Overview
The Aditya Birla Activ Health Platinum Essential is a health insurance plan offering sum insured options ranging from ₹2 lakhs to ₹50 lakhs. Its key features include Day-1 coverage for chronic conditions like diabetes and hypertension, mental illness hospitalization, and home treatments. The plan rewards healthy behavior through HealthReturns™, which offers up to 50% of the premium back. Additional features include pre- and post-hospitalization coverage (30 and 60 days), access to wellness coaching, and optional co-payment waiver benefits, making it a comprehensive healthcare package.
Experts Review
Written by Nikhil Nair
Senior Writer
The Activ Health Platinum Essential by Aditya Birla is a comprehensive health insurance plan that excels in chronic disease management with Day-1 coverage for conditions like diabetes and hypertension—an uncommon feature in most policies. Mental illness, hospitalizatio,n and home treatments further enhance its appeal by addressing modern healthcare needs. The HealthReturns™ program stands out, incentivizing active lifestyles by offering up to 50% of the premium back, which can be used for medical expenses or premium discounts.
The plan’s affordability is another highlight, making it accessible to a wide audience. However, it has certain drawbacks. Room rent restrictions, disease-wise sub-limits on conditions like cataract, knee replacement, etc., and a mandatory 20% co-payment apply unless waived with an additional premium, increasing out-of-pocket expenses for some policyholders.
Pros
Feature set is satisfactory.
Insurer has a solid track record with great claim and service metrics.
Cons
No Restoration Benefit, which is a notable gap.
Maternity benefits not offered, which could be a drawback for some.
Doctor consultations are not covered, which is a key feature. Need to opt add-on for doctor consultations.
Aditya Birla
Key Insights
Founded
2016
Aditya Birla was established 9 years ago, making it a relatively new entrant with a developing track record.
Claims Experience
95% claims settled in 30 Days
Aditya Birla settles 95% of all claims it receives demonstrating strong credibility.
Network Hospitals
12,000+
Aditya Birla has a strong network with over 12,000 hospitals, ensuring wide accessibility and convenience for policyholders.
Complaints
22 complaints per 10,000 claims registered
Aditya Birla experiences a moderate number of complaints, indicating room for improvement in addressing customer concerns.
Features
All
Great
Good
Bad
Co-payment
The policy will only cover 80% of the final bill. The rest is on you. They call this a co-payment.
Customisable
Waives off 20% of the co-payment
Room Rent
Customisable
Change Any Room to Shared Room or Single Private Room.
Disease sub-limit
Your insurance cover won’t be fully available in case you are treated for Angioplasty, Knee or hip replacement, Cataract, Cholecystectomy and a few other diseases. Meaning the insurance company has a cap on the total amount they’ll pay out if you are treated for these specific illnesses.
Pre existing diseases waiting
If you are already dealing with Asthma, Hypertension, Hyperlipidemia, Diabetes, then the insurer will cover you from day 1. However, if you are dealing with other pre-existing diseases including thyroid, kidney stones, etc., then you’ll have to wait 3 years before they start covering these complications.
Pre/Post hospitalization
No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount in full for a pretty reasonable duration - 30 days before you are hospitalized and 60 days after discharge. This includes the cost of medication by the way.
Add-ons
Future Secure
Recommended
Cover increases in line with inflation, consumables covered, and No Claim Bonus is protected if total claim amount is less than 25% of sum insured.
Co-Payment Waiver
Recommended
Waives off 20% of the co-payment
OPD
Get coverage for outpatient consultations, prescribed diagnostics and pharmacy up to defined limits as chosen.
Hospital Cash
Hospital cash benefit paid out if hospitalization is at least 1 day, with a maximum payout of ₹500 to 5000 for up to 30 days.
Critical Illness
Paid out as a lump sum amount for Critical illnesses between Rs. 3 lakhs to Rs. 20 lakhs based on the cover chosen.
International
Covers international planned treatments up to defined limits for listed major illnesses on reimbursement/cashless basis.
Personal Accident Cover
Paid out as a lump sum amount for Accidental Death, Total Permanent Disability between Rs. 5 lakhs to Rs. 30 lakhs based on the cover chosen.
Room Modifier
Change Any Room to Shared Room or Single Private Room.
Cancer Booster
Get additional coverage up to 100% of Sum Insured for medical expenses linked to Cancer of Specified Severity.
Tele-OPD Consultation
Each insured member can get unlimited e-consultations from General Physicians.
Vaccine Cover
Get coverage against vaccination for diseases declared as pandemic or epidemic up to specified limits per insured person.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Expenses related to any admission primarily for diagnostics and evaluation purposes are excluded.
Diagnostic expenses not related or incidental to current diagnosis and treatment are excluded.
Expenses for admission primarily for bed rest and not for treatment are excluded.
Custodial care at home or in a facility for help with daily activities is excluded.
Services for terminally ill individuals addressing non-medical needs are excluded.
Disclaimer: For illustration purposes only - exact terms are in the policy wording.
Specific Illness
The following illnesses are not covered under the policy for 2 years.
Cataract
Glaucoma
Refractive Error Correction
Sinusitis
Rhinitis
Waiting Period
30 days Initial waiting period
2 years Specific illness waiting period
3 years Pre-existing disease waiting period
Ditto's Take
◦ Standard ◦
After a close look at the waiting periods, it’s safe to say they are fairly standard.
What's missing in the policy
No Restoration Benefit.
Maternity benefits not offered.
Doctor consultations are not covered. Need to opt add-on for doctor consultations.
Customer Reviews
S
Siddharth Gupta
Cashless home treatments offer great convenience and comfort.
S
Shilpa Sharma
Day-1 coverage for chronic conditions like diabetes & hypertension is a standout feature!
S
Shweta Verma
Mental illness hospitalization coverage addresses a critical modern healthcare need.
S
Sumitra Joshi
Focus on chronic conditions is good, but ensure overall coverage for other ailments is also robust.
S
Sudha Khan
The 50% HealthReturns™ sounds great, but achieving the activity levels might be tough for some.
M
Mrs. Archana Verma
The Expert Health Coaches of ABHI have helped me understand the OPD benefits, and various medical reimbursements that I'm entitled to get. I'm especially thankful to Dr. Nitin, who diagnosed a complication in my Diabetes on the telephone and saved me from hospitalisation. -
Compare Policies
Still confused?
Talk to our expert
advisor for
instant clarity
Frequently Asked Questions
Does Activ Health Platinum Essential have waiting periods?
- 30-Day Waiting Period: Hospitalizations won’t be covered for the first 30 days of the policy unless it’s an accident.
- Specific Illness Waiting Period: There’s a 2-year waiting period for a list of diseases which is a mandate before you can start claiming.
- Pre-Existing Disease Waiting Period: There's a 3-year waiting period for any pre-existing disease you may have while buying the policy.
- Chronic Management Program Waiting Period: No waiting period for illnesses and conditions arising out of Asthma, Hypertension, Hyperlipidemia, Diabetes.
Does Activ Health Platinum Essential have room rent restrictions?
Does Activ Health Platinum Essential offer a restoration benefit?
TALK TO OUR ADVISORS
Get real help from advisors who listen, guide and go the extra mile for you.