Activ One MAX
Annexure III - Product Benefit Table
This document will offer you a clear summa of your health insurance coverage including in-built and optional covers, details of our
unique health management program as well as waiting period information.
| Product Benefit Table | |
| Entry Age (Adult) | Minimum – 18 Years, Maximum – No capping |
| Entry Age (Child) | Dependent Child (Floater / Multi Individual) – 91 Days to 25 Years Individual – minimum age of entry – 5 Years |
| Policy Type | Individual & Floater |
| Tenure | 1 / 2 / 3 Years |
| Family Definition | Up to 2 Adults, 4 Children |
| Premium – 3 Zones | Zone 1, 2 & 3 |
| Premium Type | Age Banded |
| Relationship Covered |
Individual: Self, legally married spouse or live-in partner (same or opposite sex), son, daughter, brother, sister, grandson, granddaughter, son-in-law, daughter-in-law, brother-in-law, sister-in-law, nephew, niece, parents and parents-in-law Floater: Self, legally married spouse or live-in partner (same or opposite sex), dependent Children (Natural / legally adopted), Parents and Parents-in-law |
| Base Sum Insured (INR) | 2 Lacs, 3 Lacs, 4 Lacs, 5 Lacs, 7 Lacs, 10 Lacs, 15 Lacs, 20 Lacs, 25 Lacs, 50 Lacs, 75 Lacs, 1 Crore, 2 Crores, 3 Crores, 4 Crores, 5 Crores, 6 Crores |
| In-built Covers | ||
| Hospitalization Treatment | Room Rent | Actuals up to Base Sum Insured |
| ICU Charges | Actuals up to Base Sum Insured | |
| Road Ambulance Cover (per hospitalization) | Actuals up to Base Sum Insured | |
| Day Care Treatments | Actuals up to Base Sum Insured | |
| Modern Procedures / Treatments | Actuals up to Base Sum Insured for listed procedures | |
| HIV / AIDS and STD Cover | Actuals up to Base Sum Insured | |
| Mental Illness Hospitalization | Actuals up to Base Sum Insured | |
| Obesity Treatment | Actuals up to Base Sum Insured | |
| Pre-Hospitalization Expenses (up to Base Sum Insured) | 90 Days | |
| Post-Hospitalization Expenses (up to Base Sum Insured) | 180 Days | |
| Claim Protect (Non-Medical Expense Waiver) | Non-payable items will be covered (all 4 lists of Annexure I) | |
| Domiciliary Hospitalization | Actuals up to Base Sum Insured | |
| Home Health Care | Actuals up to Base Sum Insured | |
| AYUSH Treatment | Actuals up to Base Sum Insured | |
| Organ Donor Expenses | Actuals up to Base Sum Insured | |
| Annual Health Check-up | Listed & Cashless | |
| Super Reload | Unlimited Refill 2nd Claim Onwards – Unlimited Times (up to Base Sum Insured) |
|
| Super Credit (Increases Irrespective of Claim) | 100% of Base Sum Insured per year, up to 500% of Base Sum Insured (up to Max of INR 3 Crores under this benefit) | |
| Health Management Program (In-built Covers) | |
| Health Assessment™ | Applicable once in a policy year undertaken at our Network Providers / Empanelled Service Providers on a cashless basis or on digital basis |
| HealthReturns™ | Applicable up to 100% of the premium |
| Optional Covers | |
| Reduction in Specific Disease Waiting Period | 2 Years to 1 Year |
| Reduction in Pre-Existing Disease Waiting Period |
Option 1 – 3 Years to 2 Years Option 2 – 3 Years to 1 Year |
| Room Rent Type Options |
Option 1 – Single Private Room Option 2 – Shared Accommodation |
| Per Claim Deductible |
Option 1 – INR 15,000 Option 2 – INR 25,000 |
| Preferred Provider Network (PPN) Discount | 10% Discount Applicable |
| Critical Illness Cover (Initial Waiting Period – 60 Days and Survival Period – 15 Days) | Base Sum Insured Options – INR 10 Lacs, INR 15 Lacs, INR 20 Lacs and INR 25 Lacs |
| Personal Accident Cover (Accidental Death, Permanent Total Disability, Permanent Partial Disability) |
Base Sum Insured Options – INR 10 Lacs, INR 15 Lacs, INR 20 Lacs, INR 25 Lacs, and INR 50 Lacs |
| Chronic Care (Day 1 In-patient Hospitalization) Applicable for Listed Chronic Conditions: |
1. Diabetes 2. Hypertension 3. Asthma 4. Hyperlipidemia 5. COPD 6. Obesity 7. Coronary Artery Disease (PTCA done prior to 1 year) |
| Pre-Existing Disease Waiting Period and Initial Waiting Period will be waived for the listed chronic conditions | |
| Chronic Management Program (OPD) | Applicable on Cashless Basis |
| Cancer Booster: 1. Cover Pre-Hospitalization and Post-Hospitalization medical expenses 2. Covers Day Care Treatment upto Sum Insured |
