Shefali Hajee / Garment Manufacturer

PROTECTING your health has its

own rewards
Activ Health - Platinum
- Wide range of cover from `2 lacs - `2 crore
- Earn up to 30% premium as HealthReturns™
- Day 1 cover for Chronic Illnesses
- 100% Reload of Sum Insured in case of unrelated illness
- Cumulative Bonus of 20% of Sum Insured for every claim free year, max upto 100%

Health Insurance
Aditya Birla Health Insurance Co. Limited
Platinum Plan Comparison: Essential and Enhanced

Product Features Essential Enhanced

Policy Term 1,2 or 3 years
Sum Insured (`) 50,000, 75,000, 1 Lac – 10 Lacs* 2 Lac - 10 Lac*, 15 Lac, 20 Lac, 25 Lac, 30 Lac, 40 Lac, 50 Lac, 100 Lac,
150 Lac, 200 Lacs
I. Basic Covers
a In-patient Hospitalization a) Single Private Room b) Shared room c) General/Economy ward a) Any room (Available for Sum Insured > 7 Lacs) b) Single Private Room
Covered up to c) Shared Room (available for Sum Insured’s < 5 Lacs)
b Pre-hospitalization Medical Expenses 30 days 60 days
c Post-hospitalization Medical Expenses 60 days 180 days
d Day care Treatment Available Available
e Domiciliary Hospitalization Available Available
f Road Ambulance Cover Network Providers - Covered up to Actual expenses Network Providers - Actual expenses
Non- network Providers- Reimbursed up to max of `2000 per hospitalization Non-Network Providers - Reimbursed up to max of `5000 per hospitalization
g Organ Donor Expenses Not Available Available
h Reload of Sum Insured Not Available Available
i Mandatory Co-payment 20% Not Applicable
j Co-payment for treatment in a Higher Zone Zone II to Zone I: 10% • Zone III to Zone II: 15% • Zone III to Zone I: 25% Zone II to Zone I: 10% • Zone III to Zone II: 15% • Zone III to Zone I: 25%
k Co-payment for treatment in a Higher room category a) General/ Economy ward to Shared Room - 15% a) Shared Room to Single Private Room - 15%
b) General/ Economy ward to Single Private Room - 25% b) Shared Room to Any Room - 40%
c) General/ Economy ward to Any Room - 50% c) Single Private Room to Any Room- 25%
d) Shared Room to Single Private Room - 15%
e) Shared Room to Any Room - 40%
f) Single Private Room to Any Room - 25%
l Benefit for Hospital Room Choice a) Shared Room to General/ Economy Ward – 10% a) Single Private Room to Shared Room - 10%
For Zone 1 cities b) Single Private Room to General/Economy Ward – 20% b) Any room to Shared Room – 30%
c) Single Private Room to Shared Room – 10% c) Any room to Single Private Room – 20%
For Zone 2 and 3 cities a) Shared Room to General/ Economy Ward - 5% a) Single Private Room to Shared Room – 5%
b) Single Private Room to General/Economy Ward - 15% b) Any room to take treatment in Shared Room - 25%
c) Single Private Room to Shared Room - 5% c) Any room to Single Private Room - 15%
II. Additional Benefits
m Cumulative Bonus - 10% increase of Sum Insured every claim free year, Max up to 100% - 20% increase of Sum Insured every claim free year, Max up to 100%
- Accumulated bonus will not reduce even when you claim in any subsequent year - Accumulated bonus will not reduce even when you claim in any subsequent year
n Health Check up program Available once every policy year, starting from the first year Available once every policy year, starting from the first year
o Recovery Benefit Not Available 1% of Sum Insured, max of `10,000 (10 days of hospitalization)
p Second E-Opinion on Critical Illness Available Available
q Worldwide Emergency Assistance Services Not Available Available

III. Value Added Benefits

r Chronic Management Program Available
s HealthReturnsTM Available, Earned by ways of
Percentage of Premium earned through Healthy Heart Score™ and Active Dayz™ • Benefit for Hospital Room Choice
t Wellness Coach Available
*In multiples of `1 Lac Please contact your advisor for available optional covers.
 Product Features Essential Enhanced

Free look cancellation:

• Customers will have a period of at least 15 days from the date of receipt of the policy to review the terms and conditions of the policy and to return the same if not acceptable.
• Health insurance policy contracts with a term of 3 years offered over distance marketing mode shall have a period of 30 days from the date of receipt of the Policy.
Eligibility and Coverage:
• The minimum age of entry is 91 days and there is no maximum entry age.
• Children up to 25 years can be covered under the floater as dependents.
• Family floater plan we cover upto 9 members (6 Adults + 3 children)
comprising of self, spouse, dependant parents, dependant parents-in-law,
children up to 25 years (up to 3).

