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

If you're looking to purchase a healthcare plan that provides comprehensive coverage and is affordable, this plan is perfect for you. In addition to the plan being easy on the pocket, it offers a range of features and benefits that set it apart. It's got you covered for hospitalisation expenses and more- maternity expenses, everyday expenses like meds and tests, and management costs diabetes, hypertension, high cholesterol, and asthma, right from the get-go. One standout feature of this plan is that it covers bariatric surgery for weight loss! Their customer support is very prompt on Twitter ensuring timely response.

However, it's important to note that the plan doesn't offer the option for monthly premium payments and there is a limit on the type of hospital room you choose. Furthermore, our research indicates that the insurer has received a higher number of complaints regarding claim settlements and policy purchases. This suggests that their track record in both purchase and claims service may be poor.

What are the benefits offered by the Aditya Birla Activ Health Platinum (Enhanced)

Inpatient hospitalisation coverage: The Aditya Birla Activ Health Platinum (Enhanced) plan offers you coverage for expenses associated with inpatient hospitalisation. These expenses include the costs incurred when you are admitted to a hospital for more than 24 hours. This means that the plan covers the expenses 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 expenses, known as pre-hospitalisation charges, encompass fees for consultations, laboratory tests, checkups, and medical reports, among other things. It's important to bear in mind that the insurance company will only cover your expenses if they are directly linked to the medical condition that leads to your hospitalisation and if the claim is approved as part of your inpatient hospitalisation expenses. With the Aditya Birla Activ Health Platinum (Enhanced) plan, you can rest assured that your pre-hospitalisation expenses will be taken care of for a period of 60 days prior to your hospitalisation, up to the sum insured.
Post-hospitalisation coverage: Once you are discharged from the hospital, you may come across certain medical costs referred to as post-hospitalisation expenses. These expenses typically include consultation fees, check-up charges, medical test costs, and more. It is important to note that for these expenses to be covered, they must be directly linked to your hospital stay and approved as part of your inpatient hospitalisation coverage. With Aditya Birla Activ Health Platinum (Enhanced) plan you can enjoy the benefits of comprehensive coverage for post-hospitalisation expenses up to the sum insured for a period of 180 days following your hospital discharge.
Daycare treatment coverage: With the Aditya Birla Activ Health Platinum (Enhanced) plan, you can now enjoy comprehensive coverage for all your daycare treatments without any limit up to the sum insured. As medical procedures or surgeries that used to require an extended hospital stay can now be completed within 24 hours, thanks to advancements in medical technology, the plan ensures you are covered through it all. Do note that any daycare procedure that necessitates a period of specialized observation or care following the procedure is also covered.
Domiciliary treatment coverage: Domiciliary treatments are medical treatments for illnesses or injuries that require immediate attention in a hospital, but are administered at home due to the patient's severe illness or injury, making it unsafe to transport them to a hospital. This coverage is also applicable if there are no hospital beds available in the patient's immediate vicinity. With the Aditya Birla Activ Health Platinum (Enhanced) plan, you can rest easy knowing that all expenses related to domiciliary treatments (excluding 9 illness given in the policy document) are fully covered up to the sum insured.
Organ donor coverage: Aditya Birla Activ Health Platinum (Enhanced) plan offers coverage for organ donor expenses. It takes care of the expenses related to harvesting the organ, up to the sum insured, when you are the recipient.
Modern treatment coverage: With the constant advancement of medical technology, you now have access to previously unimaginable innovative treatments. Procedures like stem cell therapy and radio surgeries are specifically designed to treat conditions that were once considered untreatable. The Aditya Birla Activ Health Platinum (Enhanced) plan is tailored to keep up with these developments and covers the expenses associated with these modern treatments up to the sum insured.
Non-medical expenses coverage: Non-medical expenses include consumables like gloves, nebulization kits, oxygen masks, and other essential items needed for your treatment. Aditya Birla Activ Health Platinum (Enhanced) plan, it will cover non-medical expenses up to the sum insured only when you choose this benefit as an add-on.
No Claim Bonus: If you don't make any claims during your policy period, the insurance company will reward you with a No-Claim Bonus. With the Aditya Birla Activ Health Platinum (Enhanced) plan, you can accumulate a bonus of 100% of your sum insured, up to a maximum of 1 crore. You can get a maximum of 50% bonus every year, though if you make a claim during the policy year the bonus will get reduced if it is above 25% of the sum insured.
Super No-Claim Bonus: The Super No Claim Bonus is an enhanced version of the No Claim Bonus that works in a similar way. The Aditya Birla Activ Health Platinum (Enhanced) plan however does not offer this feature.
Refill benefit: The restoration benefit is designed to restore your sum insured after you exhaust it within a policy year. When you choose the Aditya Birla Activ Health Platinum (Enhanced) plan, you can take advantage of this benefit for unrelated illnesses. This helpful feature kicks in when both your sum insured and no claim bonus have been partially utilised. You can use this benefit once in a policy year.

