Aditya Birla Activ Fit Plan

What’s The Plan All About?

Aditya Birla Activ Fit is a health insurance policy provided by Aditya Birla Health Insurance Company Limited. It harmoniously combines a safety net for medical costs with the inspiration to adopt a vibrant and well-balanced life. Activ Fit stands as your ultimate companion in healthcare, embracing a variety of attributes, advantages, cost reductions, and additional safeguards to address your complete healthcare requirements. During uncertain times, it forms a comprehensive safety shield. The plan comes in two versions: Plus and Preferred.

Who is Eligible?

Minimum Entry Age

• Adults: 18 years

Maximum Entry Age

• Adults: 99 years

Let’s Look At The Benefits and Limits!

In addition to providing coverage for the cost of hospitalisation when you’re admitted for more than 24 hours, including charges for the room, nursing care, medical consultant fees, prescribed medications, drugs, intensive care unit fees, and related expenditures, here are some of the other expenses that the Aditya Birla Activ Fit Plan covers -

• Pre & Post Hospitalisation Expenses: If the doctor needs to perform various tests before or after your hospital stay, Aditya Birla Activ Fit Plan has you covered. It will pay for them up to the sum insured for a reasonable period  - 90 days before admission and 180 days after you are discharged. However, you should remember that the insurer will assume these expenses only if they are related to the medical issue you were hospitalised for and approved as part of the inpatient hospitalisation coverage.

• Daycare Treatment Coverage: Daycare treatments are medical procedures or surgeries that required you to get admitted to the hospital for a long time, but now, thanks to medical progress, they can be done in just a day. The Aditya Birla Activ Fit Plan takes care of all these treatments, with no cap. So, your bills will be covered up to your sum insured.

• Domiciliary Treatment Coverage: Domiciliary treatments mean medical care for any urgent illness or injury that requires hospitalisation but is instead given at home due to the patient’s severe condition or because there are no beds at a nearby hospital. The Aditya Birla Activ Fit Plan pays for domiciliary treatment expenses up to the sum insured.

• Organ Donor Coverage: The Aditya Birla Activ Fit Plan also pays for the expenses related to organ donors. It takes care of the costs of harvesting the organ from the donor's body for the transplantation (where the insured is the recipient), up to the sum insured.

• Modern Treatment Coverage: Huge technological strides in the field of healthcare have led to the development of many new treatments and techniques that can treat diseases that were once deemed incurable. The Aditya Birla Activ Fit Plan is designed to keep up with these evolving changes and pays for the costs of modern treatments, up to the sum insured.

• Non-Medical Expenses: The Aditya Birla Activ Fit Plan does more than just pay for medical expenses. It also covers non-medical items like gloves, masks, bandages, syringes, etc. if you choose the ‘Non-Medical Expenses Waiver’ add-on. The plan covers these costs up to the sum insured - so you need not worry about any additional expenses.

• No-Claim Bonus: When you don't make any claims in a year, the insurer rewards you by increasing your cover amount by 10% as a bonus, which is subject to a maximum of 100%. But if you do make a claim later on, the bonus will decrease by the same rate.

• Super NCB: When you choose the NCB Super option, you earn extra rewards for not making claims and keeping your policy active without any breaks. Your cover amount increases by 50%, capped at a maximum limit of 100%. You should know that if you do make a claim in the future, your bonus will go down by the same amount.

• Binge Refill: If the total sum insured, along with any earned No Claims Bonus/Super NCB (if available), runs out or isn't enough, it will be restored unlimited times in a policy year. You can use this benefit for any claims, whether they are related or unrelated to the claim made. You should keep in mind that this coverage is subject to certain rules and conditions.

• Room Rent Limit
  This is the maximum amount your health insurance will pay for your room during your hospital stay.  If you go for a room that fits within this limit, you won't have to pay anything extra. However, if you decide on a pricier room than what's covered, you will be responsible for a proportionate share of the whole bill, not just the extra room cost. For the Aditya Birla Activ Fit Plan, you are free to choose any room you want -shared, single, deluxe, or any type available. Your room choice won't be questioned since the policy doesn't have any restrictions on room rent.

Some Extra Benefits!

• Mental Health Assessment Program
  Aditya Birla Active Fit understands how vital mental well-being is for a satisfying and healthy life. Enter, the Mental Health Assessment Program. This special feature is built into the plan and aims to give you the resources to gauge your current mental well-being. It also offers full assistance to help you lead a happier and more emotionally steady life through mental health coaching. Mental health coaches are there for you, available over the phone or through other suitable ways of communication. This ensures that you can easily and privately access the help you need. However, there are some limits and terms and conditions applicable to this coverage.

• Premium Waiver
  The Premium Waiver feature is a useful advantage that secures your finances when things get tough. If you are diagnosed with a listed critical illness for the first time or face a permanent total disability due to an accident within a year from the accident date (during the policy term), you won't have to pay premiums for one policy year. This means that while dealing with a critical illness or adapting to life after a serious accident, you won't need to stress about health insurance premiums for a whole year.

• OPD Expenses
  This feature covers the costs of outpatient treatments, right from personal to teleconsultations. You have the flexibility to get advice, suggestions, and expert treatment from qualified Medical Practitioners or AYUSH Medical Practitioners. However, there are some restrictions on this benefit.
   

Navigating the Nuances of Waiting Periods

When you get a health insurance plan, there are waiting periods for certain illnesses and diseases. You can't make a claim for them during this period of time.

