About Aditya Birla Health Insurance

Aditya Birla Health Insurance Company Limited was incorporated in 2015 as a joint venture between the Aditya Birla Group and MMI Holdings of South Africa with 51% and 49% stake respectively. The company is a subsidiary of Aditya Birla Capital Limited.

The company offers a wide range of health insurance products consisting of unique insurance covers and offerings including incentive wellness and chronic care. The company believes in transparency, technology, trust and efficient customer service.

Claim settlement ratio 94%

NCB* 50%, up to 100% of SI*

PED Waiting# 48 months

Network Hospital 6500+

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Top Plans

Aditya Birla Health Insurance Plan(s) Plan Type Entry Age
Activ Fit Plan Type : Base Product Entry Age : Minimum 91 days
Activ Assure Diamond Plan Type : Base Product Entry Age : 91 days to 65 yrs
Activ Health - Platinum (enhanced + essential) Plan Type : Base Product Entry Age : Minimum 91 days

What’s Inside?

Key Highlights of Aditya Birla Health Insurance Company

Some key highlights of the companies are as follows:

Lives Covered 2.3 million lives covered till date
Cashless hospitals  11000+ cashless hospitals
Selling Agents 17,100+ selling agents
Claims settled 1.97 lacs claims settled
Presence 5000+ cities across India

Features of Aditya Birla health insurance plans

The health insurance policies offered by Aditya Birla offer the following standard coverage benefits –

Benefit Brief description
Inpatient hospitalization A 24-hour or more hospitalization is called inpatient hospitalization. In such cases, the costs of hospitalization and the associated treatments are covered by the policy
Pre hospitalization The medical costs that you incur before you are admitted to the hospital are covered under this benefit. You get covered for a specific number of days
Post hospitalization The medical costs that you incur after you are discharged from the hospital are called post hospitalization costs. Such costs are covered for a specific number of days after discharge
Daycare treatments In some treatments you do not need 24-hour hospitalization. Such treatments are called daycare treatments and they are covered under the scope of the policy
Ambulance costs If you need ambulance services for getting admitted to the hospital, the cost of the ambulance would be covered up to specified limits
Organ donor treatments This benefit covers the costs incurred on the donor’s hospitalization and the cost of harvesting the organ if you need an organ transplant surgery
Domiciliary treatments Hospitalization at your own home because of non-availability of hospital beds or if you cannot be transferred to the hospital is called domiciliary hospitalization. Such hospitalization is covered under the plan
Free health check-ups Aditya Birla health insurance plans allow free health check-ups regularly to ensure that you can monitor your health
No claim bonus If you don’t make claims in your plan, you get awarded with a no claim bonus. This can be allowed as an increase in the sum insured or as a premium discount

Exclusions in Aditya Birla health insurance plans

Aditya Birla health insurance plans have exceptions wherein claims are not paid. These exceptional instances are called exclusions. The specific list of exclusions depends on the plan that you buy. However, some of the most common exclusions in Aditya Birla health insurance plans are as follows –

  • Pre-existing conditions have a specific waiting period. These illnesses are covered after the waiting period is over.
  • There is a waiting period of 30 days from the start of the policy. During this period illnesses would not be covered.
  • Specific treatments have a waiting period of 2 years. Such treatments are not covered during the waiting period.
  • HIV, AIDS or STDs are not covered.
  • Cosmetic or medically unnecessary treatments are excluded.
  • Unproven medical treatments are not covered.
  • Criminal acts, illegal acts, hazardous acts, etc. are not covered.
  • Claims due to war, civil commotion, nuclear perils, etc. are excluded.
  • The cost of hearing aids, dental treatments, spectacles, lenses, etc. is excluded.
  • The cost of vitamins, minerals and health supplements are not covered under the plan.

Health insurance plans offered by Aditya Birla

Aditya Birla offers different types of health insurance policies. The most popular plan, also available at PayBima, is as follows –

Activ Assure Diamond

A comprehensive health insurance plan, Activ Assure Diamond offers sum insured levels up to Rs.2 crores.

