Aditya Birla Activ Health Essential
Product Overview
Aditya Birla -Activ Health Essential plan offers comprehensive cover for medical treatment of illness and accidents requiring in-patient hospitalisation.This plan offers add-on optional coverage for OPD & Maternity expenses.
Unique Features of Aditya Birla - Activ Health Essential
- Reduction up to 30% in Renewal premium through Health Returns
- Hospital Room choice-first of its kind in industry
- Enrollment into Chronic Management programme subsequent to diagnosis of any 4 chronic conditions
- Non Reduction of accumulated cumulative bonus even in the event of claim (10 to 100%)
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OneInsure App Benefits
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Critical features of Aditya Birla - Activ Health Essential
- Room rent:
Limits imposed towards room and ICU rent expenses
Covered up to :
- Single Private Room OR
- Shared Room OR
- General/Economy ward
- Co-Pay:
Specific % of admissible claim amount to be borne by Insured
- Mandatory Co-payment-20% applicable on each and every applicable claim
- Co-payment for treatment in higher zone-25%
- Co-payment for treatment in higher room category is up to 50%
| Co-payment treatment in Higher room category | |||
| Plan | Eligible Room Category | Room Category at which treatment taken | Co-payment applicable |
| Essential | General/Economy Ward | Shared Room | 15% |
| General/Economy Ward | Single Private Room | 25% | |
| General/Economy Ward | Any Room | 50% | |
| Shared Room | Single Private Room | 15% | |
| Shared Room | Any Room | 40% | |
| Single Private Room | Any Room | 25% | |
| Co-payment for treatment in Higher zone | ||
| Applicable Zone | Treatment Taken at | Co-payment Applicable |
| Zone II | Zone I | 10% |
| Zone III | Zone II | 15% |
| Zone III | Zone I | 25% |
| Sub-limits | |||
| Disease Category | Zone I | Zone II | Zone III |
| Cataract (including cost of lens) per eye | Rs.40,000 | Rs.3,00,000 | Rs.20,000 |
| Angioplasty (including cost of stent) | Rs.3,00,000 | Rs. 2,50,000 | Rs.2,00,000 |
| Knee replacement (including revision Surgery) | Rs.3,00,000 | Rs.2,50,000 | Rs.2,00,000 |
| Hip replacement (including revision Surgery) | Rs.3,00,000 | Rs.2,50,000 | Rs.2,00,000 |
| Cholecystectomy (open or lap) | Rs.60,000 | Rs.45,000 | Rs.35,000 |
| Lap / open / vaginal hysterectomy (with / without Salpigo-oophorectomy) | Rs.60,000 | Rs.45,000 | Rs.35,000 |
- No Claim Bonus:
10 % of Basic Sum Insured per year upto a maximum of 100% for each unclaimed year in case opted for (The cumulative bonus will not be reduced in event of any claim)
- Pre-Existing Diseases:
Means any condition, ailment or injury or related condition(s) for which you had signs or symptoms, and / or were diagnosed, and / or received medical advice/ treatment, within 48 months prior to the first policy issued by the insurer
This plans has a waiting period of 4 years is case of pre-existing diseases
Eligibility Criteria
- Minimum Age of Entry:- Children-91 days to 5 years/Adult-18 years
- Maximum age of Entry:- Children-25 years/Adult-No Limit
- Renewal Age:- Life Long Renewal
- Sum Insured:- Rs 50,000 - Rs 10 lakhs
- Policy Tenure:- 1,2 or 3 years
- Family Defination:-
Individual Plan - Self, Spouse, Mother, Father, Mother-in-law, Father-in-law, Son, Daughter, Brother, Sister, Niece, Nephew, Brother in law,Sister in law, Grand Son, Grand Daughter, Grandmother, Grandfather, Daughter in law, Son in-law (20 Relationship Covered)
Family Floater - Self, Spouse, Parents, Parents-in-law (Max up to 9 persons) - Premium Calculated on Basis of:- Age, Zone (i.e. sum Insured Choosen)
Add-ons
- OPD
- Maternity Expenses
- Hospital Cash
- Deductible
- Waiver of co-payment
Additional discounts
- Family Discount of 5% if 2 members or more family members and 10% if 3 or more family members.
- Long term Discount of 7.5% and 10% on selecting 2 and 3 policy terms respectivly.
Exclusions
Any claims arising out of or attributable to any of the following is not covered,Please refer policy T & C for detailed list of exclusions.
- War, invasion, acts of foreign enemies, hostilities
- Plastic surgery unless necessary for the treatment of cancer, burns or accidental Bodily Injury/Dental treatment or surgery
- Sterility/Infertility & Congenital disorder
- Convalescence, general debility, rest cure, congenital external diseases or defects or anomalies, genetic disorders, stem cell implantation or surgery, or growth hormone therapy
- Intentional self-injury,treatment due to use or abuse of any substance, drug or alcohol and treatment for de-addiction
- Medical Expenses relating to any hospitalisation primarily and specifically for diagnostic, X-ray or laboratory examinations and investigations
- Treatment for any mental illness
Tax Benefits
- You can claim tax deduction benefit u/s 80D as per IT Act 1961 for premium paid towards this policy.
- Self, Spouse, Children- Up to Rs 20,000/-
- Parents-Up to Rs 25,000/-
- Parents (Senior Citizens)-Up to Rs 30,000/-