Hospitalization Benefits
Key Features
• 60 days of pre and 180 days of
post-hospitalisation coverage
• Road ambulance expenses covered
• 527 Day Care procedures covered
• Annual health check up from 1st year

100% Reload of Sum Insured

• We will reload 100% of sum insured
in case of an unrelated illness in the
same policy year.
• In case of road accidents, we reload
the sum insured in the first claim
itself.

Cumulative Bonus
Earn a cumulative bonus every policy year
when you don’t claim
• 20% on Enhanced plan,
maximum up to 100% of sum insured. `
• The already accumulated bonus will not
reduce even when you claim in any
subsequent year unless utilized.
Chronic Management Program
Activ Health’s Chronic Management Program (CMP) has been
specially designed for people with chronic conditions like
Diabetes, Asthma, High Cholesterol and High Blood Pressure.

Day 1 Cover*
We offer you Day 1 cover for chronic conditions to help
you get back on the path of healthy living.

Automatic Upgrade
If you develop a chronic condition aer buying the policy, you will
get upgraded to the program without any additional premium.

The Chronic Management Program Benefits

Covers tests,
consultation, and
medicines

Wellness coaches
guide you to
make healthy choices

Hospitalization cover
post 30/90 days*
 HealthReturnsTM
Stay active and get upto 30% of your premium as HealthReturnsTM

How to earn HealthReturnsTM

Get Started Know Your Health Get Active

1 2 3
Download the Find out your Healthy Heart Score™ Improve Your Health by Getting Active
Activ Health App
Take the Health Assessment by calling
our call centre and get the score.
1 10,000 steps per day or
300 calories burned or
Active =
It indicates how healthy you are.
Day 30 minute gym session
AMBER
Low Risk or do a fitness assessment test every
six months.
GREEN RED
Healthy High Risk

Get Rewarded
• Earn up to 30% of your premium as HealthReturnsTM by just completing
13 Active DayzTM every month

• Earn up to 6% of your premium as HealthReturnsTM by just completing

4 Active DayzTM every month

Earn HealthReturns™ as a % of your premium

Active Healthy Heart ScoreTM
DayzTM Green Amber Red
13+ 30% 12% 6%
10-12 18% 7% 4%
7-9 12% 5% 2%
4-6 6% 2% 1%
0-3 0% 0% 0%

HealthReturnsTM is an offering under Aditya Birla Health Insurance plan and will be managed end to end by Aditya Birla
Health Insurance Co. Limited.
How to use HealthReturnsTM*

Use it to Use it to pay for

buy medicines diagnostic tests.

Use it to pay your Keep it like a fund for

next policy premium. any health contingency.

*Conditions apply
 Key Renewal Terms
The Policy will automatically terminate at the end of the Policy Period. The Policy is ordinarily renewable on
mutual consent for life, subject to realization of Renewal premium.

The premium payable on Renewal shall be paid to Us on or before the Policy Period end date and in any event
before the expiry of the Grace Period. Policy would be considered as a fresh policy if there would be break of
more than 30 days between the previous Policy expiry date and current Policy Start date.

We however shall not be liable for any claim arising out of an ailment suffered or Hospitalisation commencing or
disease/illness/condition contracted during the period between the expiry of previous policy and Start date of
subsequent policy and such disease/Illness/condition shall be treated as a Pre-Existing Disease.

Any unutilised funds under HealthReturnsTM (from the previous Policy year/ month) will be available for claims
during the Grace Period. You shall not be able to earn HealthReturnsTM during the Grace Period.

In case the Policy is not renewed before the end of the Grace Period, any unutilized funds under
HealthReturnsTM shall be available for a claim as up to a period of 12 months from the date of expiry of the
Policy.

Renewals will not be denied except on grounds of misrepresentation, fraud, non-disclosure of material facts or
non-co-operation by You.

Where We have discontinued or withdrawn this product/plan You will have the option to renew under the nearest
substitute Policy being issued by Us, however benefits payable shall be subject to the terms contained in such
other Policy which has been approved by IRDAI.

You shall disclose to Us in writing of any chronic condition acquired by any Insured Person at the time of seeking
Renewal of this Policy or during the Policy tenure, irrespective of any claim arising or made. If an Insured Person
is found to be suffering from a covered chronic condition, post any waiting period (if applicable), then We shall
manage such conditions under Chronic Management Program as per the terms and conditions laid out under the
relevant section.