The salient features of the plan are as follows –

  • Sum insured reload: You might use up the sum insured if you suffer a claim in the policy year. In the case of a second or any other subsequent claim, if the sum insured is not available, the plan offers the reload benefit. Under this benefit, the sum insured is refilled up to 150% so that the claim can be met.
  • Hospital daily cash benefit: If you are hospitalized for 24 hours or more, besides covering the hospitalization expenses, the plan also pays a daily allowance. The allowance depends on the sum insured that you choose and is paid for up to 5 days.
  • Vaccination cover: You get covered for the costs of vaccinations, up to Rs.10,000 if you choose a sum insured of Rs.1 crore and above
  • Second opinion: The plan covers 15 critical illnesses. If you are diagnosed with any of the covered illnesses, you can avail of a free online second opinion from the company’s panel of specialists.
  • Air ambulance cover: If you suffer a medical emergency and need an air ambulance for transportation, the plan would cover the cost of hiring the same.
  • International coverage: In a medical emergency, Activ Assure Diamond allows international coverage too which also includes coverage for air ambulance services.
  • Health Returns: The plan offers the unique feature of Health Returns wherein, if you practice healthy living and stay fit, you earn Health Return points. You can accumulate these points and use them to claim a premium discount on renewals.
  • Range of optional coverage benefits: Activ Assure Diamond offers different types of optional coverage benefits. These benefits allow you to customize your policy as per your needs and avail of enhanced coverage.

Eligibility conditions for Activ Assure Diamond Plan

Entry age Adults – 18 years onwards
Children – 91 days onwards in a floater policy or 5 years onwards for individual cover. Children are covered up to 25 years on a floater basis
Sum insured Rs.2 lakhs to Rs.2 crores
Policy term 1 year to 3 years
Pre-existing waiting period 48 months

How to buy Aditya Birla Health Insurance Plan?

PayBima is an online platform that offers various services relating to insurance. You can buy Aditya Birla health insurance plan online through www.paybima.com in a very simple and hassle-free manner. The process to be followed is discussed below:

Select your plan online: Go online and visit the PayBima website or simply click on www.paybima.com and select health insurance from the options available.

Fill in details to calculate the premium: Provide all the requested personal and medical information to calculate the premium based on your eligibility and coverage requirements. Fill in your name, eligibility conditions, lifestyle habits, medical history, number of dependents, sum assured in the plan, age, gender, location, etc. This information and details are required to assess your needs and filter health insurance plans for you. Also, provide your contact details to enable PayBima to provide personalized consultations to help you buy the most suitable health plan.

Compare the plans: PayBima will show you a list of available plans after assessing your requirements and eligibility. The list would contain the best available plans with their features and premiums. You can select a suitable health plan from the list and check the premium to be paid for the plan. You will find Aditya Birla Health plans in the list. Select the most suitable plan only after comparing it with other leading health plans in the market.

Fill proposal form: After you have shortlisted the health policy, provide your correct and complete details as required in the proposal form to apply to the insurance provide to issue you the policy. Affix your signature and submit the form online. Ensure to fill in correct details for easy claim settlement.

Premium payment and policy issuance: The last step is the payment of the premium. Just pay the premium online and the policy will be issued instantly. However, there should be no adverse declarations made in the proposal form about lifestyle habits and the medical history of the insured. In such cases, the policy will be issued only after assessing the adverse declarations and risk involved.

Pre-entrance health check-ups: Some insurance companies require their customers to undergo a medical check-up before the issuance of the policy. A pre-entrance medical check-up is necessary if the risk involved in the plan is high. You can avail of the check-up at any networked facility of the insurance company

Aditya Birla Health Insurance Renewal

You can not only buy Aditya Birla health insurance policy online through PayBima but also renew it. PayBima offers the facility to renew your policy online easily and smoothly. Health insurance policies allow lifelong renewal. As such, if you renew your Aditya Birla health insurance plan online within the due date you can easily enjoy non-stop coverage and avail uninterrupted benefits of the plans.

Renewal of the policy is an online procedure in which you would have to provide your details of the policy and policy number. We can check your policy details and also make changes to it if required. Aditya Birla Health Insurance offers various riders which can be added to your health plan to enhance its coverage. You can add riders or top-ups to your plan at the time of renewal. However, the addition of a rider might shoot up your premium. When you make the payment of renewal premium online, your policy will be renewed instantly. For any assistance to renew Aditya Birla health insurance policy, you can contact PayBima through call at 1800 267 67 67 or drop an email at paybima.care@mahindra.com.

Aditya Birla health insurance plan claim process

Claiming an Aditya Birla health insurance policy is as easy as buying one. You can not only buy Aditya Birla health insurance policy online but also claim your health plan with the help of PayBima. PayBima offers a very smooth and hassle-free claim settlement process to its customers. The process is discussed as follows:

Network hospital

The very first thing that you need to do is to locate a network hospital of the insurance company. Every insurance company has tied up with health providers in which you can avail cashless treatment. You can locate the network hospital on the website of the company or by contacting PayBima. Aditya Birla Health Insurance has tied up with leading hospitals which will help you to locate one very easily

Admission of the insured

After locating a network hospital, you can get yourself admitted to the hospital by showing your health card and ID proof.