Up to 100% of Base Policy Sum Insured |
| Durable Equipment Cover: |
1. Ventilator 2. Wheelchair 3. Prosthetic Device 4. Suction Machine 5. Commode Chairs 6. Infusion Pump 7. Continuous Passive Motion Devices in case of Knee Replacement 8. Oxygen Concentrator A combined sub-limit of INR 5 Lacs or up to Base Sum Insured, whichever is lower |
| Compassionate Visit | Up to INR 50,000 for two-way travel fare if hospitalization exceeds 10 days |
| Second Medical Opinion for listed Major Illnesses | Applicable |
| Annual Screening Package for Cancer Diagnosed Patients | INR 10,000 / Member / Policy Year |
| Waiting Period – Inbuilt Cover | |
| Pre-Existing Diseases Waiting Period | 3 years |
| Specific Diseases Waiting Period | 2 years |
| Initial Waiting Period (Excluding Accidental Hospitalization) | 30 Days |
Annexure IV - Chronic Management Program
The Insured member(s) would be eligible for below benefits only if the same is opted or applicable as an in-built offering and mentioned in the Policy Schedule.
This document outlines the services and benefits included under the seven listed chronic conditions in our Chronic Management Program
for complete clarity and information around your health management journey ultimately helping you with better health outcomes.
Single Condition
Asthma
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 1 |
| Consultation | Teleconsult – Pulmonologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / Random Glucose | 1 |
| Pathology | Follow-up 6 months later (only if Onboarding Abnormal) BMI / BP / RR / HR / Random Glucose | 1 |
Hypertension
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Digital BP (Facial Scan) | 5 |
Hyperlipidemia
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Lipid Profile | 1 |
Diabetes Type 1
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 1 |
| Consultation | Teleconsult – Endocrinologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Diabetes Type 2
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 1 |
| Consultation | Teleconsult – Endocrinologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Coronary Artery Disease with PTCA done prior to 1 Year
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Chronic Obstructive Pulmonary Disease (COPD)
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 1 |
| Consultation | Teleconsult – Pulmonologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / Random Glucose | 1 |
| Pathology | Follow-up 6 months later (only if Onboarding Abnormal) BMI / BP / RR / HR / Random Glucose | 1 |
High Body Mass Index (Obesity)
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later Lipid / BP / Heart Rate | 1 |
Co-Morbid (2 Conditions)
Asthma + Hypertension
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Consultation | Teleconsult – Pulmonologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later (only if Onboarding Abnormal) BMI / BP / RR / HR / Random Glucose | 1 |
Asthma + Hyperlipidemia
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Consultation | Teleconsult – Pulmonologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Lipid Profile | 1 |
Asthma + Diabetes 1 / Diabetes 2
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 1 |
| Consultation | Teleconsult – Endocrinologist | 1 |
| Consultation | Teleconsult – Pulmonologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Asthma + Coronary Artery Disease with PTCA done prior to 1 Year
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Consultation | Teleconsult – Pulmonologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Asthma + High Body Mass Index (Obesity)
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Consultation | Teleconsult – Pulmonologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Hypertension + Hyperlipidemia
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Lipid Profile | 1 |
| Pathology | Digital BP (Facial Scan) | 5 |
Hypertension + Diabetes Type 1 / Diabetes Type 2
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Consultation | Teleconsult – Endocrinologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Hypertension + Coronary Artery Disease with PTCA done prior to 1 Year
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Hypertension + Chronic Obstructive Pulmonary Disease COPD
