Activ Assure Diamond

The policy provides coverage for the medical expenses for one or more of the following arising out of the insured person’s hospitalization during the policy period, following an illness or injury that occurs during the policy period room rent, ICU (Intensive Care Unit), OT (Operation Theatre), nurse charges, medicines, medical practitioner’s fees including fees of specialists and anesthetists, anesthesia, blood, oxygen and blood transfusion charges, surgical appliances and prosthetic devices.

30 days of pre-hospitalization and 60 days of post-hospitalization expenses are covered under the policy.

The policy provides coverage for 586 day care procedures .

Covers your medical expenses in case you need to get treated at home.

This is available when:

• The condition of the patient is such that he/she is not in a condition to be removed to a hospital, or
• The patient takes treatment at home on account of non-availability of room in a hospital.

Covers the medical expenses incurred for organ donor’s treatment for harvesting of the organ donated.

This covers the costs incurred on transportation of the Insured Person by road ambulance to a hospital for treatment in an emergency:

• Network providers – Actual expenses.
• Non network providers – Reimbursed up to max of Rs 5000 per hospitalization.

Covers the medical expenses on a reimbursement basis for sum insured who has undergone Ayurveda / homeopathic treatment.

Covers a fixed amount of daily allowance for a complete and continuous period of 24 hours of hospitalization (INR 500 per day, maximum 5 days per hospitalization). This benefit is applicable for sum insured max up to 4 lacs.-

Covers the expenses of insured person up to 18 years of age for protection against diseases falling under vaccine preventable diseases grid mentioned in provisions.

• Health Checkup program: Annual (comprehensive health checkup in a policy year.
• Second e-opinion on critical illness: This benefit is available in case a person is diagnosed with any of 15 critical illness’.
• Reload of sum insured: Up to 150% of sum insured as per the provision once in a active policy year, reload is provided in case of sum insured inclusive of bonus is insufficient as a result of previous claims (max up to 5 lacs).
• Domestic & International Emergency Assistance Services: Emergency medical evacuation & medical transportation is provided to the Insured, if travelling more than 150 kms for a period of < 90 days.
• No Claim Bonus: 10% of sum insured every claim free year, max up to 100%.
• Health Returns: An insured person can earn up to 30% of premium as Health Returns. This is earned through a combination of Healthy Heart Score and Active Dayz and premium is calculated monthly basis fitness grid and scores are generated. This can be redeemed against renewal premium or other incidentals such as diagnostic tests, medicines etc.
• Health Coach: Two coaching sessions available every policy year for customers above 18 years with asthma, hypertension, hyperlipidemia or diabetes.

• Accidental & Cancer hospitalization booster: Provides additional sum insured towards medical expenses incurred following an emergency due to accident & cancer of specific severity respectively, during policy year.
• Any room upgrade: Offers choice of upgrading room type category eligibility to insured.
• Super No Claim Bonus: Over & above NCB explained above, a super no claim bonus will be applied provided insured person has not made any claim in policy year and successfully renewed the policy without any break.
• Reduction in pre-existing diseases period: This cover reduces waiting period for claims related to pre-existing diseases to 24 months.
• Unlimited reload of sum insured: Offers unlimited times reload during policy as per limits specified in policy schedule.

A no claim bonus of 10% of the basic sum insured for every claim free year will be offered accumulating maximum up to 50% of the sum insured. The already accumulated bonus will not reduce even when you claim in any subsequent year.

One can avail long-term discount of 7.5% and 10% upon selecting a 2 and 3-year policy respectively. One can avail family discount of –

• 5% in case of 2-3 member multi individual policy.
• 10% in case of 4-6 member multi individual policy.

At the inception of the policy, the client has a period of 15 days from the date of receipt of the policy from the date of receipt of the policy document to review the terms and conditions of this policy. If customer has any objections to any of the terms and conditions, customer may cancel the policy stating the reasons for cancellation and provided that no claims have been made under the policy. If the insured person has not made any claim during the free look period, the insured person shall be entitled to—

• A refund of the premium paid less any expenses incurred by company on medical examination of the Insured Persons and the stamp duty charges or;
• where the risk has already commenced and the option of return of the policy is exercised by the policyholder, a deduction towards the proportionate risk premium for period on cover or;
• Where only a part of the insurance coverage has commenced, such proportionate premium commensurate with the insurance coverage during such period.

• War, act of foreign enemy, uprising, revolution, insurrection, military 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.

The above exclusions are indicative and not exhaustive. For a detailed list of exclusions, refer to the document at the bottom of this page.

Should you wish to cancel your Activ Assure Diamond insurance coverage, you can contact Aditya Birla Health Insurance Co. Limited, through the contact details mentioned in the product brochure.