Aditya Birla India health insurance

Aditya Birla General health insurance - review

• Why Should a customer opt for Aditya Birla Health?

  • Nationwide Cashless Hospital network of 7,000+ hospitals
  • 8.9 million lives insured and 630,000 + claims settled since inception
  • Through their app, get access to 800+ fitness centres including Yoga, Gym centres and more
  • Get special rates on pharmacy products across 2,300+ outlets in 250 cities
  • Offer services like HealthReturns which reward insureds who maintain active and health lifestyles:
    • Earn up to 30% of your premium as HealthReturnsTM.
    • This is earned through a combination of Healthy Heart Score™ and Active DayzTM

• What's Great about Health Insurance by Aditya Birla?

  • Sum Insured Options - Wide range of Sum Insured from ₹2 lakhs - ₹2 crores under the Diamond Plan
  • Cashless Treatment - Get admitted to one of the 7,000+ hospitals across the country in their network and avail cashless treatment facility
  • Reload of Sum Insured at 150% - Even if your Sum Insured gets exhausted, we will reload your Sum Insured amount by another 150%.
  • Day Care Procedures - ABHICL covers you for 586 listed day care procedures even if hospitalization is less than 24 hours.
  • Pre & post Hospitalisation Cover You will be covered for medical expenses not only during your hospitalization, but also from 30 days before hospitalization and 60 days after hospitalization
  • AYUSH Cover - Covers treatments given under Ayurveda, Unani, Siddha, Yoga & Naturopathy and Homeopathy systems.
  • Emergency Assistance Services - Cashless Treatment Domestic & International emergency assistance including Air Ambulance.
  • Earn up to 30% of your premium as HealthReturns™ Use it to pay
    • your next policy premium
    • for medicines
    • for diagnostic tests
    • as a fund for any health contingency.
  • Covers pandemics like the coronavirus – India is one of worst affected countries when it comes to the COVID-19. We cover the same as part of our health insurance so you needn’t really get a separate coronavirus policy.
  • Discounts on Premiums
    • 7.5% - For 2 year policy
    • 10% - For 3 year policy
    • 5% - 2-3 member Multi Individual Policy
    • 10% - 4 or more members Multi Individual Policy
  • Cumulative Bonus - A reward for staying healthy! You can get yearly cumulative bonus for claim-free years.
  • In-patient treatment includes Hospital room rent or boarding expenses, nursing, Intensive Care Unit charges Operation Theatre charges, Medical Practitioner’s charges, fees of Surgeon, Anaesthetist, Qualified Nurse, Specialists, the cost of diagnostic tests, medicines, drugs, blood, oxygen, the cost of prosthetics and other devices or equipment if implanted internally during a Surgical Procedure. A minimum period of 24 consecutive hours hospitalization as in-patient is must.

• Claim Process :

  • Call us at : Toll Free 1800-270-7000 (for Health Claims including Covid claims) Whatsapp on +91 8828800035
  • Email : Care.healthinsurance@adityabirlacapital.com
  • Visit us Online at : https://www.adityabirlacapital.com/healthinsurance/#!/claim
  • Write to Us at : Claims Department, Aditya Birla Health Insurance Co Ltd, 5th Floor, Modi Business Centre,Kasarvadavali, Mumbai, Thane West 400615
  • Visit : Anywhere in India, closest or in your city of residence

  Cashless Hospitalization Process - Claims Journey

  Follow below steps to avail Cashless facility through our In house Health Claims Management:

  Step I	To avail cashless facility approach to our Network Hospital. For a list of our network hospitals, kindly visit https://www.eindiainsurance.com/aditya-birla/health/
  Step II	Show patient’s Aditya Birla Health Insurance Cashless Card or provide policy number. Also show valid ID proof like Passport, PAN card, Voter’s ID etc. for identification purposes.
  Step III	Post identification, the network hospital will submit the Cashless Hospitalisation Claims Form to us. To speed up the process of Cashless Pre - authorization, intimate us by filling the request form. Emergency - Cashless Hospitalization Request Form needs to be submitted within 48 hours from the time of hospitalization. Planned - Cashless Hospitalization Request Form needs to be submitted 3 days before hospitalization.
  Step IV	We will review and provide our decision to the network hospital and also send a SMS and an e-mail to you within 2 hours, when a request is received within usual business hours.You can also check your claim status by logging on https://www.adityabirlacapital.com/healthinsurance/#!/claim
  Step V	We will process the claim (as per policy terms & conditions) with the hospital after the completion of all the formalities.

