Aditya Birla Activ Assure Diamond Plan

In recent times there has been a hike in managing all our medical treatments and one needs to be financially independent to handle these sudden expenses. These expenses can’t be ignored as it is the matter of health & life of our loved ones. This is where Aditya Birla’s Activ Assure Diamond Plan comes to aid. This plan can be considered an all-inclusive benefit-rich plan as it covers most of the health benefits one may look out for.

This plan gives wide coverage of health features to choose from making it one of the most optimal plans to be invested in. This plan offers a high sum assured with the ease of buying.

 

Key Features & Benefits

• 

  Modern Treatment Methods Covered

  The plan includes new-age Treatments such as Robotic Surgeries, Oral Chemotherapy, Balloon Sinuplasty procedures

• 

  Mental Illness Expenses Covered:

  This policy covers In-patient hospitalization due to mental illness.

• 

  Domiciliary Hospitalisation Covered:

  Expenses incurred for treatment of an Illness/injury which in the normal course would require care and treatment at a hospital but actually taken at home, as the patient is not in condition to be moved to a hospital OR non availability of room in a hospital

• 

  In-patient Hospitalisation Expenses:

  Aditya Birla Activ Assure Diamond plan covers the in-patient hospitalization charges which includes the consultation fee, nursing fee, room rent and OT charges.

• 

  Pre-Hospitalisation Expenses

  This policy covers medical costs incurred due to an illness or injury 30 days immediately before hospitalisation.

• 

  Post-Hospitalisation Expenses:

  The plan pays for the medical costs incurred due to an illness or injury 60 days immediately after hospitalisation.

• 

  Super No Claim Bonus:

  If you opt for the Activ Assure Diamond plan and do not claim for a fiscal year, you can avail no claims bonus (NCB) in the subsequent year. The NCB is 10% of the sum assured for the policy and can be accumulated up to 50%. In SuperNCB which is an optional benefit the NCB is 50% of Sum Insured , max upto 100% of Sum Insured.

• 

  586-day care procedures are covered

  This comprehensive plan covers a total of 586 day-care listed procedures.
  Diamond Policy Wording

• 

  Second E-opinion for Critical Illness:

  Diagnosis of a critical illness can be devastating news for a family. In such cases, the insurer offers a second e-opinion for the top critical illness mentioned in the policy brochure. A pool of well-qualified health practitioners looks at the case.

• 

  Free Health Check-up:

  For both individual and family floater plan, the insured can avail the benefit of annual free health check-up which are based on the age and the sum insured opted for.

• 

  Organ Donor Expenses:

  Medical Expenses incurred for an organ donor’s treatment for the harvesting of the organ donated will be covered under the policy.

• 

  Emergency Road Ambulance Cover:

  The plan covers emergency ambulance expenses during the policy period.

• 

  Vaccination Cover:

  Vaccination expenses for the new-born baby till the age of 2 years will be covered in this policy. Please refer the policy wording for the detailed list of vaccine covered.

• 

  Accidental Hospitalisation Booster:

  In case of an accident, this optional coverage will provide an additional sum-insured equal to the sum insured for in-patient hospitalization.

• 

  Cancer Hospitalisation Booster:

  For the insured above 18 years, the company will provide an additional sum-insured equal to the sum-insured for in-patient hospitalization.

• 

  Room Upgrade Facility:

  This optional cover is available to the policyholders with 5 Lakhs Sum Insured. They have the freedom to get admitted to the hospital without any restriction on room type

• 

  AYUSH Treatment:

  Policyholders who believe in AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy) treatment can also benefit from buying the plan as it covers the in-patient treatment charges for the same.

Aditya Birla Activ Assure Diamond Health Plan
Insurer Name	Aditya Birla Health Insurance Co. Limited
Policy Type	Individual (Self Only)/Family Floater
Entry Age	Individual plan: Minimum entry age – 5 years Maximum entry age – No max-age Family Floater Dependent Children – 91 days to 5 years Maximum age– No Maximum age
Renewal	Lifetime Renewable
Tenure	One, two and three years
Sum Insured	Rs. 2 lakh – Rs. 2 crore
Number of members covered	6 members (2Adults+4Children)

Health Insurance helps you to be stress-free while dealing with medical contingencies due to sickness and accidental injuries. The plans are available starting from Rs. 2774(including taxes), with maximum coverage of Rs. 2 crore, to know more about the plan in detail please click here.

