Aditya Birla Health Activ Care Plan

Delving Into The Details Of The Aditya Birla Health Activ Care Plan

Aditya Birla Activ Care is a health insurance offering from Aditya Birla Health Insurance Company Limited that is crafted specifically for elderly individuals or couples. Tailored to address the distinctive health concerns accompanying ageing, the plan unfolds in three versions: Standard, Classic, and Premier. Each variant is a robust plan equipped with a multitude of features, ensuring a comprehensive solution for your ageing parents' healthcare needs. You can also enjoy cost savings through attractive discounts that come with the plan.

Who Is Eligible To Buy The Aditya Birla Health Activ Care Plan?

• Minimum Age Of Entry: 55 years
• Maximum Age Of Entry: 80 years
   

Coverage And Restrictions Of The Aditya Birla Health Activ Care Plan

The Aditya Birla Health Activ Care Plan takes care of all inpatient costs when you stay in the hospital for over 24 hours. This includes room and nursing charges, fees for the medical practitioner, expenses for prescribed medicines, drugs, ICU charges, and other related costs. Now, let's look at some of the other expenses covered in the Aditya Birla Activ Care Plan -

• Pre- & Post-Hospitalisation Expenses
  Do not stress if the doctor needs to conduct various tests before or after your hospital stay, as the Aditya Birla Health Activ Care Plan has got you covered. The policy will cover these expenses, up to the sum insured, for a reasonable period of 30 days before you get admitted and 60 days after discharge. Just keep in mind that these costs will be covered by the insurer only if they are connected to the medical condition that led to your hospitalisation, and the approval of your claim is part of the inpatient hospitalisation coverage.
   
• Daycare Treatment Coverage
  Daycare treatment refers to a medical procedure or surgery that used to need a long hospital stay. But now, thanks to medical advances, it can be done in just 24 hours. The Aditya Birla Activ Care Plan covers 586 daycare procedures, and there's no cap on the expenses – they will be covered up to the sum insured.
   
• Domiciliary Treatment Coverage
  Domiciliary treatments are medical treatments for illnesses or injuries that need urgent attention in a hospital but are given at home. This could be because the patient is too sick or injured to travel safely, or there are no hospital beds nearby. The Aditya Birla Activ Care Plan covers the costs of domiciliary treatment (except for certain listed illnesses or health conditions) up to the sum insured.
   
• Organ Donor Coverage
  The Aditya Birla Activ Care Plan also includes coverage for organ donor expenses. This covers the costs of harvesting the organ from the donor for organ transplantation if you are the recipient. These expenses will be covered up to either 50% of the sum insured, or up to the entire sum insured, depending on whether you choose the Classic or Premier plan. However, this coverage is not available if you choose the Aditya Birla Activ Care - Standard Plan.
   
• Modern Treatment Coverage
  Advancements in healthcare are happening fast due to new technologies, bringing about treatments that were once thought impossible. The Aditya Birla Activ Care Plan is crafted to keep up with these changes. It covers the costs of these modern treatments, up to the sum insured.
   
• Non-Medical Expenses
  Apart from medical costs, the Aditya Birla Activ Care Plan also takes care of non-medical expenses when you choose an add-on. These non-medical expenses include things like gloves, nebulization kits, oxygen masks, and other items you might need for treatment. They can be pricey and quickly pile up. With this plan, these expenses are covered up to the sum insured, easing the financial strain they might cause.
   
• No Claim Bonus
  With the Aditya Birla Activ Care Plan, you get a bonus – 10% of the sum insured for each year you do not make a claim. It is a reward for staying healthy and not making a claim in a policy year. You can stack up this bonus, for a maximum of up to 50% of the sum insured. But, if you do make a claim, the bonus reduces by the same rate it grew.
   
• Reload Of Sum Insured (Restoration Benefit)
  With the restoration benefit, if you use up your sum insured in a policy year, it is replenished – either up to 50% or 100% of the sum insured, depending on your chosen variant. This benefit kicks in when you have exhausted your base sum insured and No Claim Bonus (if you have any) partially or entirely. You can use it for any subsequent claims within the policy year, but just once per year as long as you keep renewing your policy. The restored sum insured is applicable specifically for unrelated illnesses and complications.
   

• Room Rent Limit
  The highest amount your insurer will pay for the room during your hospital stay is called the room rent limit. If you pick a room within this limit, you will not have to pay any extra amount. But if you choose a room with a higher rent, you will face a proportionate deduction. This means that you will pay a share of the total cost, not just the extra room charge. With Aditya Birla Activ Care, there is a cap on the room type you can choose based on your plan.

You can also pay more to upgrade your room limit to 'any room except suite & above'.
 

Additional Highlights That You Should Know About The Aditya Birla Health Activ Care Plan

• No Financial Limits On Treatments/Diseases
  Many plans for seniors usually limit coverage for certain diseases or minor high-frequency surgeries to manage claims, considering the higher vulnerability of elderly individuals to illnesses due to age. However, this plan doesn't have any restrictions on common treatments like cataract, joint replacement surgeries, etc. This means you can claim the entire amount up to the sum insured for such treatments.

