In an individual policy, each person is covered for a separate sum insured as selected at the time of buying the policy. In a Family Floater plan, all insured members are covered on a floater sum insured basis. The sum insured for a family floater is our maximum liability for any and all claims made by all the insured members (a single sum insured which is shared by all members).

Your policy is valid for the duration mentioned in your policy schedule. You have an option of buying our health policy for 1 year, 2 years and a 3 years term. You can renew your policy at the end of the policy term.

You can avail of a long term discount of 7.5% and 10% on your premium for 2 and 3 years policy respectively.

You can avail a 5% discount on premium on covering 2 family members and a 10% discount on premium on covering 3 or more family members in an Individual policy type.

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. 25,000 in respect of medical insurance premium paid on the health of yourself, your spouse and children.

In addition to it, if you pay a health insurance premium for your parents you will be entitled to an additional deduction of up to Rs. 25,000/- (if your parents are not senior citizens) or up to Rs. 30,000/- (if your parents are senior citizens)

A pre-existing disease 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.

We offer you a lifetime renew-ability for this health plan, subject to payment of the premium and the fulfillment of other policy conditions.

Yes, you can request for an enhancement of the sum insured at the time of renewal. However, the enhancement is subject to an underwriting decision and the applicability of waiting periods such as first 30 days waiting period, two years waiting period and pre-existing disease waiting period.

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.

We may apply a risk loading (additional premium) on the premium payable based on the details and declarations in the proposal form and the results of the pre-policy medical examination.

Your health insurance policy is issued on the basis of information provided and disclosed by you regarding yourself and the other insured persons in the proposal forms. We assume that this is complete and correct and underwrite policy basis the same. In case we find that there is a case of fraud, misrepresentation, or nondiscloser, we have the discretion to terminate your policy with immediate effect without refund of payments made or fulfilment of claims raised.

The premium for your Activ Health policy depends on following factors:

1. Your age

2. Gender (for Individual plan)

3. Plan selected (Essential / Enhanced)

4. Plan type (Individual / Floater)

5. Number of members covered (in Individual policy, you get a discount on premium for covering 2 or more members under the same policy)

6. Selected term for policy (you get a 7.5% and a 10% discount on premium respectively for buying 2 years and 3 years term policy)

7. Selected sum insured

8. Selected room category

9. Selection of optional covers (including amount of deductible selected under deductible optional cover; amount of OPD cover selected under OPD expense cover (where applicable), and amount of daily cash benefit selected under hospital daily cash cover)

10. Any pre-existing condition that you may have at the time of first buying this policy or detected at the time of the pre-policy medical check up

You also get an additional discount on premium if you are an employee of Aditya Birla Group.

Yes, newly wedded spouse and a new born baby can be added in the policy during the term of the policy by paying the premium, as applicable.

No, you can only be covered under an individual sum insured policy if you are suffering from chronic conditions such as Asthma, Diabetes, Hypertension and/or Hyperlipidaemia.

We cover medical expenses that you incur before your admission to a hospital within the policy period. The number of days for which this cover is applicable will be as per the plan chosen by you at the time of buying the policy. Please note such expenses will be covered subject to your hospitalization claim being admissible and subject to the other terms and conditions of your policy.

We cover medical expenses that you incur after your discharge from the hospital. The number of days for which this cover is applicable will be as per the plan chosen by you at the time of buying the policy. Please note such expenses will be covered subject to your hospitalization claim being admissible and subject to other terms and conditions of your policy.

Day care treatment means medical treatment, and/or a surgical procedure which is:

1. Undertaken under general or local anaesthesia in a hospital/day care centre in less than 24 hours because of technological advancements and
2. Which would have otherwise required hospitalization of more than 24 hours.

As many as 527 listed day care procedures are covered under the Activ Health policy.

No, OPD treatment is not covered under the day care benefit. However, you can get a reimbursement for your OPD cover if you have opted for an optional cover ‘OPD expenses’ or you can reimburse such expenses from your accrued HealthReturns™.

Yes, we cover road ambulance to a hospital for treatment in an emergency following an illness or injury, subject to limits, terms and conditions applicable as per your plan.

Coverage shall also be provided under the below circumstances, if the medical practitioner certifies in writing that:

1. It is medically necessary to transfer the insured person to another hospital or diagnostic center during the course of hospitalization for advanced diagnostic treatment in circumstances where such a facility is not available in the existing hospital.

2. It is medically necessary to transfer the insured person to another hospital during the course of hospitalization due to lack of a super-speciality treatment in the existing hospital.

No, medical expenses for donor are covered if the organ is for the use of insured person, who is recipient for the organ.

We provide for a 100% reload of the sum insured specified in the policy schedule, in case available sum insured inclusive of earned cumulative bonus (if any) is insufficient as a result of previous claims in that policy year.

The reload of sum insured is available only for future claims and not in relation to any illness / injury (including its complications) for which a claim has been admitted for the insured person during that policy year.