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Consultation | Teleconsult – Pulmonologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later (only if Onboarding Abnormal) BMI / BP / RR / HR / Random Glucose | 1 |
Hyperlipidemia + High Body Mass Index (Obesity)
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later Lipid / BP / Heart Rate | 1 |
Hyperlipidemia + Diabetes Type 1 / Diabetes Type 2
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Consultation | Teleconsult – Endocrinologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Hyperlipidemia + Coronary Artery Disease with PTCA done prior to 1 Year
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Hypertension + Chronic Obstructive Pulmonary Disease COPD
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Consultation | Teleconsult – Pulmonologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / Random Glucose | 1 |
| Pathology | Follow-up 6 months later (only if Onboarding Abnormal) BMI / BP / RR / HR / Random Glucose | 1 |
Hyperlipidemia + High Body Mass Index (Obesity)
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later Lipid / BP / Heart Rate | 1 |
Diabetes Type 1 / Diabetes Type 2 + Coronary Artery Disease with PTCA done prior to 1 Year
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Consultation | Teleconsult – Endocrinologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Diabetes Type 1 / Diabetes Type 2 + Chronic Obstructive Pulmonary Disease COPD
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 1 |
| Consultation | Teleconsult – Endocrinologist | 1 |
| Consultation | Teleconsult – Pulmonologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Diabetes Type 1 / Diabetes Type 2 + High Body Mass Index (Obesity)
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Consultation | Teleconsult – Endocrinologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Coronary Artery Disease with PTCA done prior to 1 Year + Chronic Obstructive Pulmonary Disease COPD
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Consultation | Teleconsult – Pulmonologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Coronary Artery Disease with PTCA done prior to 1 Year + High Body Mass Index (Obesity)
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Chronic Obstructive Pulmonary Disease COPD + High Body Mass Index (Obesity)
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Consultation | Teleconsult – Pulmonologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later Lipid / BP / Heart Rate | 1 |
Co-Morbid (3 Conditions)
Asthma + Hypertension + Hyperlipidemia
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Consultation | Teleconsult – Pulmonologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Asthma + Hypertension + High Body Mass Index (Obesity)
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Consultation | Teleconsult – Pulmonologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later Lipid / BP / Heart Rate | 1 |
Asthma + Hyperlipidemia + Diabetes Type 1 / Type 2
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Consultation | Teleconsult – Endocrinologist | 1 |
| Consultation | Teleconsult – Pulmonologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Asthma + Hyperlipidemia + Coronary Artery Disease with PTCA done prior to 1 Year
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Consultation | Teleconsult – Pulmonologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Asthma + Hyperlipidemia + High Body Mass Index (Obesity)
| Category | Sub Category | No. of Visits |
|---|---|---|
| Consultation | Teleconsult – Physician | 2 |
| Consultation | Teleconsult – Pulmonologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later Lipid / BP / Heart Rate | 1 |
Asthma + Diabetes Type 1 / Diabetes 2 + Coronary Artery Disease with PTCA done prior to 1 Year
| Category | Sub Category | No. of Visits |
|---|---|---|
| Consultation | Teleconsult – Physician | 2 |
| Consultation | Teleconsult – Pulmonologist | 1 |
| Consultation | Teleconsult – Endocrinologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Asthma + Diabetes Type 1 / Diabetes 2 + High Body Mass Index (Obesity)
| Category | Sub Category | No. of Visits |
|---|---|---|
| Consultation | Teleconsult – Physician | 2 |
| Consultation | Teleconsult – Pulmonologist | 1 |
