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Top Features From Aditya Birla Health Plans

HDFC Ergo General Insurance Company is a leading name in the general insurance industry. The company has been established as a joint venture between HDFC Limited and ERGO International AG. While HDFC Limited is a leading financial services company of India, ERGO International AG is the main insurance company of the Munich Re Group. HDFC Ergo offers a range of general insurance products which meet the insurance requirements of common individuals as well as corporate entities. You can find motor insurance plans, travel insurance plans, fire insurance plans, commercial insurance plans and health insurance plans offered by HDFC Ergo. All the company’s plans provide a good scope of cover and come with competitive premiums

  •  The company is spread across more than 100 cities of India with 120+ branches and 3000+ employees working for it
  • ICRA has conferred the company with a rating of ‘iAAA’ because of the high claim settlement record that the company has
  • The company also enjoys ISO certification for its efficient services in customer service, policy issuance, technological developments, etc.
  • The company has won various awards over the years since it was established
  • More than 1 crore customers are currently being served by HDFC Ergo

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Exclusions Across Aditya Birla Health Plans

  • Pre-existing illness waiting period:All pre-existing illnesses are excluded for an initial 48 months. For example, diabetes, hypertension, coronary artery disease etc are not covered during this waiting period
  • Initial waiting period clause:Treatment expenses incurred for any disease/illness/injury for the initial 30 days from the date of policy inception are excluded.
  • Specific treatments/illnesses –waiting period-Expenses incurred for specific illnesses/treatments are excluded for a specified waiting period (one to two years). Benign ENT disorders and surgeries and polycystic ovarian diseases are excluded for the first one year from the date of inception of the policy. Surgery of hernia, hydrocele, non-infective arthritis, Undescended testes, cataract, surgery of benign prostatic hypertrophy and hysterectomy etc. are excluded for initial two years from the date of inception of the policy.
  •  Maternity waiting period-Any treatment arising from or traceable to pregnancy, childbirth including caesarean section will not be covered until 24 months of continuous coverage has elapsed for that particular insured person since the inception of the maternity expenses benefit under the policy
  • War and nuclear perils:Any treatment for illness/injury directly or indirectly caused by or attributable to war, invasion, warlike operations (whether war be declared or not), the act of foreign enemy, civil war, public defence, uprising, rebellion, insurrection, revolution, military or usurped acts or by nuclear weapons and materials
  • Breach of law:An insured person committing or attempting to commit a breach of law with criminal intent are not covered
  • Self-inflicted injuries:Suicide, attempt to suicide and intentional self-injury and willful or deliberate exposure to danger are not covered
  • Military operations and Adventurous activities:Participation in naval, military or air force operations, circus, diving, aviation, scuba diving, racing in wheels or horseback, hang-gliding, mountain climbing, parasailing, bungee jumping, river rafting, skydiving, ballooning, ice sports etc are not covered
  • Alcohol and/or drug abuse:Any injury caused due to or arising out of alcohol consumption or being under the influence of intoxicating drugs
  • Cosmetic treatments:Plastic surgery, cosmetic surgery and aesthetic treatments (other than necessitated due to accidents/illnesses), re-shaping treatments and surgeries and any complications arising out of it are not covered
  • Dental treatments:Any dental treatment/surgery which is cosmetic, corrective or of aesthetic procedure, crowns, filling of cavity, root canal treatment etc are not covered
  • Non-allopathic treatments: Expenses incurred for non-allopathic treatment of illness/injury are not covered
  • Unproven and experimental procedures:Any treatment that has no proper base which is still in the experimental and investigational phase are not covered
  • Vaccination:Vaccination or inoculation of any kind, unless it is posted animal bite and there is hospitalisation as an in-patient
  • Congenital illnesses:Any expenses related to the treatment of congenital illness, birth defects or anomalies and genetic disorders are not covered
  • Mental disorders:Any expenses incurred for treating mental illness, stress, psychiatric or psychological disorders are not covered
  • Stem cell therapy : Stem cell therapy or surgery, or growth hormone therapy are not covered
  • Sexually transmitted diseases : All expenses incurred on the treatment of venereal diseases and sexually transmitted diseases like HIV/AIDS, LAV are not covered
  • Pregnancy and childbirth : Expenses incurred for treatments arising from pregnancy, miscarriage, abortion, childbirth, caesarean section and complications arising out of it are not covered. The policy also excludes treatments for fertility, subfertility, infertility and related complications
  • Developmental problems : Treatments for developmental problems, learning difficulties, for example, dyslexia, behavioural problems including attention deficit hyperactivity disorder are not covered
  • Non-medical expenses : Non-medical charges incurred during the treatment and hospitalisation are not covered
  • Overseas treatment : Treatments availed outside India are not covered