Reload shall not apply to the first claim in the unless related to a road traffic Accident, where the claim amount exceeds the Sum Insured.

Yes, unless there is unsufficient information to determine admissibility for hospitalization.

If the policy is issued on a Floater basis, the reload of sum insured will be available on a Floater basis for all the insured people in the family.

During a policy year, the aggregate claim amount payable, subject to admissibility of the claim, shall not exceed the sum of:

(1) The sum insured

(2) Cumulative bonus (if earned)

(3) Reloaded sum insured (if applicable)

Benefits for optional covers, chronic management program are over and above this.

Additionally, if you have funds under HealthReturns™, you may choose to reimburse this against the medical expenses.

Simply put, co-pay is a cost sharing requirement under a health insurance policy that provides that the policyholder/insured will bear a specified percentage of the admissible claims amount. A co-payment does not reduce the sum insured.

A 20% co-pay is applicable for the Essential plan. No mandatory co-pay is applicable for the Enhanced plan.

The zones are as below:

Zone I: Bangalore, Gurgaon, Mumbai, Navi Mumbai, New Delhi, Thane

Zone II: Ahmedabad, Kolkata, Noida, Pune, Hyderabad, Chennai, Chandigarh, Mohali

Zone III: Rest of India excluding the locations mentioned under Zone I & Zone II

Yes, we offer an option to select a zone higher than that of the applicable zone as per the city of residence on the payment of the relevant premium at the time of buying the policy or at the time of renewal.

There is no co-payment for treatment if hospitalization is availed in lower zone (Zone III in your case). For availing treatment in a higher zone, a co-payment is applicable. In your case since the applicable zone is II and if treatment is availed in Zone I, a 10% co-payment will be applicable.

Yes, a claim is admissible even if the treatment is availed in a room category higher than the eligible room category. However, a co-payment will be applicable in case of treatment in a higher room category. In your case the co-payment applicable is 15%.

We offer a benefit as a percentage of payable hospitalization claims, if the treatment is availed at a room category lower than the eligible room category, as per your policy schedule. The benefit percentage is as per the room category and zone. It is defined in the policy wordings. The benefit is credited as HealthReturns™ in respect of the insured person.

If the insured person is hospitalized during the policy period for the treatment of an injury suffered due to an accident where hospitalisation continues for at least 10 consecutive days, then we will pay the lump sum amount specified in the policy schedule. This benefit amount will not reduce the sum insured.

Second E-opinion is available for 11 critical conditions namely: cancer of specified severity, myocardial infarction, open chest CABG, open heart replacement or repair of heart valves, coma of specified severity, kidney failure requiring regular dialysis, stroke resulting in permanent symptoms, major organ / bone marrow transplant, permanent paralysis of limbs, motor neuron disease with permanent symptoms, multiple sclerosis with persisting symptoms.

We provide emergency medical assistance when an insured person is travelling a 150 (one hundred and fifty) kilometres or more away from his/her residential address as mentioned in the policy schedule for a period of less than 90 (ninety) days. Emergency assistance services are provided for emergency medical evacuation and medical repatriation, subject to terms and conditions in your policy wordings.

No, in case of Family Floater Policy, once selected, the optional covers shall apply to all the insured persons without any individual selection.

If this benefit is in force, the applicable mandatory co-payment under Essential plan shall not apply on payable claims under the policy. You can opt for this waiver of mandatory co-pay cover by paying an additional premium.

A waiting period of 24 months from the policy start date shall apply to the treatment, whether medical or surgical and of the illness / conditions and their complications as below:

Please refer to permanent exclusion section in the policy wordings to know the diseases / conditions / treatment that are not covered in this health policy.

You can earn HealthReturns™ by way of (subject to plan opted):

1. Percentage of premium earned through your Healthy Heart Score™ and Active Dayz™
2. Benefit for hospital room choice
3. Carried forward unutilized OPD expenses plus earned cumulative bonus (where applicable)

Step 1: Complete the Health Questionnaire & Health Assessment (applicable for each individual insured person)

Step 2: Comply with the Chronic Management Program

Step 3: Earn Active Dayz™ by being physically active on an ongoing basis or earn HealthReturns™ based on your results of fitness assessment and Healthy Heart Score™

Please refer to policy wordings for detailed explanation of each of these steps.

Funds under HealthReturns™ may be utilized for:

1. In-patient medical expenses and day care treatment, provided that the sum insured, cumulative bonus and reloaded sum insured (if applicable) are exhausted during the policy year.
2. Payment of co-payment and deductible (wherever applicable).
3. For non-payable claims, in case of an in-patient hospitalization or day care treatment.
4. Non-medical expenses, that would not otherwise be payable under the policy.
5. Out-patient expenses up to the value of accrued funds, subject to complete utilization of OPD expenses (if opted under the policy)
6. Alternative treatments or you can also utilize the funds under HealthReturns™ to pay your premium for the renewal of the policy.

