Activ Health Platinum Enhanced

Live worry free by getting a comprehensive coverage against medical bills.

Rewards to stay fit and healthy in the form of HealthReturns™

Day 1 cover for chronic diseases like diabetes, hypertension, high cholesterol and asthma

Choice of Hospital Room category

Reload of Sum Insured

What are the features of Activ Health Platinum Enhanced plan?

Product Features Platinum Enhanced
Sum Insured Rs 2 Lac, 3 Lac, 4 Lac, 5 Lac, 6 Lac, 7 Lac, 8 Lac, 9 Lac, 10 Lac, 15 Lac, 20 Lac, 25 Lac, 30 Lac, 40 Lac, 50 Lac, 100 Lac, 150 Lac, 200 Lac
In-patient Hospitalization - For hospitalization for more than 24 hours, we will cover expenses like room rent, operation theatre expenses and other consumables as per your eligibility. You also have a choice to select your hospital room category from
a) Any room (Available for Sum Insured > 7 Lacs)
b) Single Private Room
c) Shared Room (available for Sum Insured's < 5 Lacs)
Pre-hospitalization Medical Expenses Costs up to 60 days before your hospitalization will be covered where the hospitalisation claim is accepted by the company.
Post-hospitalization Medical Expenses Costs up to 180 days after your discharge from the hospital will be covered where the hospitalisation claim is accepted by the company.
Day care Treatment We will cover you for 527 day care procedures
Domiciliary Hospitalization We will cover your medical expenses up to Sum Insured in case you need to get treated at home, if your health condition did not allow hospital transfer or due to unavailability of a bed at the hospital.
Road Ambulance Cover We will cover costs incurred on transportation to a hospital as per actuals, if services are availed from a network provider and up to Rs 5000 per hospitalization in a non-network provider.
Organ Donor Expenses In case of organ transplants, we not only cover you, we also cover the medical expenses of the organ donor for harvesting the organ up to Sum Insured.
Reload of Sum Insured In case the sum insured with cumulative bonus (if any) is insufficient as a result of previous claims in that policy year, then you get an added 100% of sum insured for your health needs resulting out of an illness unrelated to previous claims in that policy year. In case of an unfortunate hospitalisation due to an accident, reload of sum insured can be triggered in the 1st claim itself.
Cumulative Bonus With our policy, you even get benefits if you do not claim. We increase the sum insured by 20% each year that you do not claim, maximum up to 100% (up to maximum of 50 Lacs). There is no claw back of this bonus even if you claim in subsequent years
Health Check up program We provide a free health check-up for each adult once in a policy year customized to the life stage you are in.
Recovery Benefit If you stay for 10 or more days in a hospital then we give you a lump sum amount of 1% of Sum Insured, max of INR 10,000 towards such expenses.
Benefit for Hospital Room Choice We give you the flexibility on choosing the room category that you want at the start date of the Policy and you pay a premium for the hospital room that you choose. But what if you get treated in a lower room category than opted? We give you a pre-defined percentage of payable claims back in the form of HealthReturns™.
Second E-Opinion on Critical Illness We provide you with a second e-opinion through a consortium of well qualified specialists for 11 Critical Illnesses.
Worldwide Emergency Assistance Services We travel on work or sometimes to get away from our busy lives and sometimes we may end up going to places that are remote. In such cases where an adequate medical facility is not available and you need medical help, we will help you reach such a medical facility and then take you back to your home.
Chronic Management Program We know that you don’t choose the illnesses that you get; they can happen to just about anyone. Illnesses like diabetes, hypertension, high cholesterol and asthma can be controlled if proper medication and control is followed. Our team of specialists and doctors have designed a special program to help you control these conditions to keep you healthy. This includes consultation with medical practitioners, diagnostics tests and pharmacy benefits.
HealthReturns™ We encourage you to stay fit and healthy by giving you a benefit in the form of HealthReturns™. You can use this for something as small as getting medicines for a fever or even for a surgery that is not covered due to a waiting period or excluded in the policy. Furthermore, you can use this for paying your premium from the 1st renewal of the policy.
Wellness Coach We constantly keep reminders for our work and schedules, but what about our diet, fitness and nutrition. We give you a qualified wellness coach that will guide you through your wellness journey and give you pointers for being the healthiest version of yourself.