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

Aditya Birla Activ Health Platinum (Enhanced): 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. However, if you decide to go for a more expensive room, you will be responsible for a proportionate portion of the total hospital bill, not just the difference in room rent. With the Aditya Birla Activ Health Platinum (Enhanced) plan, you have a cap on the type of room you can select. If you avail the add on then this limit no longer holds true and you can select any room without any restrictions.
ICU rent limit: In the Aditya Birla Activ Health Platinum (Enhanced) plan, you won't have to worry about any limits on your ICU rent. This means that your plan will cover the full cost of your stay in the intensive care unit at the hospital, up to the maximum amount insured.
Co-payment: In the Aditya Birla Activ Health Platinum (Enhanced) plan, you won't have to worry about any copayments. A copayment is usually a portion of the approved claim amount that you would be responsible for paying out of pocket. But with this plan, once you make your payment, the insurer will cover the remaining expenses without any additional cost to you.
Deductible: A deductible is an amount that you, as the policyholder, must pay out of your own pocket before your insurance coverage comes into effect to cover the remaining costs.With the Aditya Birla Activ Health Platinum (Enhanced) plan there are no deductibles.
Limits on surgeries/treatments: When it comes to your health insurance policy, it's important to understand the limits on surgeries and treatments. These limits refer to the maximum amount that your 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 Health Platinum (Enhanced) plan, you can rest assured knowing 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 Health Platinum (Enhanced): Waiting Periods & Exclusions

👉Waiting period

During a waiting period certain illnesses and medical conditions are not immediately covered by your health insurance policy. It's important to note that claims for these specific conditions can only be made once the waiting period has passed. Here are some types of waiting periods to be aware of:

Initial waiting period: There is an initial waiting period for all medical conditions, except accidents for the first 30 days from policy purchase. During this time, you won't be eligible to make a claim for any hospitalisation, except in cases of accidents.
Waiting period for pre-existing conditions: In the Aditya Birla Activ Health Platinum (Enhanced) plan, you need to be aware of the waiting period of 36 months for pre-existing conditions. This means that if you have experienced any medical condition or illness within the 36 months before purchasing your health insurance policy, you will not be eligible to make any claims for costs associated with your pre-existing disease during this waiting period.
Waiting period for specific diseases: In addition to your pre-existing conditions, insurers have a list of specific medical conditions or illnesses that require waiting periods, regardless of whether you have had those diseases before or not. The waiting period is set by the insurer and is not based on your current health status. With the Aditya Birla Activ Health Platinum (Enhanced) plan, there is a waiting period of 24 months for specified illnesses which extends to 48 months for genetic disorders.

👉Exclusions

Health insurance policies do not provide coverage for specific medical conditions or situations known as exclusions. Let's take a look at some of these exclusions:

