Activ One NXT
Overview
Aditya Birla Activ One NXT is the most basic variant in the Active One series offered by Aditya Birla Health Insurance Co. Ltd. Yet, the plan is all-inclusive offering 2X cover from day 1 with no sub-limits. It covers all hospitalisation expenses, including day care treatments.
However, you do miss out on no-claim bonus and coverage for non-medical items, which other variants offer.
Pros and Cons
- 2X cover – Get 2X from day 1 with the inbuilt Super Reload feature.
- No copayment – The plan includes no copay or disease-specific limits. You get full coverage on hospitalisation.
- No room restriction – Includes no room rent restriction. Pick any room you like. Your insurer covers the cost.
- Unlimited restorations – The insurer refills your sum insured unlimited times in case you run out of coverage.
- Cover for HIV/ AIDS and Mental Health – Covers hospitalisation expenses related to HIV/AIDS and mental health.
- 100% HealthReturns – Stay healthy and earn HealthReturns to get up to a 100% discount on renewal premium.
- Reasonably priced – The plan is reasonably priced.
- No free health check-ups – This variant does not include free health check-ups.
- No cover for non-medical items – You get cover for non-medical items with an add-on.
- Longer waiting period – 3 years waiting period for pre-existing conditions.
Plan Benefits
Get 2X cover with Super Reload
Get 2 times cover from day 1 with this plan. This is an in-built feature and you do not need to activate it.
Pick any room of your choice
The plan covers inpatient hospitalisation expenses up to the sum insured. It does not impose a room rent restriction. Pick any room you like during hospitalisation. The insurer covers the cost fully.
Pre and post-hospitalisation expenses cover available
The plan covers hospitalisation-related medical expenses for up to 90 days before and 180 days after hospitalisation. These include consultation fees, diagnostic tests, medication and other related expenses.
Road ambulance charges covered
The insurer covers road ambulance charges up to the sum insured.
Includes cover for daycare procedures
Many advanced surgeries or procedures done under anesthesia now require less than 24 hour hospitalisation. These are called day care treatments. Your insurer fully covers the cost of such procedures up to the sum insured.
Get cover for alternative treatments
Want to take an alternative treatment like Ayurveda or Homeopathy? Don’t worry. Your insurer fully covers your hospitalisation and related expenses.
Organ donor expenses covered
If you are an organ recipient, your insurer will cover the hospitalisation expenses of the organ donor for harvesting the donated organ.
Covers HIV/ AIDS and STD
The plan covers expenses related to treatment of any complication arising due to AIDS/ HIV and sexually transmitted diseases.
Get cover even if you are forced to be hospitalised at home
Are you forced to be hospitalised at home? Imagine this. No beds are available in the hospital or the patient’s medical condition does not allow him to be moved to a hospital. This is called domiciliary hospitalisation. Your insurance policy covers the cost of hospitalisation if it happens for at least 3 consecutive days under the supervision of a medical practitioner.
Covers mental health and related hospitalisation expenses
You get cover for any treatment related to stress, anxiety, depression or any illness impacting mental health.
Unlimited restorations of sum insured available
Even if you claim a portion of your base cover, you don’t have to worry about the coverage for future claims. The insurer restores your full sum insured for all future claims unlimited times during a policy year. This feature comes in handy if you make multiple claims during a policy year.
Get up to 100% discount on renewal premiums
Stay healthy and earn HealthReturns from your insurer. You can use these HealthReturns to pay for OPD expenses, deductibles, non-payable items or get up to a 100% discount on renewal premiums. HealthReturns earned in a policy year, if not utilised, will automatically get adjusted towards the next renewal premium.
Get free annual health check-ups with an add-on
With this add-on, get a health check-up every year to monitor your health. Health check-ups can only be taken on a cashless basis at network centres via pre-booking through the insurer’s app.
Option to reduce waiting periods to 1 year with an add-on
With this add-on, reduce the waiting period on PEDs or specified diseases to 1 year.
Get day 1 cover for certain PEDs with Chronic Care add-on
With this add-on, you get day 1 coverage for certain pre-existing conditions. These health conditions include Asthma, Hypertension, Hyperlipidaemia, Diabetes, Chronic Obstructive Pulmonary Disease (COPD), Obesity and Coronary Artery Disease with PTCA. A great add-on for those living with any of these conditions.