What are the major exclusions in the policy?

  • War, act of foreign enemy, uprising, revolution, insurrection, military or usurped acts.
  • Breach of law with Criminal Intent, intentional self injury
  • Abuse or the consequences of the abuse of intoxicants or hallucinogenic substances
  • Cosmetic, aesthetic and re-shaping treatments and surgeries
  • Hearing aids, spectacles or contact lenses including optometric therapy
  • Psychiatric or psychological disorders, mental disorders, Congenital external diseases, defects or anomalies, genetic disorders.

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

Key Benefits

  • Comprehensive range of Sum Insured from 2 Lac to 2 Crores
  • Choice of Hospital Room category from shared, single to any room
  • Coverage for hospitalization, pre and post hospitalization, day care expenses and more
  • Reload of Sum Insured for an unrelated illness
  • Benefits to stay fit and healthy in the form of HealthReturns TM
  • Day 1 cover for chronic diseases like diabetes, hypertension, high cholesterol and asthma
  • Health check-up for all adults each year irrespective of claim status
  • Worldwide Emergency Assistance Services to keep you safe when you travel
  • Policy term options of 1, 2 or 3 years
  • Discount of 7.5% and 10% on 2 and 3-year policy terms respectively
  • Family discount of 10% on covering more than one member in an individual policy
  • Cashless treatment at network hospitals
  • Life-long renewability, subject to regular receipt of premiums by Us.
  • Tax benefits under 80D of Income Tax Act*

*Tax benefit are subject to changes in tax laws. Please consult your tax advisor for more details.

What is the claims process under the policy?

For Cashless Claims

  1. In order to avail a planned cashless facility, We must be contacted to pre-authorise Cashless facility at least 72 hours prior to the proposed treatment.
  2. In order to avail cashless facility in emergency, We must be contacted to pre-authorise Cashless facility within 24 hours of the Insured Person’s Hospitalization
  3. Once the request for pre-authorisation has been granted, the treatment must take place within 15 days of the pre-authorization date at a Network Provider. Each request for pre-authorisation must be accompanied with all the following details:
    1. The health card We have issued to the Insured Person supported with the Insured Person’s KYC documents.
    2. The Policy Number;
    3. Name of the Policyholder;
    4. Name and address of Insured Person in respect of whom the request is being made;
    5. Nature of the Illness/Injury and the treatment/Surgery required;
    6. Name and address of the attending Medical Practitioner;
    7. Hospital where treatment/Surgery is proposed to be taken;
    8. Proposed date of admission;
    9. Additional information or documentation as assessed by Us.

For Reimbursement Claims:

  1. For all claims for which Cashless facilities has not been pre-authorized or for which treatment has not been taken at a Network Provider, We shall be given written notice of the claim along with the following details within 48 hours of admission to the Hospital or before discharge from the Hospital, whichever is earlier:
    1. The Policy Number;
    2. Name of the Policyholder;
    3. Name and address of the Insured Person in respect of whom the request is being made;
    4. Health Card, Photo ID, KYC documents
    5. Nature of Illness or Injury and the treatment/Surgery taken;
    6. Name and address of the attending Medical Practitioner;
    7. Hospital where treatment/Surgery was taken;
    8. Date of admission and date of discharge;
    9. Any other information that may be relevant to the Illness/ Injury/ Hospitalization
  2. If the Claim is not notified to Us within the earlier of 48 hours of the Insured Person’s admission to the Hospital or before the Insured Person’s discharge from the Hospital, then We shall be provided the reasons for the delay in writing.

Claim submission

You can submit your claim to the nearest Aditya Birla branch or courier the claim documents to . Aditya Birla Health Insurance Head office within 15 days from the date of discharge. Please call our toll free number 18002707000 for more information.