Active Aditya Birla Health Insurance Plans
Everybody’s health insurance needs are different. So there can’t be one best health insurance plan that can suit everybody’s requirements. One of the health insurance plans that can be considered is Activ Health insurance plan from Aditya Birla Health Insurance. The plan is offered in two variants: Essential and Enhanced. The plan comes with interesting features, some of which are discussed below.
1) Annual health check-up:
Every insured individual above 18 years of age can avail a comprehensive health check-up under the Health Check-up Program of the insurance policy. The health check-up can be availed once every year during the policy year and the charges for it are paid by the insurance company. So the company offers a FREE health check-up to every individual once in a policy year.
2) Chronic Management Program:
Under this program, an individual is covered for medical expenses related to the outpatient treatment of chronic conditions like Diabetes, Asthma, High Cholesterol and Hypertension right from Day 1. If the individual is suffering from any of the above chronic conditions and if the individual is covered under the Chronic Management Program, then, the policy pays for medical consultation, diagnostic tests, and pharmacy expenses etc. The insured doesn’t need to be hospitalized for availing the benefits of the Chronic Management Program.
The insured can avail the benefits of the Chronic Management Program, subject to certain terms and conditions which can be checked in the policy brochure and policy wording available on the insurance company’s website.
The plan rewards insured people to be active and maintain good health through HealthReturns.
HealthReturns can be earned by compliance with the Chronic Management Program (if applicable), Healthy HeartScore and ActiveDayz.
An individual can get up to 30% of his / her premium in the form of HealthReturns.
HealthReturns (earned through Chronic Management Program, HeartScore, and ActiveDayz) can be used for payment of the next policy premium, buying medicines, paying for diagnostic tests, paying for non-payable claims or paying for any health emergency irrespective of whether it is covered by the policy.
4) Reload of sum insured:
Once in every policy year, the sum assured can be 100% reloaded, if the available sum assured is insufficient to pay the current claim as a result of the previous claims in that policy year.
Example: Raghav has bought the Activ Health Enhanced plan (family floater) for his family of four individuals (self, spouse, and two children) for a sum assured of Rs. 5 lakh.
During the first four months of the policy year, Raghav and his son fell ill and had to be hospitalized.
The entire sum assured of Rs. 5 lakh got used during the 2 hospitalization events.
In this case, as per the reload feature, the sum assured will be restored from Rs. 0 to Rs. 5 lakh again for the remainder part (remaining eight months) of the policy year.
The reload of sum insured is subject to certain terms and conditions which can be checked on the policy brochure or policy wording available on the insurance company website.
5) Outpatient Department (OPD) Expenses:
This is an optional benefit that can be availed by paying additional premium at the time of buying the policy. Under this benefit, the insurance company covers OPD expenses (doctor consultation, diagnostic tests, pharmacy expenses etc.) up to a specified limit. If in a policy year, the complete OPD limit is not utilised, the unutilised amount is carried forward to the next year.
6) Maternity expenses:
This is an optional cover that can be availed by paying additional premium at the time of buying the policy. The waiting period is 48 months. Coverage includes expenses related to the delivery of a child, pre, and postnatal maternity expenses. The coverage also includes newborn baby expenses, vaccinations, and stem cell preservation.
7) Benefit of hospital room choice:
At the time of buying the policy, the insured has to choose what type of hospital room he would like to get admitted in the event of hospitalisation. Later, at the time of actual hospitalisation, if the insured is admitted in a hospital room of lower category (for example shared room) than what he had opted for (example single private room) at the time of buying the policy, then he / she is eligible for a benefit. The benefit will be a certain percentage of the payable claims amount and the benefit will be transferred into the HealthReturns account of the insured.
8) Wellness Coach:
Every insured person shall have access to wellness coaching in areas such as weight management, activity and fitness, nutrition, tobacco cessation etc. The aim of wellness coaching is to educate, empower and engage insured persons to become more aware of their health and proactively manage it. The wellness coaches will be available as a chat service on the insurance company’s mobile application and website or as a callback service.
