Learn about Aditya Birla Health Insurance (A Guide)

Aditya Birla Health Insurance company Ltd is a joint venture between Aditya Birla Group and South African corporation, MMI Holdings Ltd. Aditya Birla Health Insurance has a Pan India presence with 8000+ network hospitals. The company has insured over 20 lakh individuals and has a robust claim settlement ratio of 92%.

The company has a solid presence in over 650+ cities and provides health insurance services ranging from comprehensive health plans, senior citizen plans, accidental health plans, cancer secure plans, and more.

Along with their extensive range of health plans, the company also offers wellness and chronic care management services that assist with chronic illnesses like diabetes, hypertension, asthma, etc. Aditya Birla also provides a ‘Doctor on-call’ facility in some of their health plans. The company also offers multiple optional covers such as cancer cover, critical illness cover, personal accident cover, hospital cash benefit, etc.

Important Facts

Types of Plans Offered by Aditya Birla Health Insurance

Benefits of Aditya Birla Health Insurance

• Network Hospitals: Aditya Birla Health insurance has more than 8000+ network hospitals, which gives you a vast range of hospitals to choose from. You can avail of cashless treatment in these hospitals without worrying to pay the hospital bill from your pocket.
• High Sum insured: The company provides you with a wide sum insured ranging from Rs 10 lakh to up to Rs 2 crores.
• Cover Restoration: Multiple plans offered by the company come with cover restoration benefits. This automatically replenishes your coverage up to the sum insured.
• Additional Benefits: Aditya Birla Health Insurance offers plans with additional unique benefits such as wellness coach and health return awards. The company also provides specialized chronic care management programs for severe illnesses.
• Recovery Benefit: Many plans offered also come with a unique recovery benefit feature that will assist you during your recuperating period.
• Tax Benefit:  You can claim a tax deduction on premiums paid under Section 80D of the Income Tax Act.
• Cumulative Bonus: Certain plans provide the benefit of a cumulative bonus that increases your sum insured as a reward for claim-free years.

Inclusions

What is covered under Aditya Birla Health Insurance? Find out:

• Inpatient hospitalization
• Domiciliary hospitalization
• Emergency ambulance
• Maternity benefits
• Hospital cash allowance
• Organ donor expenses
• Pre and post-hospitalization
• Ayush Treatment
• Modern treatments
• Dental consultations

Exclusions

• Pre-existing conditions until the waiting period
• Cosmetic and plastic surgeries
• Rehabilitation cost
• Stem cell therapy
• Alcohol and drug-related injury
• Experimental treatment or procedures
• Any non-allopathic treatment
• Birth defects, genetic disorders, congenital disorders
• Sexually transmitted diseases
• Change of gender procedure
• AIDS or HIV related treatments
• Dietary supplements
• Weight loss or obesity-related treatments

Aditya Birla Health Insurance claim process

Cashless Claims

You will have to file for a cashless claim if you are admitted to any of the network hospitals of the insurer. Follow these simple steps to file for a cashless claim with Aditya Birla Health Insurance.

• Step 1: Inform the company 72 hours in advance in case of a planned hospitalization or within 24 hours in case of emergency hospitalization.
• Step 2: Provide all required documents to the TPA section of the hospital.
• Step 3: The insurance company will verify your claim with the terms and conditions of your policy.
• Step 4: After investigation, the company will approve your claim and will directly settle the bill with the hospital.

Note: In case of the rejection of the claim, the company shall intimate the policyholder in writing stating the reason for rejection.

Reimbursement Claims

You will have to file for reimbursement if you get admitted to a non-network hospital of the company. In a reimbursement claim, you will have to initially pay the hospital bill from your pocket and can then file for a refund from the insurer.

• Step 1: Inform the company 72 hours in advance of a planned hospitalization or within 24 hours in case of emergency hospitalization.
• Step 2: After discharge, submit all the required documents to the company so the company can initiate the claim process.
• Step 3: The insurance company will then evaluate the claim’s authenticity.
• Step 4: Once all the supporting documents relating to the claim are proved authentic, the claim shall be accepted and the amount shall be reimbursed to the policyholder.

List of Documents needed for the claim process

1.  Duly filled claim request form
2. Original discharge summary
3. All original bills and receipts, prescriptions
4. Original reports, scans,X-rays, CT scans
5. FIR (if applicable)
6. Death certificate (if applicable)