Types of waiting periods –

1. Initial Waiting Period
   When you purchase your health insurance plan, there's a 30-day waiting period for all medical issues except accidents. This means you can't make a claim for hospitalisation during the first 30 days unless it is due to an accident.
    
2. Waiting Period for Pre-Existing Diseases
   Any medical condition or illness you had in the last 48 months before getting health insurance is called a pre-existing disease. With Aditya Birla Activ Fit Plan, there is a waiting period of 48 months for these conditions. During this period, the policy won't pay for any costs related to your pre-existing diseases.
    
3. Waiting Period for Specific Diseases
   Insurance companies maintain a list of medical conditions or illnesses that will have a waiting period, regardless of whether you had those diseases before or not. This waiting period is set by the insurer and isn't related to your current health. For Aditya Birla Activ Fit Plan, there is a 24-month waiting period for specific diseases and 48 months for genetic disorders.

What Is Not Included?

Your health insurance won't cover certain situations at all odds. These are called exclusions. They include –

• Standard Permanent Exclusions
  The IRDAI has made a list of 'standard permanent exclusions' that must be followed by all insurance companies. Some of these include –

1. Investigation and evaluation: Staying in the hospital just to observe or monitor your condition.
2. Rest cure, rehabilitation, and respite care: Being in a facility for resting without any active treatment.
3. Obesity/weight control: Treating obesity or trying to control weight through surgery or other methods.
4. Change of gender treatment: Medical treatment to change physical traits to the opposite sex's characteristics.
5. Plastic/cosmetic surgery: Surgery or treatments to change the appearance of your body.
6. Profession in hazardous or adventure sports: Treatment costs incurred from engaging in dangerous activities like racing, climbing, diving, etc. as a professional.
7. Breach of law: Costs related to the treatment of an individual who has committed or attempted to commit any sort breach of law with criminal motive.
8. Excluded providers: Getting treatment from practitioners or hospitals not covered by the insurance provider.
9. Narcotics: Treating alcohol, drug, etc. addiction.
10. Treatments in establishments for a domestic purpose: Costs associated with treatments undertaken in health spas, nursing homes, etc. for domestic reasons - completely or partially.
11. Dietary supplements, substances purchased without prescription: Expenses for vitamins, minerals, etc. not prescribed by a doctor.
12. Refractive error: Expenses associated with correcting refractive errors of up to 7.5 diopters for improved eyesight.
13. Unproven treatments: Any surgery, treatment, or medical procedure not proven to be effective.
14. Birth control, sterility, infertility: Costs associated with medical procedures like sterilisation, artificial insemination, IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
15. Maternity expenses: Costs associated with pre/post-natal healthcare, childbirth-related hospitalisation, etc.
     

• Additional Permanent Exclusions
  Apart from the standard permanent exclusions mentioned earlier, insurance companies won't cover specific situations or health problems. If you have certain diseases or serious conditions that insurers think are too risky to cover, they could permanently exclude them from your policy. It is important to know that insurers can only apply a permanent exclusion for illnesses listed by the Insurance Regulatory and Development Authority of India (IRDAI).
   

• Non-Standard Exclusions (Specific Exclusions)
  These exclusions go beyond the standard ones set by the IRDAI. They can vary between insurance companies and may change according to the policy’s regulations.
  
  Here's a list of some of the specific exclusions in the Aditya Birla Activ Fit Plan –

1. Circumcisions (unless needed due to illness or injury and part of treatment).
2. Preventive care, vaccinations, and tests (except for post-bite treatment); physical, psychiatric, or psychological exams.
3. Hospital stays for nutritional and electrolyte supplements unless a doctor certifies them necessary in relation to a covered claim.
4. External Congenital Anomalies or diseases or defects.
5. Stem cell therapy (not including hematopoietic stem cells for bone marrow transplant/surgery), growth hormone therapy, or Hormone Replacement Therapy
6. Effects of war, invasion, rebellion, military action, terrorism, etc.
7. Any sort of nuclear events, chemical and biological weapons, usurped acts, etc.
8. Taking part in terrorist acts.
9. Suicide or self-inflicted injuries.
10.  Partaking in illegal activities.
11.  Injury resulting from alcohol consumption, drugs, or intoxication.
12.  Using drugs not prescribed by a doctor. Drug usage for curing drug addiction is not covered as well.
13.  Hearing aids, glasses, contacts, etc.
14.  Wigs, toupees, and related costs.

Let’s Sum Up!

Here’s the Reading Material You Need

• Brochure:
  https://marketingcontet.azureedge.net/assets/pdf/Activ-Fit-Brochure.PDF
   
• Policy Wording:
  https://marketingcontet.azureedge.net/assets/pdf/Activ_Fit_Policy_Wording.pdf

FAQs

1. What's the highest coverage available with the Aditya Birla Activ Fit Plan?
   You can get a health cover of up to Rs 1 Crore with Aditya Birla Activ Fit.
    
2. Is maternity coverage included in the Aditya Birla Activ Fit Plan?
   Yes, if you select the 'Preferred' plan option, it covers expenses related to maternity.
    
3. Are there any special discounts available with the Aditya Birla Activ Fit Plan?
   Absolutely, if you fall between the ages of 18 and 35, you can receive an 'Early Bird Discount'.
    
4. Are there any limits on room choices with the Aditya Birla Activ Fit Plan?
   No, you have complete freedom to choose any room you prefer with the Aditya Birla Activ Fit Plan.
    
5. Does Aditya Birla Activ Fit Plan include AYUSH treatment in its coverage?
   Absolutely, it covers non-allopathic or alternative treatments.