• Minimum Entry Age:

• Min Entry Age Child: 91 days Adult: 18 years
• Max Entry Age Child: 23 years (family floater policy) Adult: No limit Relationships:
• Individual Policy Covers: self, spouse, children, parents, siblings, parent in-laws, grandparents, grandchildren, son-in-law, daughter-in-law, uncle, aunt, nephew and niece
• Family Floater Covers: self, spouse, children up to the age of 23 years or parents (a maximum of 2 adults and 3 children can be covered under a single policy).

• Maximum Entry Age: No maximum age limit

• To apply for the Aditya Birla Activ Assure Diamond Insurance plan, click on the “Buy Now” button and fill in your basic and health details.
• Ensure that the information given in the form is complete and accurate.
• You may be required to undergo a pre-policy medical examination at our network diagnostic centres.
• Policy schedule, policy wordings, cashless cards and health guide will be sent to your mailing address.

Life is uncertain and so are medical emergencies and accidents. We are here to guide you in these tough times and complete your claim processing in a few simple steps

Cashless Claims

With the Aditya Birla Activ Assure Diamond Plan, you can avail the benefit of cashless treatment at more than 6,000+ network hospitals anywhere in the country. The procedure to file a claim is as follows:

 

• First, search for an Aditya Birla network hospital in the city where you want to get cashless treatment.
• Intimate the insurer within 48 hours (emergency hospitalisation) and 3 days before admission in case of planned hospitalisation.
• While visiting the hospital, carry the patient’s insurance cashless card or the policy details.
• Show the health insurance cashless card and valid ID proof at the insurance desk of the hospital.
• Fill in the pre-authorization request form correctly available at the hospital and submit it to the hospital.
• For quicker action, fill the request form on the official website and intimate the insurer. Wait for the decision as your request will be reviewed.
• The insurer may take up to 2 hours after receiving the request and will inform about the decision via an e-mail and an SMS.
• You can also check the status online. The claim will be processed as per the terms and conditions of the policy after all the formalities are completed.

Reimbursement claim:

• In case of an emergency admission, you need to notify the insurer within 48 hours and pay the charges to the hospital directly unless a pre-authorization has been issued by us.
• Collection and submission of claim documents- send the list of the documents mentioned below within 15 days of discharge from the hospital.
• After reviewing the documents, the insurer will approve or reject the same as per the terms and policy.
• If the request is approved, the insurer will send the reimbursement amount via NEFT to your registered bank account.
• If the request is rejected, the same will be communicated to your registered contact phone number and email id.

Documents Required for Reimbursement Claims:

Collect below mentioned relevant document in original from the hospital and submit them to us within 15 days of discharge from the hospital

 

• Original investigation reports
• Final hospital discharge summary FIR or post-mortem report if happened
• Pharmacy bills along with the prescription
• Cancelled cheque or NEFT details for payment.
• Original bills, receipts, and discharge report.
• Indoor case papers and duly filled claim form.
• Original hospital bills and a valid photo ID proof Treating doctor's report
• Original consultation notes Nature of operation performed and surgeon's bill and receipt
• Test reports along with attending doctor’s or surgeon’s report

1. Treatment directly or indirectly arising from or consequent upon war or any act of war, invasion, act of foreign enemy, war like operations.
2. Breach of law with criminal intent, intentional self Injury or attempted suicide while sane or insane.
3. Abuse or the consequences of the abuse of intoxicants or hallucinogenic substances such as intoxicating drugs and alcohol
4. Circumstance unless required for the treatment of Illness or accidental bodily injury.
5. Cosmetic, aesthetic and re-shaping treatments & surgeries.
6. Psychiatric or psychological disorders, mental disorders.
7. Hearing aids, spectacles or contact lenses including optometric therapy.
8. Abuse or the consequences of the abuse of intoxicants or hallucinogenic substances.
9. Waiting Period:
   • 15 Days Initial Waiting Period: In case the insured members are diagnosed with COVID-19.
   • Listed Illness/Procedure Waiting Period: 24 Months
   • Initial Waiting Period: 30 Days (not applicable in case of accident and subsequent renewal)
   • Specified Disease/Procedure Waiting Period: 48 Months
   • Pre-existing Disease Waiting period: 48 months

 
This is an indicative list. Please refer to policy wordings for detailed list of exclusions and waiting periods.

BFL Helpline Number: 08698010101

Aditya Birla Health Insurance: 1800-270-7000

E-mail –  wecare@bajajfinserv.in

Mailing address:Ground Floor, Bajaj Finserv Corporate Office, Off Pune-Ahmednagar Road, Viman Nagar, Pune – 411014.

*For claim related issues please refer your policy document or certificate of insurance (COI).