9) Daycare procedures:
The insurance plan covers treatment for 527 daycare procedures. This is higher than the number of day care procedures covered in most health insurance plans of most insurance companies. A day care treatment means medical treatment and / or surgical procedure which requires less than 24 hours of hospitalisation e.g. cataract, piles, cancer c etc.
In the below table we have presented a comparison between the two variants for your reference.
At the time of choosing any health insurance plan, there are some important factors that you should consider. Some of these factors include:
1) Individual or family floater plan: Decide whether you want to go for an individual plan or family floater plan. Family floater should be the preferred option as the same health insurance cover can be utilised by all family members.
2) Does your employer cover you under a group health insurance plan: Consider buying health insurance even if you are already covered under a corporate group health insurance plan
3) Coverage amount: Decide the health insurance cover amount (sum assured) based on factors like age of the family members, demographic profile, lifestyle, past illness/hospitalisation, family medical history, city you live in, number of dependents and their age, premium you can pay etc.
4) Premium amount: Premium depends on factors like age, features of the plan, sum assured chosen by you etc.
5) Incurred claim ratio (ICR): ICR is the ratio between the claims paid by the company against the premium received. In simple words, ICR is the amount of claims paid by the company for every Rs. 100 received by the company as premium. Insurance companies having ICR between 60-80% are considered good for buying a health insurance plan. For example, if the company has an ICR of 70, it means it is paying Rs. 70 as claims for every Rs. 100 collected as premiums and hence the company is making profits.
6) Pre-existing diseases: Health insurance companies have a waiting period of 2-4 years in a health policy for acceptance of some pre-existing diseases, while some pre-existing diseases are permanently excluded. Before investing in a health plan, check the waiting period of pre-existing diseases and the one with the shortest waiting period may be considered for investment.
7) Waiting period: Most health insurance plans have a waiting period of 30 days, only after which any medical claims are admissible for payment. The exception to this clause is hospitalisation due to an accident, which can be covered right from day 1.
8) Sub-limits / Co-pay: It is better to choose a health insurance plan that does not have any sub-limits or co-pay clause or has the minimum sub-limit or co-pay percentage/amount
9) Network hospitals: Before finalising a health plan check the hospital network of the insurance company. The bigger the hospital network, the better. Check whether the hospitals in your residential area are covered under the insurance company’s network. Also check whether the well-known hospitals in your city are covered under the insurance company’s network.
10) Reward/Bonus: Consider a health insurance plan that offers you increase in sum assured or discount in renewal premium or a combination of both, for every claim free year.
11) Maternity benefits: If you are at that stage of lifecycle where you will be planning a child few years down the line, then you need to select a health plan which offers maternity benefits. Choose a plan that offers maximum maternity benefits and the lowest waiting period. However this may come at a higher cost.
12) Free medical check-up: Choose a health plan which offers free medical check-up/s to you and family members covered in the plan. Most health plans offer medical check-ups once in every 2-4 years or after every 2-4 claim free years. Some plans also offer annual health check-ups.
Benefits of Health Insurance
Critical Illness Cover:
A critical illness covers health condition like heart attack, cancer, paralysis, stroke, kidney failure & more, this add-on cover comes in handy while providing you a lump sum amount to tackle all the expenses associated with the treatment.
Personal Accident Cover:
It provides financial assistance to your family in the event of a death or disability due to an accident and helps compensate for the loss of income during the treatment while easing the financial pressure on you & your family.
Hospital Cash Insurance Cover:
It will help you handle the daily cash required during emergency admission to ICU, accident, medical treatment, and surgery.
To apply medical claim in Aditya Birla Health Insurance.
You can download the claim form from their website.
Fill it properly mentioning the dates, disease, bills, reports etc and submit by hand to their branch and take a receiving of it.
So, the online claim is no term.
You can intimate about your admission to the hospital but to claim for reimbursement for what you have paid. you have to take the physical mode.
You can take help of your advisor if you have one.
Note; Buying a policy a through an advisor saves you from a lot of trouble, provided the advisor is genuine and has good knowledge and experience.
cost of Policy is same though, but the experience is not an online way is always open in any scenario.