Aditya Birla Activ Assure Diamond Plan
Activ Assure Diamond health insurance plan provides you countless health benefits along with health returns. What are the reasons to buy Activ Assure Diamond? First, it is linked to Aditya Birla Group that proves plan’s credibility and accountability due to the company’s excellent image in the market. Second, it includes unique benefits such as health coaching, E-opinion, reloading of sum insured etc. Third, it has add-on options to boost the coverage. Fourth, it offers worthwhile bonuses on every claim free year.
The plan brought on by a venture of Aditya Birla Capital called Aditya Birla Health Insurance which gives us myriad of reasons to buy Activ Assure Diamond plan. Under this plan, you can assure health safety of you and your family from medical uncertainties.
Features of Activ Assure Diamond
- The sum insured limit goes from minimum 10 lakh to maximum 2 crores.
- The policy can be taken for one year, two years, or three years.
- The Activ Assure Diamond is for both individual and family.
- No restrictions are imposed on maximum age for both individual and family floater plan.
- For an individual, the minimum age limit is 5 years.
- Under family floater, the coverage can be taken for of 6 members (2 adults and 4 children).
- Any dependent child between 91 days to 5 years can be covered on the condition that one adult must be included in the plan.
Basic Coverage
In-Patient Hospitalization : All expenses incurred at the time of in-patient treatment are covered which include ICU charges, pharmaceuticals, diagnostic process, medical practitioner fee, nursing fee, operation theatre expense etc.
Pre-Hospitalisation : The pre-hospitalization expenses are covered on a reimbursement basis and coverage provided is only for 30 days before hospitalization.
Post-Hospitalisation : The expenses acquired upon oneself after the hospitalization are named as post-hospitalization expenses. This can be covered for 60 days after discharge from the hospital.
Road Ambulance : When insured need transportation to reach the hospital in case of some medical emergencies, then the expenses incurred on hiring road ambulance will be borne by the insurer. However, when you get relief from the hospital, you will not be provided any ambulance for going home.
Domiciliary Hospitalisation : The hospitalization that has taken place at home due to some difficult situations -
- The insured medical condition is not allowing to go outside for treatment.
- There is no availability of room in the hospital.
The insured must accomplish any of these conditions in order to avail this coverage.
Day Care Treatments : The treatments that do not require not more than 24 hours and get completed in a day are called daycare treatments. The company has listed 586 daycare procedures under which various treatments can be availed by the insured. Some common day care procedures are angiography, gastrostomy, ear related treatments, nose operations, cysts, piles, chemotherapy, joint treatment, fractures etc.
Organ Donor Expense : When you get transplanted with an organ, the insurer will cover all the expenses of transplantation and the donor who is donating you the organ.
Vaccination : This plan covers all the vaccination expenses that may be taken by the policyholder to safeguard from Polio, Measles, Tetanus, Hepatitis B, Tuberculosis, Diphtheria, Pneumonia, Hib meningitis etc.
Ayush Inpatient Treatment : Any expenses occurred due to in-patient hospitalization under AYUSH or non-allopathic treatment can be reimbursed on claiming the amount. The treatment should be taken by a government recognized hospital or institution along with maintenance of the criteria as mentioned by the government.
Daily Allowance : The policyholder will get a fixed amount for the daily expenses occurred for a day within 24 hours of hospitalization.
Benefits
No Claim Bonus : It is a reward given to the policyholder when he/she didn’t claim the sum insured for one year or more than one year on every renewal date of the policy. The maximum limit of No Claim Bonus shall not surpass 50% of the sum insured. On every claim, the NCB value is minimized by 10% on the sum insured.
Reload of Sum insured : When the insured claim all the sum insured and other bonuses, then the insurer will offer a refill of the sum insured with several limitations. The reloaded sum insured should be utilized for In-patient hospitalization and Daycare treatments, only. This is only for one time use in the whole life of the policy.
Health Returns : This will give financial assistance when you have consumed the whole amount of sum insured, NCB, Super NCB, and other add-on coverages, if chosen. With health returns, you can pay all the medical expenses, co-payment, non-payable claims, non-medical expenses etc.
Second E-opinion on Critical Illness : During the term of the policy, if the insured is diagnosed with the time symptoms of critical illness then he will be provided the facility of E-opinion from the insurer panel of medical experts. Critical illness can include cancer of specific kind, heart replacement, kidney failure, strokes, bone marrow, paralysis, blindness, end-stage lung failure etc.
Health Coach : Health Coach is just like a coach which provide guidelines on taking precautions when you suffer from any chronic diseases listed in the policy. Some diseases covered are asthma, hypertension, diabetes Mellitus or hyperlipidemia. The insured can take overall two coaching session with the health expert in a policy tenure. The eligibility for this to avail this benefit is 18 years and above.
Health Check-up Programs : Under this program, the policyholder will get the facility of health check-ups at network hospitals of the insurer. However, the number of medical tests depends on the sum insured value and the age of the insured. Anyone who is below 18 or above can avail this benefit with regard to the terms and conditions of the plan.