| Consultation | Teleconsult – Endocrinologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Hypertension + Diabetes Type 1 / Type 2 + High Body Mass Index (Obesity)
| Category | Sub Category | No. of Visits |
|---|---|---|
| Consultation | Teleconsult – Physician | 2 |
| Teleconsult – Endocrinologist | 1 | |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Hypertension + Coronary Artery Disease with PTCA done prior to 1 Year + Chronic Obstructive Pulmonary Disease COPD
| Category | Sub Category | No. of Visits |
|---|---|---|
| Consultation | Teleconsult – Physician | 2 |
| Teleconsult – Pulmonologist | 1 | |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Hypertension + Coronary Artery Disease with PTCA done prior to 1 Year + High Body Mass Index (Obesity)
| Category | Sub Category | No. of Visits |
|---|---|---|
| Consultation | Teleconsult – Physician | 2 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Hypertension + Chronic Obstructive Pulmonary Disease COPD + High Body Mass Index (Obesity)
| Category | Sub Category | No. of Visits |
|---|---|---|
| Consultation | Teleconsult – Physician | 2 |
| Teleconsult – Pulmonologist | 1 | |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Asthma + Coronary Artery Disease with PTCA done prior to 1 Year + High Body Mass Index (Obesity)
| Category | Sub Category | No. of Visits |
|---|---|---|
| Consultation | Teleconsult – Physician | 2 |
| Consultation | Teleconsult – Pulmonologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Hypertension + Hyperlipidemia + Diabetes Type 1 / Type 2
| Category | Sub Category | No. of Visits |
|---|---|---|
| Consultation | Teleconsult – Physician | 2 |
| Consultation | Teleconsult – Endocrinologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Hypertension + Hyperlipidemia + Coronary Artery Disease with PTCA done prior to 1 Year
| Category | Sub Category | No. of Visits |
|---|---|---|
| Consultation | Teleconsult – Physician | 2 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Hypertension + Hyperlipidemia + Chronic Obstructive Pulmonary Disease COPD
| Category | Sub Category | No. of Visits |
|---|---|---|
| Consultation | Teleconsult – Physician | 2 |
| Consultation | Teleconsult – Pulmonologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Hypertension + Hyperlipidemia + High Body Mass Index (Obesity)
| Category | Sub Category | No. of Visits |
|---|---|---|
| Consultation | Teleconsult – Physician | 2 |
| Pathology | Onboarding Physical HA Includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later Lipid / BP / Heart Rate | 1 |
Hypertension + Diabetes Type 1 / Type 2 + Coronary Artery Disease with PTCA done prior to 1 Year
| Category | Sub Category | No. of Visits |
|---|---|---|
| Consultation | Teleconsult – Physician | 2 |
| Consultation | Teleconsult – Endocrinologist | 1 |
| Pathology | Onboarding Physical HA Includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Hypertension + Diabetes Type 1 / Type 2 + Chronic Obstructive Pulmonary Disease COPD
| Category | Sub Category | No. of Visits |
|---|---|---|
| Consultation | Teleconsult – Physician | 2 |
| Consultation | Teleconsult – Endocrinologist | 1 |
| Consultation | Teleconsult – Pulmonologist | 1 |
| Pathology | Onboarding Physical HA Includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Hyperlipidemia + Diabetes Type 1 / Type 2 + Coronary Artery Disease with PTCA done prior to 1 Year
| Category | Sub Category | No. of Visits |
|---|---|---|
| Consultation | Teleconsult – Physician | 2 |
| Teleconsult – Endocrinologist | 1 | |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Hyperlipidemia + Diabetes Type 1 / Type 2 + Chronic Obstructive Pulmonary Disease COPD
| Category | Sub Category | No. of Visits |
|---|---|---|
| Consultation | Teleconsult – Physician | 2 |
| Teleconsult – Endocrinologist | 1 | |
| Teleconsult – Pulmonologist | 1 | |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Hyperlipidemia + Diabetes Type 1 / Type 2 + High Body Mass Index (Obesity)
| Category | Sub Category | No. of Visits |
|---|---|---|
| Consultation | Teleconsult – Physician | 2 |
| Teleconsult – Endocrinologist | 1 | |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
| Hyperlipidemia + Coronary Artery Disease with PTCA done prior to 1 Year + Chronic Obstructive Pulmonary Disease | ||
