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.

Activ Assure Diamond Plan 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.

Activ Assure Diamond Plan 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.