Care (Premier) plan, you can availof  this benefit for unrelated illnesses, including any complications that may arise. This feature comes into effect once both your sum insured and no claim bonus have been partially utilised. You can make use of this benefit once in a policy year for subsequent claims.

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

Aditya Birla Activ  Care (Premier): Financial Limits

• Room rent limit:  The room rent limit refers to the highest amount that your insurance provider will cover for your hospital room expenses. By selecting a room within this limit, you can avoid any additional charges. However, if you opt for a more expensive room, you will be responsible for a proportionate portion of the overall hospital bill, not just the difference in room rent. With the Aditya Birla Activ Care (Premier) plan, you have the flexibility to choose any room except suite category without any restrictions - if you opt for an add-on.
• ICU rent limit: The maximum amount that your plan will cover for your stay in the intensive care unit at the hospital is referred to as the ICU rent. With the Aditya Birla Activ Care (Premier) plan, there is no limit on the ICU rent. This means that the plan will fully cover the cost of your ICU stay, up to the sum insured.
• Copayment: A copayment, also known as a copay, refers to the portion of the approved claim amount that you are required to pay out of your own pocket. After you have made this payment, the insurer will take care of the remaining expenses. There is a 10% copayment limit in the Aditya Birla Activ Care (Premier) plan.
• Deductible: A deductible is an amount that you are required to pay upfront before your insurance coverage comes into effect and covers the remaining expenses. It is worth mentioning that the Aditya Birla Activ Care (Premier) plan does not have a deductible.
• Limits on surgeries/treatments: This term refers to the maximum coverage provided by a health insurance policy for specific medical procedures or treatments. Certain plans have predetermined limits on the amount they will cover for certain procedures, while others do not. With the Aditya Birla Activ Care (Premier) plan, you can be assured that 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 Care (Premier): Waiting Periods & Exclusions

👉Waiting period

A waiting period refers to a designated period of time in which certain illnesses and medical conditions are not immediately covered under a health insurance policy. Claims for these specific conditions can only be made once the waiting period has elapsed. Let's take a look at some of the different types of waiting periods -

• Initial waiting period: There is an initial waiting period of 30 days for all medical conditions, except accidents, before you can make a claim for hospitalisation. Please note that during this time, you will not be eligible to make a claim for any non-accident-related hospitalisation.
• Waiting period for pre-existing conditions: Any health condition or medical illness that you have had in the 36 months prior to purchasing a health insurance policy is termed as a pre-existing disease. With the Aditya Birla Activ Care (Premier) plan, there is a waiting period of 24 months for pre-existing conditions. During this waiting period, you will not be able to make any claims for costs related to your pre-existing disease.
• Waiting period for specific diseases: In addition to pre-existing conditions, insurance providers maintain a list of specific medical conditions or illnesses that require waiting periods, irrespective of whether you have previously experienced those diseases or not. The duration of the waiting period is determined by the insurer and is not influenced by your current state of health. For the Activ Care (Premier) plan, there is a waiting period of 24 months in place for specific diseases.

👉Exclusions

Health insurance policies do not step in to 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: Expenses for treatments for injury/illness arising from participating in risky activities such as mountaineering, river rafting, 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 specifically 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, procedures, or treatments that are not proven to be effective.
14. Expenses linked to birth control, sterility, and infertility: Sterilisation, contraception, artificial insemination, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc. 
15. Maternity expenses: Pre/post-natal expenses, childbirth-related hospitalisation expenses, etc. 

• Additional permanent exclusions: Insurance providers have the discretion to impose additional exclusions on specific medical conditions or circumstances, in addition to the standard permanent exclusions. In cases where you have certain diseases or severe medical conditions that insurers deem to be high-risk, they may choose to permanently exclude coverage for them from your policy.

However, it is important to note that health insurers are limited to a specific list of illnesses defined by the Insurance Regulatory and Development Authority of India (IRDAI) for which they can apply a permanent exclusion. They are not permitted to impose permanent exclusions for illnesses or diseases that are not included in this list.

• Non-standard exclusions (Specific exclusions): Insurers impose specific exclusions imposed in addition to the aforementioned standard permanent exclusions as defined by the IRDAI. It's important to bear in mind that these exclusions may differ across insurance companies and are contingent on the terms and conditions of the policy. Below are some of the specific exclusions listed under the Aditya Birla Activ Care (Premier) plan -

1. Injury or disease resulting from war, invasion, acts of foreign enemies, and warlike operations.
2. Injury or illness arising from self-inflicted harm or involvement in naval, military, or air force operations.
3. Injury or illness caused by the abuse of intoxicants, participation in smoking cessation programs, and treatment for nicotine addiction, unless prescribed by a medical professional.
4. Circumcision, unless deemed necessary for the treatment of a disease or injury.
5. Non-allopathic treatments excluding AYUSH in-patient treatments.
6. Experimental or investigational pharmacological regimens or devices.
7. Preventive care, vaccination, inoculation, and immunization costs (excluding post-animal bite treatment) or any related examinations.
8. Admission for nutritional and electrolyte supplements unless medically necessary.
9. Expenses for hearing aids, multifocal lenses, spectacles, contact lenses, etc.
10. Expenses for hair loss treatments and products
11. Costs for elastic stockings, diabetic test strips, and other medical supplies.
12. Expenditure on prosthesis or external equipment used for diagnosis or treatment.
13. Expenses related to Parkinson's disease.
14. Treatment costs for external birth defects.
15. Stem cell therapy, excluding bone marrow transplant for haematological conditions.
16. Medical expenses for venereal and sexually transmitted diseases.
17. Coverage for expenses linked to the treatment of HIV and AIDS.
18. Screening expenses of organ donor.
19. Coverage for medical treatment pertaining to spinal injuries, skeletal structure issues, and muscle stimulation, excluding hairline fractures.
20. Coverage for dental treatments, excluding those necessitated by accidents.
21. Financial assistance for treatments such as Hyperbaric Oxygen Therapy, KTP laser surgeries, cyber knife treatment, and other similar procedures.
22. Utilisation of radio frequency technologies other than with prior written approval.
23. Overall fatigue or weariness

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 dynamic collaboration between Aditya Birla Group and MMI Holdings of South Africa. With a focus on innovation, ABHICL offers unique solutions like chronic care and incentivised wellness. Since its inception in 2015, ABHICL has been headquartered in Mumbai, Maharashtra. The CEO and MD of the company is Mr. Mayank Bathwal.