Get OPD cover for chronic health issues with Chronic Management Program (OPD)
This add-on provides coverage for OPD consultations and diagnostic tests for listed chronic health conditions, provided you declare them as PEDs at policy purchase. This facility can be availed on a cashless basis at the insurer’s network provider centres.
Buy Claim Protect add-on to get coverage for non-medical items
The base plan does not cover the cost of non-medical items such as masks, gloves, syringes, and others. The cost of such items is 10% to 20% of every health claim. Buy Claim Protect add-on to get cover for these items.
Option to add critical illness cover
With Critical Illness add-on, you get coverage for 20 listed critical illnesses. The insurer pays you a fixed lump sum benefit amount in case you are diagnosed with any of the 20 listed critical illnesses when the policy cover is active. This cover includes an initial waiting period of 60 days and a survival period of 15 days for the benefit to be paid.
Option to add personal accident cover
Personal accident add-on covers you against the risk of accidents. The insurer pays you a fixed lump sum benefit in case of death or partial or total disability due to an accident.
Add cumulative bonus with Super Credit add-on
The base plan does not include cumulative bonus benefit. With Super Credit add-on, you get a 100% cumulative bonus every year up to a maximum of 500% of sum insured, irrespective of claims.
Get Cancer Booster cover
With this add-on, get an extra cover equal to the base sum insured towards hospitalisation expenses related to cancer of specified severity. This benefit is only available on a reimbursement basis.
Annual screenings for cancer-diagnosed patients
With this add-on, get an annual screening package of up to Rs 10,000 per year in case you are diagnosed with cancer of specified severity. The amount can be utilised to cover medically prescribed diagnostics for cancer patients. This benefit is only available on a cashless basis.
Get cover for Durable Equipment with an add-on
This add-on covers the expenses incurred towards the cost of buying or renting durable medical equipment as prescribed by the doctor during or after hospitalisation. Durable medical equipment such as wheelchairs, ventilators, and prosthetic devices, among others, are included. The upper limit for this benefit is Rs. 5 Lakh.
Get cover for Compassionate Visit with an add-on
In case the hospitalisation exceeds 10 consecutive days, Compassionate Visit add-on covers the cost of travel expenses of an immediate family member to visit the patient. It includes the cost of a 2-way economy class air ticket, up to a maximum of Rs. 50,000.
Get Second Medical Opinion cover
With this add-on, you get access to a second medical opinion from a medical practitioner in case of a major illness. This benefit can be availed once in a policy year at an eligible network provider.
Add Per Claim Deductible to reduce premium
If you want to reduce your premium, add a small deductible. Choose this add-on with caution, as you need to pay the deductible amount for every claim upfront for policy benefits to kick in. Deductible options of Rs. 15,000 and Rs. 25,000 are available.
Add Preferred Network Provider (PPN) discount
Adding the preferred provider network gets you a 10% straight discount on the premium. However, any claim outside the PPN network incurs a 10% copayment.
Modify room category
If you want to make the plan affordable, choose a lower room category, such as a single private room or a shared accommodation.
Policy Conditions
| Sum Insured Range | Rs. 2 Lakh and Rs. 6 Crore |
| Entry Age | 91 Days – 25 Years for dependent children; 18 Years onwards for adults |
| Policy Tenure Options | 1, 2 or 3 Years |
| Coverage Types | Individual and Family Floater |
| Family Coverage | Self, legally married spouse or live-in partner (same or opposite sex), dependent Children (Natural / legally adopted), parents and parents-in-law; up to 2 adults and 4 children can be included under family floater option |
| Premium Payment Options | Monthly, Quarterly, Half-Yearly and Annual |
Exclusions
Waiting Periods
- Initial Waiting Period: 30 days (except accidents)
- Specific Illness Waiting Period: 24 months
- Waiting Period on Pre-Existing Diseases: 36 months
- Critical Illness Cover Waiting Period (Add-on): 60 days
Medical Exclusions
- Change of gender treatment
- Cosmetic surgeries (unless due to accident, cancer, etc.)