Domestic Emergency Assistance Services : This emergency assistance when insured is traveling within the frontiers of India but away from his home for 150 km or more. In case of any medical emergencies, the insured will be kept under medical supervision along with the transport facility till the residential address or to the nearest hospital.
International Emergency Assistance Services : This plan also offers you emergency medical evacuation when you are traveling 150 km or more away from your home in some foreign land. In case of no medical facility is possible at that time, the insured will be given transportation to a nearby hospital under of a medical practitioner. The insured can also be transported to his/her place of residence if it becomes necessary as consulted by a medical practitioner.
Add-on Coverage
Super NCB : Under this add-on cover, you can avail a bonus of 50% of the sum insured on every renewal without any claim. This percentage can rise up to a maximum of 100%. Moreover, this is an extended part of NCB and it diminishes by 50% when you claim the sum insured.
Room Upgrade : The insured is free to choose any room where he wants to carry his treatment as there is no restrictions forced by the insurer on room eligibility.
Unlimited Reload of Sum Insured : You can face a shortage of sum insured at some period of policy due to regular claims. This cover gives you the opportunity to recharge your sum insured for an endless number of times. There are some terms and conditions which need to be compiled by the insured.
Cancer Secure Cover : If anybody has chances of getting infected by cancer by future, then this cover will finance the treatment by providing 150% of sum insured on the payment of additional premium. Also, this cover becomes activ when the amount of sum insured has been totally consumed.
Personal Accident Cover : This will cover all the ICU charges, nurse charges, medicines, room rent charges, operation theatre expense, medical tests, surgery etc only when the insured met with an accident which caused injuries to the body. The insurer will provide extra sum insured to the insurer in case of an accident.
Critical Illness Cover : It offers unconditional financial assistance at the time of any critical illness where the insured will receive a lump sum payment of Rs 1 lakh to Rs 1 crore depending upon the gravity of the diseases.
Reduction in PED Waiting Period : This can tremendously reduce your waiting period of 48 months to 24 months for any Pre-existing illness. This option will start from the policy starting day.
Discounts Offered
- 7.5% long term discount will be given if an individual buys a policy
- 10% long term discount on the purchase of three years policy.
- 5% discount on including more 2 or more members in the policy
- 10% discount on including more than 4 members in the policy.
Permanent Exclusion
- Any mental, psychological or psychiatric disorders
- Hearing problems, eyesight weakness or optometric therapy, spectacles, multifocal lens etc
- Cosmetic surgeries, plastic surgery, or any re-shaping treatments
- Suicides, intentional self-injury, injuries due to involvement in military or naval forces
- Intake of drugs, hallucinogenic stuff, alcohol, cigarettes etc.
- Weight management treatments or obesity
- Sexually transmitted diseases AIDS and HIV
- Injuries are due to act of war, foreign attack, insurrection, military, nuclear weapon, radioactivity.
- Dentures, implants, and artificial teeth, dental treatment etc.
- Treatment of sterility, infertility, subfertility or any other condition.
- Miscarriage, abortion, C-section deliveries etc
- Cirrhosis, stones in urinary, hernia, skin diseases, ulcers, cyst, non-infective arthritis are not covered in first two years of policy.
Case Study
Lucky purchased Activ Assure Diamond health insurance plan to cover himself as well as his family from future medical contingencies. He took policy for Rs 75 lakhs in which he included his spouse, and two children, one daughter, and a son. Lucky is 32 years of age while his wife is of 30 years.
The annual salary of lucky is 10 lakhs and by taking health insurance for his family he is getting tax benefit under Section 80D of Income Tax Act. By including his wife and children into the policy, he received 5% discount on the premium.
Lucky was diagnosed with diabetes before policy purchase which will get coverage after 3 years. But lucky opted for add-on coverage of “reduction PED waiting period” that reduced his waiting period to 2 years.
He took a two-year policy which gave him discounts. The premium for one year is 48,553 while the premium on taking two-year policy is 89,826 (after 7.5% of discount on actual premium). Lucky was getting a profit of 7280* on buying a two-year policy.
*The actual amount of premium for two years was 97,106. Gain is equal 97,106- 89,826= 7280.
About the Company
Aditya Birla health insurance is one the acing companies in the insurance sector that were instituted by the joint collaboration between Aditya Birla Capital and South African based MMI holdings. The company objective is to cover all healthcare needs and protect from risks.
The health insurance plans cater to the demands of different individuals and their family. It provides flexibility and choices to policyholders at the time of purchasing the policy.
FAQs
1. How are health returns earned?
In order to earn the health returns from your policy, the policyholder must determine their current health condition for the company has laid down some steps to know your health standards. Let’s have a look -
- Download the Activ Health App on your mobile phone which will keep a check on your physical activity.
