ALL YOU NEED TO KNOW
-
Key benefits
-
Key Features
Frequently Asked Questions
The maximum entry age is 65 years.
No, we do not cover pre and post hospitalization expenses under AYUSH treatment.
48 months.
You can avail a 5% discount on covering 2 or 3 family members and a 10% on covering 4 or more family members in an Individual Policy type.
Ayush Treatment refers to the medical and / or hospitalization treatments given under ‘Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems.
All waiting periods, as applicable for your plan, shall apply afresh on the Sum insured to the extent of enhancement over the previous policy Sum insured from the effective date of such enhancement.
It will not be covered in given case.
No, this benefit is above and beyond SI and will not reduce it.
No, Premium paid through health returns is not eligible for tax benefit
Your health insurance policy is issued based on the Disclosure to information norm, including the information provided by you in respect of the Insured Persons in the Proposal Form and any other details submitted in relation to the Proposal Form.
No, defined time gap between the two tests.
No, this benefit can be used only when he has used up his Sum Insured completely.
Policy is valid for the duration mentioned in your Policy schedule. We offer you an option of buying our health policy for a term of 1 year, 2 years or 3 years. You can renew your policy at the end of the policy term.
Dependent children age 91 days to 5yrs will be covered only if one adult is covered under family floater policy. In case of individual policy, minimum age at entry is 5 years. Children upto 25 yrs can be covered under the floater as dependents.
While doing so insured will get continuity benefit for applicable waiting periods for the number of years the existing policy was continuously renewed previously.
No, it applies only for IPD and Day care claims.
There are 9 exclusions under Domiciliary, below is the list:
- Asthma, bronchitis, tonsillitis, and upper respiratory tract infection including laryngitis and pharyngitis, cough and cold, influenza;
- Arthritis, gout and rheumatism;
- Chronic nephritis and nephritic syndrome;
- Diarrhea and all type of dysenteries, including gastroenteritis;
- Diabetes mellitus and insipidus;
- Epilepsy;
- Hpertension;
- Psychiatric or psychosomatic disorders of all kinds;
- Pyrexia of unknown origin.
Lifetime renewal.
You can email us at care.healthinsurance@adityabirlacapital.com or You can call our toll free no. 1800 270 7000 or You can visit our website www.adityabirlacapital.com/healthinsurance or You can visit any of our Branch offices or Corporate office.
No, they will not provide assistance to friend.
Health Assessment (HA) is only for adult members (above 18 years).
There are no such limits.
Yes.
Pre-hospitalization medical expenses are covered for 60 days.
Premium for your Activ Health policy depend on following factors:
- Your age
- Gender (for individual plan)
- Plan type (individual/ floater)
- No. of member covered (in individual policy, you get discount for covering 2 or more members under same policy)
- Selected term for policy (You get 7.5% and 10% discount respectively for buying 2yrs and 3yrs term policy)
- Selected SI
- Any pre-existing condition that you may have at the time of first buying this policy or detected at the time of pre policy medical checkup.
If the Sum Insured under the Policy has been increased at the time of Renewal, the Super NCB shall be calculated on the Sum Insured of the last completed Policy Year.
No, this is not permitted.
Mentioned condition is excluded under the policy hence claim related to same will not be considered.
Once during the policy year.
There is no fixed time gap between the two tests, but the customer cannot repeat the tests that were covered in HA (MER, Total Cholesterol, FBS)
Transferring the policy within ABHI is known as Migration and transferring the policy externally is known Portability.
30 days (not applicable in case of accident & subsequent renewal).
The following members in a family floater can avail of the booster - Above 18 years / Only Self & Spouse not the child.
Yes, it is covered Rs. 2, 3 & 4 Lacs Sum Insured – Rs. 500/ day & Max 5 day per hospitalization.
Yes, the premium paid for health insurance policies qualifies for deduction under Section 80D of the Income Tax Act. You are entitled to a deduction of up to Rs. 25000 as medical insurance premium paid for yourself, your spouse, and children. In addition to it, if you pay health insurance premium for your parents, you will be entitled to additional deduction of up to Rs. 25,000/- (if parents are not senior citizens) Or up to Rs. 50,000/- (if parents are senior citizens).
0%.
All Insured Persons Aged 18 Years or above, suffering from any one or more of the listed chronic conditions namely Asthma, Hypertension, Hyperlipidemia or Diabetes Mellitus is/are eligible for a health coaching session with our expert Health Coach.
Yes, it is available once in a policy year.
No.
1:1:0:0.
Yes, health check-up program is available irrespective of claim.
2 sessions during a policy year.
586 Day Care procedures is covered up to sum insured.
No. This benefit is available only for Insured Person up to 18 years.
Yes, it is available.
Yes, mandatory co-payment of 20% for age at entry 61yrs and above.
Yes, we do provide No Claim Bonus of 10% increase per annum, Max up to 50% of Sum Insured.
No.
Yes, earned Cumulative Bonus will be reduce by 10%.
Base Sum Insured.
Yes, once in a year.
No, Only customer who have SI 1 Cr and below can opt for this benefit.
100% of Sum Insured.
No.
Rs. 2, 3, 4 Lacs – 2% of Sum Insured
Rs. 5 Lacs & above Sum Insured – covered up to sum insured.
The accumulated Super NCB will not get carried forward.
If the Sum Insured under the Policy has been increased at the time of Renewal, the Cumulative Bonus shall be calculated on the Sum Insured of the last completed Policy Year.
Yes, we do provide Cumulative Bonus of 50% increase per annum, Max up to 100% of Sum Insured.
24 months.