Submit pre-authorization claim form

For the approval of your cashless claim, you are required to fill, sign and submit a pre-authorisation claim form to the insurance company to initiate the claim process. You can download the pre-authorisation claim from the website of the insurance company or can take it from the insurance desk of the hospital. The pre-authorisation claim form is to be filled with correct details so that there would be no issues at the time of settlement of the claim. Submit a pre-authorisation claim form at least 3 to 4 days before your plan admission to the hospital. You can submit a pre-authorisation claim form within 24 hours in case of emergency hospitalization

Get approval from the company for a cashless claim

The insurance company will verify your details and approve your cashless settlement of claim if all your documents and details are correct. The insurer can reject the cashless settlement of the claim in which case you can file for reimbursement.

Get the treatment

Once approval has been received by the hospital, the hospital will proceed with the treatment and all the bills will be directly settled by the insurance company.

Reimbursement claims

If your cashless claim has been rejected or if you get hospitalized in a non-network hospital then your claim would be settled on a reimbursement basis. In such cases, you will have to inform the insurance company about the claim before your planned hospitalization. In case of emergency, you can inform after admission but before discharge from the hospital. All the hospital bills are to be settled by you which on discharge are to be submitted to the insurance company along with the claim form. The company would access your claim and reimburse the costs incurred.

You can contact PayBima for easy claim settlement of Aditya Birla health insurance policy. You can either dial 1800 267 67 67 or mail us at paybima.care@mahindra.com and we would gladly help you with your claim settlement.

They are certain documents that are required to be submitted to the insurance company along with the claim form for the successful settlement of your claim. The documents include the following:

  • ID proof of the insured individual
  • Bank details of the insured to make the payment of reimbursement claim
  • Health card
  • Pre-authorisation claim form
  • Doctor’s prescription in which the doctor has advised hospitalisation to the insured
  • Original medical bills and prescriptions
  • Original Hospital bills and reports
  • Consultation notes

Aditya Birla Health Insurance Company Review

Aditya Birla Health insurance plans are quite comprehensive in their scope of coverage and are quite competitively priced. Other highlights are as follows:

Aditya Birla Health Insurance has been investing effort and time to analyze and understand individual health choices through innovative products and a wider choice of customer-relevant insurance products.
Aditya Birla health plans also provide access to experts coaches on fitness, nutrition as well as dental consultation. The company also offers homoeopathy teleconsultation and mental wellness counselling.
You can get premium discounts on Aditya Birla health plans to make them affordable.
Its plans can be brought online with a minimum of hassles.

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Frequently asked questions

Co-pay is short for compulsory payment. It means that in the case of a claim, the specified part of the claim would be paid by the policyholder and the remaining claim would be settled by the insurance company.

Under Aditya Birla’s Activ Assure Diamond plan, a co-payment of 20% is applicable if you or any other insured member is aged 61 years and above at the time of buying the policy. This means, that in a claim, 20% of the claim would be borne by you and the insurance company would bear 80%.

Yes, a range of premium discounts is offered under Aditya Birla health insurance plans. Under the Activ Assure Diamond policy, you can avail of the following types of discounts –
5% discount if you cover 2 or 3 family members on an individual sum insured basis
10% discount if you cover 4 or more family members on an individual sum insured basis
7.5% discount for choosing a 2-year policy term
10% discount for choosing a 3-year policy term

Under the Activ Assure Diamond plan, if you choose a sum insured of up to Rs.4 lakhs, the room rent sub-limit would be 1%. For a sum insured of Rs.5 lakhs, you get a single private AC room. However, if the sum insured is Rs.7 lakhs and above, there is no sub-limit. You get covered for the actual room rent incurred up to the sum insured.

The no-claim bonus depends on the policy that you buy. Under Aditya Birla’s Activ Assure Diamond plan you get a no claim bonus of 10% increase in the sum insured for every claim-free year up to a maximum limit of 50%.

No, the Activ Assure Diamond policy does not allow coverage for maternity and related expenses.

* The accumulated cumulative bonus or the NCB shall not exceed 100% of the Sum Insured on the Renewed Policy as specified in the policy terms.

# Ailments diagnosed within 48 months before policy issuance date or any medical treatment received within 48 months before the issue date of policy