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FAQs

Domiciliary hospitalisation treatment refers to treatment taken at home which would otherwise have required hospitalisation. This could be due to patients conditions to unable to move to a hospital or due to unavailability of beds in hospitals

Following are the treatments/illnesses that are excluded under domiciliary hospitalisation cover

  • Asthma
  • Bronchitis
  • Diarrhoea and all types of dysenteries including gastroenteritis
  • Chronic Nephritis and Chronic Nephritic syndrome
  • Pyrexia of unknown origin for less than 10 days
  • Diabetes mellitus and Insipidus
  • Epilepsy
  • Hypertension
  • Influenza, cough and cold
  • Tonsillitis, Upper respiratory tract infection including laryngitis and Pharyngitis
  • Arthritis, Gout and Rheumatism
  • All psychiatric and psychosomatic disorders

Following are the major 11 critical illnesses covered under the Activ Health plan

  • Cancer of specified severity
  • Myocardial infarction (first heart attack of specified severity)
  • Open chest CABG
  • Coma of specified severity
  • Open heart replacement or repair of heart valves
  • Kidney failure requiring regular dialysis
  • Stroke resulting in permanent symptoms
  • Major organ/bone marrow transplant
  • Permanent paralysis of limbs
  • Motor neurone disease with permanent symptoms
  • Multiple sclerosis with persisting symptoms

Health insurance plans not only give comprehensive protection but also benefit you by saving a few amounts of tax. You can avail tax deduction on premiums paid towards health insurance plans taken for self, spouse, children and parents. Here are the details

Description

 The maximum premium for self, spouse and dependent children     Maximum premium for parents (dependent/non-dependent) Total deductions available under Section 80D of IT Act
All members of the family < 60 years of age INR 25,000 INR 25,000 INR 50,000
Self, spouse and children < 60 years ageEither of the parents > 60 years age INR 25,000 INR 50,000 INR 75,000
Self > 60 years ageSpouse and children < 60 years of ageParents > 60 years age INR 50,000 INR 50,000 INR 1,00,000

 

Aditya Birla Health Insurance Company helps you focus on well-being and health management along with protection offered in the way of a diverse range of health insurance plans. Below are the wellness programs offered by the company

  • Activ together – you can subscribe to get valuable input on health & fitness, diet & nutrition and lifestyle conditions
  • Activ age – you can know your active age health-wise by filling in just a simple questionnaire. This would help you improve and maintain your good health
  • Healthy heart score – you can calculate heart score on their website. Aditya Birla Health Insurance policies reward you for maintaining a good score!
  • Activ Dayz – you can keep updating about your activities that promote good health and earn rewards.
  • HealthReturns – It is a monetary reward offered by Aditya Birla Health Insurance Company for staying fit and maintaining good health for each insured person.

Following are the major health services offered by Aditya Birla Health Insurance Company

  • Chronic care management program – This service comes as an in-built feature with Activ Health Platinum cover. In case an insured or his family members are suffering from chronic diseases like diabetes, blood pressure and cholesterol, the program helps them manage well to live a healthy life through experts help. Along with this, there is coverage offered for consultation with medical practitioners, diagnostic tests and medicines.
  • Wellness coaching –Under this service, insured is given personal coaching to maintain good health. Insured can seek coaching by various options like ask specialist, ask a doctor, ask a dietitian, doctor on call, a counsellor on call and smoke cessation.

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