Aditya Birla Group Activ Health Plan

Today, a majority of people suffer from pre-existing medical conditions, which are usually not covered under most of the regular health insurance plans. To ensure you are adequately covered against all kinds of health conditions, Aditya Birla Health Insurance offers Group Activ Health Plan that covers chronic illnesses like asthma, blood pressure, cholesterol, and diabetes also known as ABCD conditions.

With the help of this policy, you can stay covered against expenses arising out of medical emergencies and hospital treatments for all the insured members.

Key Features And Benefits

Here are the key features covered under this group health cover:

• 

  Cashless claim settlement

  The policyholder can avail of cashless claim settlement at any of the network hospitals across India.

• 

  ABCD disease coverage

  Aditya Birla Group Activ Health Plan covers chronic illnesses like asthma, blood pressure, cholesterol and diabetes also called ABCD conditions.

• 

  Pre-hospitalisation expenses

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

• 

  Post-hospitalisation expenses

  This policy covers medical costs for illness or injury for 60 days after hospitalisation.

• 

  527-day care procedures are covered

  This comprehensive plan covers a total of 527 day-care listed procedures as mentioned in the  group policy wordings.

• 

  Free health check-up

  The policyholder can avail of free annual health check-up under this policy.

• 

  Freedom to select the hospital room

  Option to select a shared/single private room during a hospital stay.

• 

  Organ donor expenses

  The policy covers organ donor expenses to the extent of the maximum sum insured under this policy.

• 

  Emergency road ambulance cover

  The plan covers emergency ambulance expenses up to Rs. 2,500 during the policy period.

• 

  Tax benefits

  Policyholders can avail of tax exemption under this policy as per section 80D of Income tax act, 1961.

Here are the details of the policy:

Health insurance helps you to stay stress-free during medical emergencies arising due to sickness and accidental injury. Premiums for this policy starts from Rs. 5,021 and offers a maximum coverage of Rs. 10 lakh.

Here are the steps to purchase the policy:

• To apply for the Aditya Birla Group Activ Health Plan, click on the 'Get Quote' button and fill in your basic and health details. For further assistance, you may contact the insurance provider.
• Ensure that the information given in the form is accurate and complete.
• You may be required to undergo a pre-policy medical examination at any of Aditya Birla Group’s network diagnostic centres.
• Policy schedule, policy wordings, cashless cards and health guide will be sent to your mailing address.

Here are the mandatory documents required to purchase the policy:

• Photograph of the applicant
• Age proof such as birth certificate, voter’s ID, PAN card, passport etc.
• Identity proof such as passport, Aadhaar card, PAN card, voter’s ID etc.
• Income proof such as Form 16, salary slips, employment certificate etc.
• Address proof such as telephone bill, electricity bill, passport, bank statement, voter’s ID, etc.
• Medical tests that the insurer requires you to undergo

Here are the steps to process your claim with the insurer:

Cashless claims

With the Aditya Birla Group Activ Health Insurance Plan, you can avail of the benefit of cashless treatment at more than 6,000 network hospitals across the country. Here’s the procedure to file a claim:

• First, search for an Aditya Birla network hospital in the city where you want to get cashless treatment.
• Intimate the insurer within 48 hours in case of 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-authorisation request form correctly, which will be 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 claims

Here are the documents needed to process reimbursement claims:

• 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-authorisation has been issued by the insurer.
• For collection and submission of claim documents, you can send the required documents listed below within 15 days of discharge from the hospital.

1. Original investigation reports to be produced for reimbursement claim.
2. A final hospital discharge summary FIR or post-mortem report in case of death to be given.
3. Pharmacy bills along with the prescription.
4. Cancelled cheque or NEFT details for payment.
5. Original bills, receipts, and discharge report
6. Indoor case papers and duly filled claim form
7. Original hospital bills, patient’s valid photo ID proof, and doctor's report.
8. Original consultation notes, nature of operation performed, and surgeon's bill and receipt.
9. Test reports along with attending doctor’s or surgeon’s report.

• After reviewing the above 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 you on your registered contact phone number and email id.

Here are some of the exclusions under the policy:

1. Ayurveda/homeopathy hospitalisation benefit
2. Daily cash and sum insured re-instatement
3. Dental treatments and cosmetic surgeries
4. Fertility, sub-fertility, infertility, sterility, erectile dysfunction, impotence, assisted conception operation or sterilisation procedure
5. Human Immunodeficiency Virus (HIV) or variant/mutant viruses and or any syndrome or condition of a similar kind, commonly referred to as AIDS

Waiting periods

Here are the waiting periods under the policy:

BFL Helpline Number: 08698010101

Aditya Birla Health Insurance Co. Limited: 1-800-270-7000 / 1-800-22-7000

E-mail –  wecare@bajajfinserv.in

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