• Lifestyle Support Equipment
  Lifestyle support equipment, such as wheelchairs, crutches, canes, walkers, etc., are important for helping people recover and improve their quality of life when they have physical challenges. If you choose this extra coverage, it will pay for these devices as advised by your doctor from the day after you get admitted to the hospital until you get discharged, up to a certain amount. However, there are some terms and conditions that you should be aware of.
   
• Health Check-Up
  You have the option to get a health checkup, including specific tests listed in the policy document. The insurer will cover the costs, and these checkups will be organised at their network hospitals, allowing you to access them without paying upfront. This benefit is available once per policy year.

Additionally, choosing the 'Advance Health Check-up' add-on enables you to undergo an extended set of tests, as mentioned in the snapshot.

Navigating Waiting Periods

When you get a health insurance policy, certain illnesses and diseases may not be covered for a specific time, called the waiting period. After this time, you can claim for these conditions. There are various types of waiting periods, including –

• Initial Waiting Period
  When you start your health insurance, there is a 30-day waiting period for all medical conditions except accidents. This means you cannot claim hospitalisation expenses for the first 30 days unless and until it is because of an accident.
   
• Waiting Period For Pre-existing Diseases
  Any health condition you had in the 36 months before getting the health insurance policy is called a pre-existing disease. With the Activ Care Plan, there is a 24-month waiting period for pre-existing diseases. This means the policy will not cover expenses related to these conditions during this time.
   
• Waiting Period For Specific Diseases
  Insurers set a list of medical conditions or illnesses, separate from your pre-existing conditions, that come with a waiting period. This period is decided only by the insurance company and is not related to your current health. With the Activ Care Plan, there is a waiting period of 24 months for specific diseases and 48 months for genetic disorders.
   

What Is Not Covered (Exclusions)?

These are situations not covered by your health insurance policy. They include –

• Standard Permanent Exclusions: The IRDAI has set certain exclusions that all insurance companies must adhere to. Some of these include –
  • Investigation And Evaluation: Hospital admission for observation or monitoring only.
  • Rest Cure, Rehabilitation, And Respite Care: Admission for bed rest without active treatment.
  • Weight / Obesity Control: Treatment or surgery for weight control.
  • Change Of Gender Treatment: Surgery or treatment to alter the body's characteristics to the opposite sex.
  • Plastic/Cosmetic Surgery: Treatment or surgery to modify body characteristics or appearance.
  • Profession In Adventure Or Hazardous Sports: Treatment expenses incurred while participating professionally in adventure activities like mountaineering, scuba diving, river rafting, horse racing, etc.
  • Breach Of Law: Expenses for the treatment of a person committing or attempting a breach of law with criminal intent.
  • Providers Who Are Excluded: Treatment from a hospital or medical practitioner excluded by the insurance company.
  • Narcotics: Treatment for addictive conditions like alcohol, drug addiction, etc.
  • Treatments In Establishments For Domestic Purposes: Expenses for treatment in health spas, nursing homes, or similar establishments arranged for domestic reasons.
  • Dietary Supplements, Substances Without Prescription: Vitamins, minerals, etc., not prescribed by a medical practitioner.
  • Refractive Error: Costs incurred for correcting refractive errors up to 7.5 diopters for improved eyesight.
  • Unproven Treatments: Surgeries, medical procedures, or treatments not proven to be effective.
  • Expenses Related To Sterility, Birth Control, Infertility: Contraception, sterilisation, artificial insemination, advanced reproductive technologies (IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.).
  • Maternity Expenses: Pre/post-natal costs, childbirth-related hospitalisation expenses, etc.
     
• Additional Permanent Exclusions: Other than the standard permanent exclusions mentioned earlier, insurance companies might add more exclusions for specific medical conditions or situations. If you have certain medical conditions or severe diseases that insurers see as too risky to cover, they may exclude them permanently from your policy. It is vital to note that insurers can only apply permanent exclusions to a list of illnesses specified by the IRDAI.
   
• Non-Standard Exclusions (Specific Exclusions): These are specific exclusions enforced by the insurers other than the standard permanent exclusions set by the IRDAI. They can differ among insurance companies and depend on the policy's terms and conditions. Here are some of the top specific exclusions under the Aditya Birla Health Activ Care Plan –
  • Willful or vigilant exposure to danger, intentional self-injury, or involvement in military operations.
  • External congenital anomalies, diseases, or defects.
  • Circumcisions, except when necessary due to illness or injury, as part of treatment.
  • Non-allopathic treatment, unless specifically covered by the policy.
  • Investigational or experimental treatments, drugs, devices, or regimens still under trial.
  • General debility or exhaustion (feeling rundown).
  • Parkinson's disease.
  • Hearing aids, glasses, contact lenses, or optometric therapy.
  • Treatment for alopecia (hair loss), baldness, wigs, or toupees, and related treatments.
  • Medical supplies like elastic stockings, diabetic test strips, and similar products.
     

Summary

Aditya Birla Health Activ Care Plan – Document Access: Brochure and Policy Wording

• Brochure: https://www.adityabirlacapital.com/healthinsurance/assets/PDF/20201021T132337.pdf
• Policy Wording: https://www.adityabirlacapital.com/healthinsurance/assets/PDF/20190502T124754.pdf
   

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