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

Investigation and evaluation: Hospital admission for observation or monitoring.
Rest, rehabilitation, and respite care: Admission to a facility for bed rest without active treatment.
Obesity/weight control: Treatment or surgery related to weight control or obesity.
Gender reassignment: Treatments aimed at altering the body’s characteristics to match the opposite sex.
Plastic/Cosmetic surgery: Treatment or surgery intended to modify body characteristics or appearance.
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.
Breach of law: Expenses incurred in treating a person who has committed or attempted to commit a criminal act.
Excluded providers: Treatment received from medical practitioners or hospitals excluded by the insurance company.
Narcotics: Treating addiction to substances such as alcohol, drugs, etc.
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.
Dietary supplements, substances purchased without subscription: Vitamins, minerals, etc., that a medical practitioner does not prescribe.
Refractive error: Expenses associated with correcting refractive errors of up to 7.5 diopters to improve eyesight.
Unproven treatments: Surgeries, medical procedures, or treatments that are not proven to be effective.
Expenses related to birth control, sterility, and infertility: Contraception, sterilisation, artificial insemination, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
Maternity expenses: Pre/post-natal costs, childbirth-related hospitalisation expenses, etc.

Additional permanent exclusions: Insurance providers have the authority to impose additional exclusions for specific medical conditions or circumstances, in addition to the standard permanent exclusions. If you happen to have certain diseases or severe medical conditions that insurers consider too risky to cover, they may choose to permanently exclude them from your policy. It is important to note that health insurers are bound by certain restrictions when it comes to applying permanent exclusions. These restrictions are defined by the Insurance Regulatory and Development Authority of India (IRDAI) and pertain specifically to a list of illnesses for which exclusions can be applied. It is worth mentioning that insurers are not permitted to impose permanent exclusions for illnesses or diseases that fall outside of this designated list.
Non-standard exclusions (Specific exclusions): You may come across specific exclusions that go beyond the standard permanent exclusions outlined by the IRDAI These exclusions can vary among insurance companies and are based on the terms and conditions of the policy. Some of the specific exclusions listed under the Aditya Birla Activ Health Platinum (Enhanced) plan are as follows -

Injury or illness resulting from acts of invasion, foreign enemies, civil war, or war-like operations.
Injury or illness resulting from self-harm or participation in naval, military, or air force operations.
Injury or illness caused by the misuse of intoxicants, participation in smoking cessation programs, or treatment for nicotine addiction unless prescribed by a medical practitioner.
Circumcision unless deemed medically necessary for treating a disease or injury.
Non-allopathic treatments.
Pharmacological regimens or devices that are considered experimental or investigational.
Costs related to preventive care, vaccination, inoculation, and immunization, except for post-animal bite treatment.
Any physical, psychiatric, or psychological examinations or testing.
Admission for nutritional and electrolyte supplements unless medically necessary.
Hearing aids, multifocal lenses, spectacles, or contact lenses.
Expenses associated with hair loss treatments and products.
Elastic stockings, diabetic test strips, and similar medical supplies.
Prosthesis or external equipment used for diagnosis or treatment.
Treatment for Parkinson's disease, Alzheimer's disease, general tiredness or exhaustion, sleep apnea, or stress.
Treatment expenses related to external birth defects.
Stem cell therapy, except for bone marrow transplants for hematological conditions and related surgeries.
Screening expenses for organ donors.
Treatment related to spinal injuries, skeletal structure, or muscle stimulation, except for the treatment of fractures (excluding hairline fractures).
Treatment for venereal and sexually transmitted diseases.
Dental treatment, except when required due to an accident.
Hyperbaric Oxygen Therapy, KTP Laser Surgeries, CyberKnife treatment, and similar procedures.
Use of radiofrequency, unless explicitly approved in advance in writing.

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 98.61% 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 complaint rate of 0.24% for claims in comparison to other insurance providers. This indicates that their claim settlement process is quick.
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 72.71%.
Claim settlement ratio: Aditya Birla Health Insurance Company Limited’s claim settlement ratio stands at a glorious 90.24%.. 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 0.05% complaints related to its after-sales service, which is lower 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 a quicker response time on Twitter, as compared to others.

About Aditya Birla Health Insurance Company Limited (ABHICL)

Aditya Birla Health Insurance Company Limited (ABHICL), a part of Aditya Birla Capital Ltd. (ABCL), is a joint venture between Aditya Birla Group and MMI Holdings of South Africa. ABHICL. The current product portfolio of the company includes unique offerings such as Chronic Care and Incentivized Wellness. It was founded in 2015 and is headquartered in Mumbai, Maharashtra. Mr. Mayank Bathwal is the company's CEO and MD.