Aditya Birla Health Insurance’s Activ Assure – Diamond Plan FAQs

Ans: No, we do not cover pre and post hospitalization expenses under AYUSH treatment.

Ans: There is age-based co-payment of 20% for age at entry 61 yrs. and above.

Ans: Maternity benefit is not available under Diamond plan.

Ans: Yes, Upgradation to any room in case of non-availability of single pvt room, is available for reimbursement claims as well.

Ans: Yes, we do cover Pre & Post hospitalization expenses under Day Care treatment in our Diamond product

Ans: Yes, Pre and Post hospitalization cover is applicable when a claim is accepted under domiciliary hospitalization treatment.

Ans: No, we do not have waiver of co-payment for the age 61yrs and above.

Ans: No, we do not have any sub limits for any treatment.

Ans: Reload is applicable for subsequent claims in case of unrelated illness. It doesn’t require the SI+NCB to be exhausted completely. It is not applicable for 1st claim. Please refer to policy wordings for complete details.

Ans: Yes, if he has avail a sum insured of 5lacs or more, then he can avail the optional cover of Any Room upgradation.

Ans: No, it is available for 15 listed illnesses. Provided as part of Policy Wordings.

Ans: Yes, there are SI slab based room category limits as given below.

1. 2L, 3L, 4L S.I. – 1% of S.I.

2. 5L, 7L, 10L S.I. - Single Private A/C Room

3. 15L S.I. and above- Single Private A/C Room (Upgradable to next level, only if Single Private A/C Room is not available).

Ans: No, it is applicable only for IPD and Day care claims.

Ans: Calculation of No Claim Bonus and Super NCB will be on base sum insured.

Ans: No. When he renews his policy, his SI will be Rs 10 Lakhs. If the reload of Sum Insured is not utilised in a Policy Year, it will not be carried forward to any subsequent Policy Year.

Ans: Ayush Treatment refers to the medical and / or hospitalization treatments given under ‘Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems.

The institution should be a government Hospital or any institute recognized by the government and/or accredited by the Quality Council of India or National Accreditation Board on Health.

Ans: No, this benefit is available only for Insured Person up to 18 years and also when the Sum Insured is 1Cr and above.

Ans: No Claim Bonus which is accrued during the claim free Policy Year will only be available to those Insured Persons who were insured in such claim free Policy Year and continue to be Insured Persons in the subsequent Policy Year.

Ans: All insured persons. There are separate set of tests as per age and SI slabs.