NCB gets calculated for every claim free year no matter, whether the policy tenure is for 1yr, 2yrs or 3yrs.
Pre-Existing Disease or PED means any condition, ailment or injury or related condition(s) for which there were signs or symptoms, and / or were diagnosed, and / or for which medical advice / treatment was received within 48 months prior to the first policy issued by the insurer and renewed continuously thereafter.
No, Unlimited Reload of Sum Insured calculation will be done on the base SI.
After completion of eight continuous years under the policy, no look back would be applied. This period of eight years is called as Moratorium Period.
Yes, it is covered upto 10% of Sum Insured.
As per Terms & Conditions Trips exceeding 90 days from residential address without prior notification to us are excluded.
10% discount.
Pre-hospitalization medical expenses are covered for 30 days.
Sum Insured upto 4Lacs – Rs. 15,000
Sum Insured upto 5Lacs to 10Lacs – Rs. 20,000
Sum Insured upto 15Lacs to 40Lacs – Rs. 30,000 Sum Insured upto 50Lacs to 75Lacs – Rs. 40,000 Sum Insured upto 1Cr to 2Cr – Rs. 50,000
Yes.
No, medical expense for donor is covered if the organ is for the use of insured person, who is recipient for the organ.
Yes, you can request for enhancement of Sum insured at the time of renewal. However, the enhancement is subject to underwriting decision and applicability of waiting periods such as first 30 days waiting period, two- years waiting period and pre-existing disease waiting period.
Yes, Organ Donor expenses is covered up to Sum Insured.
30 days.
Yes, he can redeem his 3 yrs. accumulated HealthReturns against the 4th year renewal premium.
No, we will not cover.
Yes, it is available.
No, this benefit can be used only when he has used up his Sum Insured completely.
No, it is important to do Health Assessment as well as Active Dayz™ to earn HealthReturns™ if a customer is not doing Active Dayz™ the substitute is to take a fitness assessment twice in a year.
No.
No.
Rs.2 Lac, 3 Lac, 4 Lac, 5 Lac, 7 Lac, 10 Lac, 15 Lac, 20 Lac, 25 Lac, 30 Lac, 40 Lac, 50 Lac, 75 Lac, 100 Lac, 150 Lac, 200 Lacs.
Yes, newly wedded Spouse and newborn baby can be added in the Policy during the term of Policy by paying premium as applicable.
Our partner Assist America Provides services globally (worldwide) and do not have any such country where they do not give the services. So, no geographical exclusions. Hence all the countries are covered for providing our medical emergency assistance.
Rs. 2, 3, 4 Lacs – 1% of Sum Insured
Rs. 5 Lacs Sum Insured – Single Private A/C Room
Rs. 7 Lacs & above Sum Insured – covered up to sum insured.
Total percentage of HealthReturns that a customer can earn is Up to 30%.
HealthReturns™ through Active Dayz™ and Healthy Heart Score™ gets calculated monthly. Irrespective of whether the premium has been paid for 1 year, 2 years or 3 years.
Health Assessment is a simple health exam that measures the Insured Person on the parameters of MER (including BP, BMI, HWR and smoking status), Fasting Blood Sugar and Total Cholesterol.
Super NCB gets calculated for every claim free year no matter, whether the policy tenure is for 1yr, 2yr or 3yr.
You can avail of a long-term discount of 7.5% and 10% on selecting 2 and 3-years policy, respectively.
No.
No, tests in HA will not be repeated.
No, optional cover of Any Room upgrade is available only with 5Lacs S.I.
Yes, it is available for 15 listed Critical Illnesses.
No, we would not consider the reports from outside and he will not get the HealthReturns.
Once during the policy year.
For calculation of Healthy Heart Score™, tests under Health Assessment™ namely - MER (including BP, BMI, HWR and smoking status), Fasting Blood Sugar, Total Cholesterol will have to be carried out at one go (together) and at least once every Policy Year.
Sum Insured upto 4Lacs – Rs. 1,500
Sum Insured upto 5Lacs to 10Lacs – Rs. 2,000 Sum Insured upto 15Lacs to 40Lacs – Rs. 2,500 Sum Insured upto 50Lacs to 75Lacs – Rs. 3,000 Sum Insured upto 1Cr to 2Cr – Rs. 5,000
Yes, it is covered up to Rs. 10,000/- (Applicable for Sum Insured 1Cr and above).
In an individual policy, each person is covered for separate Sum insured as selected at the time of buying the policy. In a Family Floater plan, all insured members are covered under a floater sum insured. The sum insured for a Family Floater is our maximum liability for all claims made by all the insured members (a single Sum Insured which is shared by all members).
No.
Yes, we do provide 100% of Sum Insured (Unlimited Times).
100% of Sum Insured.
Yes, Reload benefit is available up to 150% Sum Insured and Max upto 50Lacs.
Migration means an insured having a health insurance policy has an option to shift his/her policy to a similar policy with the same Insurer:
- An Individual Health Insurance Policy holder shall have option to shift to either:
A) A Similar Individual health insurance policy, or
B) To a Group Health Insurance Policy, provided the members meets the terms related to health insurance coverage of the group policy. - A member of Group Health Insurance policy can migrate to a similar Individual Health Insurance policy. However, the same will be applicable in case:
A) Exit from Group Policy.
B) Modification of Group Policy (including the revision in the premium rates).
C) Withdrawal of Group Policy.
No, the health check-ups will be arranged by us on cashless basis only and at our Network Providers/empanelled service providers (such as Diagnostic centres).
All Insured Person, there are separate set of tests as per age and SI slabs.
48 months.