  Reimbursement Claim Process - Claims Journey

  Reimbursement claim is when the expenses incurred during Hospitalization or bills of Hospitalization are directly settled by the Insured with the Hospital and post discharge from Hospital claimed by the Insured from the Insurer for reimbursement. Follow below steps to lodge your Health Insurance Claim through our In house Health Claims Management:

  Step I	For all claims for which Cashless Facilities have not been pre-authorised 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: Name & Address of the Policyholder; Health Card, Photo ID, KYC documents Nature of Illness or Injury and the Treatment/Surgery taken; Name and address of the attending Medical Practitioner; Hospital where Treatment/Surgery was taken; Date of Admission and date of discharge; Any other information that may be relevant to the Illness/ Injury/ Hospitalization
  Step II	Collect the relevant claims documents and submit within 15 days to the below address: Claims Department, Aditya Birla Health Insurance Co Ltd, 5th Floor, Modi Business Centre, Kasarvadavali, Mumbai, Thane West 400615
  Step III	We will review and approve claim accordingly / seek further information / documents / reject the same. (as per the terms & conditions). If your request for reimbursement of expenses is approved, we will reimburse the approved amount through NEFT to your registered bank account. In case of any information deficiency or further information requirements, you will be communicated to ensure resolution of the same at the earliest. If your request for claim is declined, you will be communicated the same along with valid reason(s) for rejection. All communication will be done on your registered e-mail and contact number.

  
  For reimbursement claim, documents to be submitted within 15 days from the date of discharge from hospital Collect below mentioned relevant document in original from the hospital and submit them to us within 15 days of discharge from the hospital :

  • Claim form Part A (Duly completed by Insured)
  • Claim form Part B (Duly completed by Hospital)
  • Health card or Policy copy
  • KYC documents (Photo ID, Address and age proof)
  • Copy of Hospital Registration Certificate.
  • Original discharge card / day care summary / transfer summary or death Summary.
  • Original final hospital bill with break up along with all the original deposit and final payment receipts.
  • Original invoice with the payment receipt for those charges which are billed outside the main hospital bill.
  • Implant stickers & invoice for all implants used during the surgeries.
  • Letter from the treating medical practitioner stating complaints, duration, past history and treatment details.
  • All the previous consultation papers for the current ailment.
  • All the original diagnostic reports (including imaging and laboratory) along with prescription and Bills.
  • Pharmacy/Medical Bills along with prescription.
  • In accidental cases additional documents required are
    • Medico Legal Certificate MLC / FIR copy
    • Letter of the treating from medical practitioner stating the details of accident/trauma and influence of alcohol/intoxication
    • Pre and post-operative imaging reports

  
  Note: This list is indicative and not exhaustive may vary depending on the case. Final settlement of claim will be done post receipt of hardcopy of the above mentioned documents to us.
  

  Claims FAQ’s

  What is a Health Card?
  It is an Identity card which is issued to each and every person covered under the Health policy. This card would entitle you to avail cashless hospitalization facility at any of our network hospitals.
  What are the benefits of a health card?
  A health card mentions the contact details the TPA. In case of a medical emergency, you can call on these numbers for queries, clarifications and for seeking any kind of assistance. You need to show the health card at the hospital.
  What is a TPA?
  Third Party Administrator is a service provider appointed by your insurance company to provide various necessary services related to benefits mentioned in the health policy to you.
  What is a Network Hospitals?
  These are the hospitals that form part of the TPA's network to provide cashless service to you upon presentation of health-card.
  What is a Non-network Hospitals?
  Hospitals which are not part of TPA's hospital tie-up list are called Non-network hospital. The bills are settled by patient & the relevant documents and bills are then submitted to the TPA. The amount, accordingly, is reimbursed to the patient.
  How long does it take to get an approval from TPA?
  TPA will issue the letter of admissibility of the claim within 3-6 hours provided all the relevant documents are submitted.
  Within how many days should I submit the claim?
  The claim must be filed within 15 days from the date of discharge from the Hospital or completion of treatment.
  What is the maximum number of claims allowed over a year?
  Any number of claims is allowed during the policy period. However the sum insured is the maximum limit under the policy.
  

• Exclusions under Aditya Birla Health Health Plan

  The major exclusions under health insurance policy are:

  • Waiting Period
    • Initial Waiting Period 30 days in the first year, except accident
    • Specific Illness Waiting Period 2 years for Cataract, Hernia, Sinusitis, Joint replacement surge¬ry, Varicose veins etc
    • PED Waiting Period of 48 months
    • Mandatory 20% Co-Payment - For age of entry¬ at 61 yrs
  • Substance abuse and Addictions by the Insured
  • War, act of foreign enemy, uprising, revolution, insurrection, milita¬ 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 & surgeries
  • Hearing aids, spectacles or contact lenses including optometric therapy
  • Psychiatric or psychological disorders, mental disorders
  • Any accidental hospitalization under the influence of alcohol
  • Unproven or Experimental treatment
  • Hazardous Activities /Professional Sports/Defence Operation
  • Sexually Transmitted Infections & Disease • Sleep Disorders and Sleep Problems
  • Any stay in Hospital without undertaking any treatment or where there is no active regular treatment by the Medical Practitioner
  • Any treatment received outside India.

List of Aditya Birla health insurance policies