- Unproven treatments
- Refractive error correction for less than 7.5 diopters
- OPD expenses and Dental OPD treatment
- Maternity and related expenses
- Sterility and infertility
Non-Medical Exclusions
- Expenses related to any admission primarily for diagnostics and evaluation purposes
- Expenses related to any admission primarily for enforced bed rest
- Self-injury or attempt to suicide
- Alcoholism, drug or substance abuse
- Treatment necessitated by committing breach of law with criminal intent
- Treatment taken by a medical practitioner outside his discipline
- War, terrorism, nuclear events
- Injuries from hazardous sports
About the Insurer
Aditya Birla Health Insurance Co. Ltd. is a stand-alone health insurance company in India. It is a collaboration between Aditya Birla Capital, an Aditya Birla Group company, and Momentum Group Ltd. of South Africa. The company started operations in 2016. The company offers specialised health insurance products covering individuals, families, and senior citizens.
The insurer grew at a fast pace in the last few years, emerging as a trusted provider in the health insurance space. It had a respectable claim settlement ratio of 95.61% in the financial year 2023-24. However, the worrisome fact is that it received a relatively high number of claim-related complaints, 22 per 10,000 claims.
Performance Highlights (FY24)
Turnover – Rs. 3,701 Crore
Claim Settlement Ratio – 95.61%
Incurred Claim Ratio – 68%
Volume of Claim Complaints – 22
Network Hospitals – 11,000+
Get In Touch
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Frequently Asked Questions
Does Aditya Birla Activ One NXT have zone-wise copayment?
No, there is no zone-wise copayment under this plan.
Can I add maternity benefits to Aditya Birla Activ One NXT?
Maternity benefits are not available in Aditya Birla Activ One NXT. For maternity coverage, consider Activ Fit or Activ One VIP/VIP+ plans.
Is there a room rent limit under Aditya Birla Activ One NXT?
No, there is no capping on room rent. You can choose any room type, including deluxe or suite rooms, without restrictions.
How often can the sum insured be reloaded?
The Super Reload benefit allows unlimited reloads of the sum insured within a policy year.
Does Aditya Birla Activ One NXT cover non-medical expenses like gloves or masks?
Yes, with the Claim Protect add-on, the plan covers the cost of non-medical consumables up to the sum insured.
Are chronic diseases covered from day one?
Yes, with the Chronic Care add-on, conditions like asthma, diabetes, hypertension, and obesity get covered immediately without waiting periods.
Does the plan include organ donor coverage?
Yes, it covers inpatient expenses for organ harvesting if you are the recipient. However, pre and post-hospitalisation expenses of the donor are not covered.
Are daycare procedures covered under the plan?
Yes, the plan covers all daycare procedures that require less than 24 hours of hospitalisation, with no sub-limits.
Are pre and post-hospitalisation expenses included under Aditya Birla Activ One NXT?
Yes, the plan covers pre-hospitalisation expenses for up to 60 days and post-hospitalisation up to 180 days.
Is mental health treatment included?
Yes, the plan extends coverage to mental health treatments, including hospitalisation for mental illnesses.
What is the minimum and maximum entry age for Aditya Birla Activ One NXT?
Minimum age at entry for adults is 18 years; for dependent children, 91 days. There is no maximum entry age limit for this plan.
What is the waiting period for pre-existing diseases under Aditya Birla Activ One NXT?
There is a 3 year waiting period for pre-existing conditions under the plan.
What is the initial waiting period for new policies?
A 30 day initial waiting period applies, except for accidents.
What is the Super Credit optional cover?
Super Credit add-on provides a 100% increase in your sum insured upon timely renewals, up to a maximum of 500% of sum insured.
Are there any wellness benefits?
Yes, the plan offers HealthReturns, allowing you to earn up to 100% of your premium back based on health assessments and physical activities.
Does the plan offer any discounts?
Yes, discounts are available for long-term policies and for covering more family members under the same policy.
How do I inform the insurer about a claim?
For emergency hospitalisation, inform within 48 hours. For planned hospitalisation, notify 3 days in advance. Reach out to your hospital’s insurance desk for claim intimation related documentation.
hat is the claim reimbursement process?
Submit necessary documents along with the claim form post-treatment, and the insurer will process the reimbursement as per policy terms.
Does the plan offer cashless hospitalisation?
Yes, cashless treatment is available at 11,000+ network hospitals across India.
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