No, certain diseases like asthma are specifically excluded under domiciliary hospitalization. However, in-patient hospitalization expenses for asthma is covered under the policy.

Any treatment taken during the first 30 days of the commencement of the policy shall not be covered under the policy, unless the treatment is required as a result of an accident that happened after the policy start date. Waiting period for hospitalization arising out of chronic conditions defined eligible for Chronic Management Program is 90 days from commencement. Standard waiting times for other illnesses and procedures are applicable as defined in the policy wordings.

If the insured person who has a covered chronic condition, has already undergone tests under the Chronic Management Program within three months from date of availing this benefit, then those specific tests shall not be covered under the Health Check-up Program in the same policy year.

Under the Chronic Management Program, the insured person will be entitled to manage medical expenses for out-patient treatment of Diabetes, Hypertension, Hyperlipidemia and Asthma, as specified in the policy schedule,

1. Medical Practitioner’s consultations
2. Diagnostic test
3. Pharmacy expenses

The below mentioned conditions are covered under the Management Program:

1. Diabetes Mellitus
2. Hypertension
3. Hyperlipidaemia
4. Asthma

Yes, we will help you manage your chronic condition, diabetes, from day 1 under the Chronic Management Program. In-patient hospitalization for the chronic condition (Diabetes, in your case) will be covered after 90 days from the start of the policy. For other pre-existing disease, if any, PED waiting period as per plan (4 years for the Essential plan & 3 years for the Enhanced plan) will be applicable.

Yes, you will be covered for CMP under this policy if and when you develop such chronic conditions later.

To get the benefit under the Chronic Management Program, you must undergo a Health Assessment within 3 months from the start date.

Subject to fulfilment of other requirements, the insured person shall be managed covered under the Chronic Management Program as applicable for the particular combination.

In such a case, if you eventually get detected with a chronic condition after 6 months of the start date of the policy or after 6 months of the policy anniversary, then the benefits under the Chronic Management Program will be pro-rated to such effect as specified in the policy schedule or the endorsement schedule.

The following expenses are covered under OPD expenses:

1. Outpatient consultations by a general medical practitioner
2. Out-patient diagnostic tests prescribed by a medical practitioner
3. Pharmacy – medicines prescribed in writing by a medical practitioner

Alternative treatments shall also be covered under this benefit.

Reimbursement claims can be submitted quarterly in a policy year.

If in a policy year you do not utilize the complete limit under OPD expenses, then the unutilized amount pertaining to that year will be carried forward to the next policy year and shall be available for utilization under HealthReturns^TM.

We will provide a bonus as specified in the policy schedule at the end of the policy year, if the policy is renewed with us provided that there are no claims paid or outstanding in the expiring policy year. This is calculated as a percentage on the sum insured.

No, any earned cumulative bonus will not be reduced for claims made in the future, unless utilized. If utilized, we will reduce only to the utilized value.

If the insured persons in the expiring policy are covered on an individual basis and there is an accumulated cumulative bonus for each insured person under the expiring policy, and such expiring policy has been renewed with us on a Family Floater policy basis then the cumulative bonus to be carried forward for credit in such renewed policy shall be the lowest among all the insured persons.

If the insured persons in the expiring policy are covered on a Family Floater policy basis and such insured persons renew their expiring policy with us by splitting the sum insured in to two or more Family Floater policies / Individual policies, then the cumulative bonus of the expiring policy shall be apportioned to such renewed policies in the proportion of the sum insured of each renewed policy.

If the sum insured under the policy has been increased at the time of the renewal, the cumulative bonus shall be calculated on the sum insured of the last completed policy year.

No, claims under optional covers do not affect your policy's cumulative bonus.

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.

Each insured person above 18 years of age on the start date may avail a comprehensive health check-up in a policy year as defined in the policy wordings.

Yes, a health check-up program is available irrespective of claim status.

You can contact us to avail a health check-up at our network providers on a cashless basis. You can also claim for reimbursement for defined health check-up tests up to defined limits as per age and plan as per terms and conditions of your policy.

For calculating the 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.

If the results of the Health Assessment indicates that you suffer from any of the aforementioned chronic conditions then you shall be entitled to avail the benefits under the Chronic Management Program, after 24 months of waiting period, provided that the detected chronic condition was not a pre-existing disease, no additional premium shall be required to activate the benefits under the Chronic Management Program.

In such case, a waiting period as per the opted plan shall be applicable for the Chronic Management Program irrespective of your health status. After completion of the applicable waiting period, if in case you are found to be suffering from a covered chronic condition (through results of Health Assessment) then, we will activate the Chronic Management Program for you.

A cumulative bonus of 5% shall be applicable on the unutilized OPD expenses available at the end of the policy year, irrespective of the claims made in the policy year.

The deductible specified in the policy schedule shall be applicable in each policy year on the aggregate of all admissible claims in that policy year. Wherever a deductible option is selected, such deductible amount will be applied on each policy year on the aggregate of all admissible claims in that policy year.