- Get your Healthy Heart Score which is an evidence of “How healthy your heart is?”. It has been divided into three categories -
- Green - Green indicates healthy heart
- Amber - Amber reflects that heart is in low risk getting stuck with a disease
- Red - Red reflects the heart is in high risk of getting affected
- After getting results of your heart’s health, it's time to improve your health by taking necessary precautions. You have to complete ActivDayz which is one of the steps to earn health returns. You have to accomplish any one of the below-mentioned activities to fulfill activ days -
- Visit a network gym and get involved in exercise sessions.
- Burn 300 calories in one session.
- Walk at least 10,000 steps in a day
- Undertake fitness tests every six months
- After the fulfillment of minimum 13 ActivDayz in a month, you will start receiving returns up to 30% of the premium paid in a year for the policy.
2. How to earn maximum health returns?
A policyholder can earn higher returns in reference to their health heart score. Let us see how -
| Number of ActiDayz in a month |
Fitness Assessment Result |
Healthy Heart Score |
| 13+ |
Level 5 |
6% |
12% |
30% |
| 10-12 |
Level 4 |
4% |
7% |
18% |
| 7-9 |
Level 3 |
2% |
5% |
12% |
| 4-5 |
Level 2 |
1% |
2% |
6% |
| 40-3 |
Level 1 |
0% |
0% |
0% |
The health return that a policyholder will get is the percentage mentioned in the table according to their healthy heart score with respect to the number of ActveDayz completed in a month.
3. If my Health Heart Score improves, can I get promoted to a higher level?
Yes, of course. In near future, if you have upgraded the health status of your heart, you are subjected to receive higher health returns. To enable this, you have to appear for a health assessment test with the company.
4. What is Healthy Heart score?
Healthy Heart Score is used to evaluate the health standard of the insured heart. This score provides you up-to-date information about your current health and helps in enhancing the health of your heart which is a crucial part of your body.
5. How Healthy Heart score is measured?
The policyholder’s healthy heart score is calculated based on factors such as height, weight, hip to waist ratio, body mass index (BDI), blood sugar levels, and cholesterol levels. You have to undergo a health assessment test in regards to these factors.
6. What is the Importance of Healthy Heart score?
As the risk of heart-related diseases is developing and making its space in the life of human beings slowly. What this Heart scorecard do is to forecast about the risk attached heart for the next ten years. Factors that lead to heart disease are -
- Blood Pressure - Anybody who has a high blood pressure problem is more inclined towards getting affected by cardiovascular diseases.
- Cholesterol- Higher quantity of cholesterol can block your arteries which will hinder the process of blood flow in the body. All this will lead to heart attack.
- Glucose - Higher the amount of glucose, greater will be the chances to get affected by cardiovascular diseases and even foot problems, vision loss, kidney failure.
- Smoking - The person who smokes is prone to endless diseases like lung cancer, heart attack, asthma, ulcers, bronchitis, cataracts etc. Also, higher intake of tobacco can result in teeth damage, mouth cancer, gum problems etc. All these directly or indirectly contribute in developing heart diseases.
7. How to improve your Healthy Heart score?
Although there are many pathways to improve your heart’s health a healthy lifestyle can significantly minimize the risk of getting heart problems. Follow the pointers -
- Healthy Diet - By including proteins, vitamins, minerals, essential carbohydrates and fibers in your daily diet can really promote the well being of heart.
- Breathing clean air - By inhaling the fresh air instead of smoking or taking any other toxic substance can work better in getting protection from heart disease.
- Live stress-free - Taking the stress of work or home every time is not a good habit as it can dump you into depression or anxiety. Excess of tension or stress can build heart problems.
8. What is ActivDayz?
The concept of ActivDayz was developed to encourage the insured person towards maintaining a healthy and activ lifestyle. ActivDayz can give your health returns when you remain activ in practicing physical activities for 13+ ActivDayz of a month.
The returns earned by doing physical activities will be returned to the insured against next year’s premium. ActivDayz serves two motives, one is sane health and second is earning profits from maintaining good health.
9. How to use the earned health returns from ActivDayz?
After you start earning returns from your ActivDayz, you can use it in different ways.
- You can use it in buying medicines, drugs or can pay for a medical test.
- You can utilize it in paying the premium for the next year of the policy.
In addition, the health will totally depend upon the healthy heart score and the number of ActivDayz. Insured should complete at least 13+ ActivDayz per months to get a higher percentage of returns up to 30% of the premium.
10. What devices can be linked to the Activ Health App to complete ActivDayz?
To track the daily record of your physical activity, you need fitness devices that are accessible in the market. The devices which can be linked with the Activ Health App are -
- Apple Watch
- Fitbit
- Tomtom
- Nokia Health Mate
- Misfit
- Jawbone
- Gramin
11. How to burn 300 calories a day to receive health returns?
The company has listed numerous ways through which calories can be burned effectively. These are running, swimming, cycling, skipping, household activities, dancing or playing outdoor games like football or basketball and many more. By discarding 300 calories a day, you secure an Activ day in your account.
12. How do I record my activity at a partner gym?
Follow three steps to record gym activities in a day-
- After visiting a partner gym, launch the Activ Health App.
- Switch on the Bluetooth mode of your phone.
- Utilize the Gym Check-in option to connect with the beacon.
