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Aditya Birla Activ Health Essential Plan

What is the Plan all About?

Activ Heath Essential helps you get a customized health cover to cater to your health care needs. It also provides cover for chronic diseases such as diabetes, hypertension and asthma.

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Key Features

  • Complete health cover
  • Health Returns Rewards to stay fit
  • Day 1 cover for chronic illnesses
  • Choice of hospital room category
  • Optional covers to enhance benefits
  • Avail cumulative bonus
  • Range of optional covers to enhance coverage
  • Second E-opinion for critical illness

Policy Benefits

  • In-patient treatment expenses like room rent, doctor’s fee, operation theater charges, ICU charges, medicines, consumables, etc are covered, when hospitalized for more than 24 hours.
  • Pre hospitalization expenses when incurred before hospitalization are covered up to 30 days.
  • Post hospitalization expenses when incurred after discharge from hospital are covered up to 60 days.
  • Listed day care procedures that require the insured person to get hospitalized for less than 24 hours are covered.
  • Domiciliary hospitalization is covered up to the limits as specified under the policy.
  • Benefit of choosing a lower hospital room category is payable on claims.

Value Added Benefits

  • Road Ambulance Cover towards cost incurred for transportation to a hospital.
  • Get cumulative bonus of 10% for every claim-free policy year.
  • A free annual health check-up is provided to each insured person (above 18 years).
  • Second E-opinion on critical illness from international specialists is available.
  • Chronic Management Program to control chronic illnesses and keep you healthy.
  • This policy rewards you for staying fit and you can get these rewards in form of Health Returns that can be used for getting medicines for fever or a surgery.
  • Get access to Wellness Coaching in areas such as weight management, nutrition, activity & fitness and tobacco cessation.
  • Riders can be opted to enhance policy coverage.
  • Avail tax benefits u/s 80D of the IT Act, 1961 for the premiums paid.

Sub Limits

  • Treatment wise sub-limits will apply which are applicable per Policy Year based on disease category and zone type.
  • Mandatory co-payment applies to all payable claims.
  • Co-payment for treatment in a higher zone. Co-pay of 10%/15%/25% applies, when treatment taken in a zone higher than the eligible zone.
  • Co-payment for treatment in a Higher room category. Co-pay of 15%/25%/40% applies, when you take a higher room category than the eligible room.
  • For an annual health check-up, you claim a reimbursement of up to Rs 1,000, depending on the age band.

Waiting Period Clause

  • Initial Waiting Period: A waiting period of 30 days from the inception date for all hospitalization claims except in case of accidents.
  • Specific Waiting Period: Specific illnesses such as Cataract, Sinusitis, Osteoarthritis, Hernia, Hydrocele, etc. are covered after 24 months of continuous policy coverage.
  • Pre existing Disease Waiting Period: Any pre-existing ailment/injury is covered after a waiting period of 4 continuous years.
  • Maternity Waiting Period: Any maternity or pregnancy-related expenses are covered after 24 months of continuous policy coverage.
  • Chronic Management Program Waiting Period: Waiting period for availing benefits of Chronic Management Program is 24 months. There is no waiting period for Chronic Management Program, if the insured person has undergone pre-policy medical examination. Hospitalization related to chronic condition is having a waiting period of 90 days.

Who can Buy the Plan?

Factor Minimum Maximum
Age (as on last birthday) Child: 91 Days Adult: 18 Years Child: 25 Years Adult: No Limit
Sum Assured 2 Lacs 10 Lacs
Cover Type Individual/Family Floater -
Policy Tenure 1 Year 3 Years
Grace Period 30 Days -
Free Look Period 15 Days/30 Days (for Distance Marketing Channel) From The Receipt Of The Policy -
Riders OPD Expenses, Deductible, Maternity Expenses, Hospital Cash Benefit, Waiver Of Mandatory Co-payment -

Exclusions

  • Congenital external diseases, defects or anomalies
  • Venereal disease
  • Treatment taken outside India
  • War, invasion, act of foreign enemy
  • Intentional self injury
  • Suicide or Attempted suicide
  • Psychiatric or psychological disorders
  • Preventive care
  • Cosmetic and aesthetic treatment/surgeries, etc.