We may revise the Renewal premium payable under the Policy or the terms of cover, provided that the Renewal
premiums are approved by IRDAI and in accordance with the IRDAI rules and regulations as applicable from time
to time. Renewal premiums will not alter based on individual claims experience. We will intimate You of any such
changes at least 3 months prior to date of such revision or modification.

Alterations like increase/ decrease in Sum Insured or Change in Plan/Product, addition/deletion of Insured
Persons (except due to child Birth/Marriage or Death) will be allowed at the time of Renewal of the Policy. You
can submit a request for the changes by filling the Proposal Form before the expiry of the Policy. We reserve Our
right to carry out underwriting in relation to acceptance of request for changes on Renewal. The terms and
conditions of the existing Policy will not be altered.

Any enhanced Sum Insured during any Policy Renewals will not be available for an illness, disease, Injury already
contracted under the preceding Policy Periods. All waiting periods as mentioned below shall apply afresh for this
enhanced limit from the effective date of such enhancement.

Where an Insured Person is added to this Policy, either by way of endorsement, all waiting periods as per relevant
section will be applicable considering such Policy Year as the first year of Policy with Us with respect to the
Insured Person.

In case of Family Floater Policies, children attaining 25 years at the time of Renewal will be moved out of the
floater into an individual cover. However, all continuity benefits for such Insured Person on the Policy will remain
intact. Cumulative Bonus earned on the Policy will stay with the Insured Persons(s) covered under the original
Policy.

Premium Details
The Premium charged on the Policy shall depend on the Sum Insured, Plan, Policy Tenure, Age, Policy Type
and Optional Covers opted.
Additionally the health status of the individual will also be considered and premium might be loaded
depending on the health condition.
Cashless Claims

• 24/7 claims assistance

• Cashless claims across large network
of hospitals
• Pre-authorization intimation available
through app and toll free
• Active engagement during hospital stay,
admission and discharge

Permanent Exclusion*
Preventive care Psychiatric or psychological disorders
Convalescence and Rehabilitation Congenital external diseases
Experimental, investigational or Unproven Treatment Sexually transmitted disease
Self-inflicted injuries HIV and AIDS
Weight management programs Treatment taken outside India
Treatment of obesity (including morbid obesity) Stem cell therapy or Surgery
All routine examinations and preventive health check-ups Non allopathic treatment
Circumcisions Cosmetic, aesthetic and re-shaping treatments and
Treatment for alopecia Surgeries
Artificial life maintenance Treatment for correction of eyesight due to
Treatment for developmental problems refractive error including routine examination
Items of personal comfort and convenience Hearing aids, spectacles or contact lenses including
optometric therapy, multifocal lens

Waiting Periods*
• 30 days waiting period: For any treatment within the first 30 days of the cover,except accidental injury.
• 2 year waiting period: For specific illnesses/treatment like Cataract, Hernia, Sinusitis, Joint replacement
surgery Varicose veins etc.
• Chronic Management program waiting period: As per terms of the policy
• Pre-existing disease waiting period: 48 months on Essential plans and 36 months on Enhanced plans

*This is an indicative list. Please refer to policy wordings for detailed list of exclusions and waiting periods.
 You can avail a long term discount of 7.5% and
10% upon selecting a 2 and 3 year policy respectively.

Health Insurance
Aditya Birla Health Insurance Co. Limited

Aditya Birla Health Insurance Co. Limited. IRDAI Reg.153. CIN No. U66000MH2015PLC263677.
Product Name: Activ Health - Platinum Enhanced, Product UIN: IRDAI/HLT/ABHI/P-H/V.1/32/16-17,
Advertisement UIN: ABHI/LF/18-19/1748. Address:- 9th Floor, Tower 1, One Indiabulls Centre, Jupiter Mills Compound, 841, Senapati Bapat
Marg, Elphinstone Road, Mumbai 400013. Email: [email protected], Website: adityabirlahealthinsurance.com,
Telephone: 1800 270 7000, Fax: +91 22 6225 7700. For more details on risk factors, terms and conditions please read terms and conditions
carefully before concluding a sale. Trademark/Logo Aditya Birla Capital is owned by Aditya Birla Management Corporation Private Limited and
Trademark/logo HealthReturns, Healthy Heart Score and Active Dayz are owned by MMI Group Limited. These trademark/Logos are being used
by Aditya Birla Health Insurance Co. Limited under licensed user agreement(s). HealthReturnsTM is an offering under Aditya Birla Health Insurance
plan and will be managed end to end by Aditya Birla Health Insurance Co. Limited.