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Consultation | Teleconsult – Pulmonologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
| Hyperlipidemia + Coronary Artery Disease with PTCA done prior to 1 Year + High Body Mass Index (Obesity) | ||
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
| Hyperlipidemia + Chronic Obstructive Pulmonary Disease COPD + High Body Mass Index (Obesity) | ||
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Consultation | Teleconsult – Pulmonologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
| Diabetes Type 1 / Type 2 + Coronary Artery Disease with PTCA done prior to 1 Year + Chronic Obstructive Pulmonary Disease COPD | ||
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Consultation | Teleconsult – Pulmonologist | 1 |
| Consultation | Teleconsult – Endocrinologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
| Diabetes Type 1 / Type 2 + Coronary Artery Disease with PTCA done prior to 1 Year + High Body Mass Index (Obesity) | ||
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Consultation | Teleconsult – Endocrinologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
| Diabetes Type 1 / Type 2 + Chronic Obstructive Pulmonary Disease COPD + High Body Mass Index (Obesity) | ||
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Consultation | Teleconsult – Pulmonologist | 1 |
| Consultation | Teleconsult – Endocrinologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
| Coronary Artery Disease with PTCA done prior to 1 Year + Chronic Obstructive Pulmonary Disease COPD + High Body Mass Index (Obesity) | ||
| Category | Sub Category | No. of Visits |
| Consultation | Teleconsult – Physician | 2 |
| Consultation | Teleconsult – Pulmonologist | 1 |
| Pathology | Onboarding Physical HA includes BMI / BP / RR / HR / HBA1C / Lipid Profile / Creatinine | 1 |
| Pathology | Follow-up 6 months later HBA1C / Lipid / BP / Heart Rate | 1 |
Active One MAX+
Annexure III-Product Benefit Table
This document will offer you a clear summary of your health insurance coverage including in-built and optional covers, details of our unique health management program as well as waiting period information.
Product Benefit Table
| Benefits | MAX+ |
| Entry Age (Adult) |
Minimum – 18 years Maximum – No capping |
| Entry Age (Child) |
Dependent Child (Floater/Multi individual) – 91 days to 25 years Individual – minimum age of entry – 5 years |
| Policy Type | Individual & Floater |
| Tenure | 1/2/3 Years |
| Family definition | up to 2A4C |
| Premium – 3 Zones | Zone 1, 2 & 3 |
| Premium Type | Age Banded |
| Relationship Covered |
Individual – Self, Legally Married Spouse OR Live-in Partner (Same Or Opposite Sex), Son, Daughter, Brother, Sister, Grandson, Granddaughter, Son in-Law, Daughter-in-Law, Brother-in-Law, Sister-in-Law, Nephew, Niece, Parents and Parents-in-Law Floater – Self, Legally Married Spouse OR Live-in Partner (Same Or Opposite Sex), Dependent Children (Natural/Legally Adopted), Parents and Parents-in-Law |
| Base Sum Insured (BSI) | 2 Lacs, 3 Lacs, 4 Lacs, 5 Lacs, 7 Lacs, 10 Lacs, 15 Lacs, 20 Lacs, 25 Lacs, 50 Lacs, 75 Lacs, 1 Crore, 2 Crores, 3 Crores, 4 Crores, 5 Crores and 6 Crores |
| Hospitalization Treatment Room Rent |
Actuals up to Base Sum Insured |
| Hospitalization Treatment ICU Charges |
Actuals up to Base Sum Insured |
| Hospitalization Treatment Road Ambulance Cover (per hospitalization) |
Actuals up to Base Sum Insured |
| Day Care Treatments | Actuals up to Base Sum Insured |
| Modern Procedures / Treatments | Actuals up to Base Sum Insured for listed procedures |
| HIV / AIDS and STD Cover | Actuals up to Base Sum Insured |
| Mental Illness Hospitalization | Actuals up to Base Sum Insured |
| Obesity Treatment | Actuals up to Base Sum Insured |
| Pre-Hospitalization Expenses (up to Base Sum Insured) | 90 Days |
| Post-Hospitalization Expenses (up to Base Sum Insured) | 180 Days |
| Claim Protect (Non-Medical Expense Waiver) | Non-payable items will be covered (all 4 lists of Annexure I) |
| Domiciliary Hospitalization | Actuals up to Base Sum Insured |
| Home Health Care | Actuals up to Base Sum Insured |
| AYUSH Treatment | Actuals up to Base Sum Insured |
| Organ Donor Expenses | Actuals up to Base Sum Insured |
| Annual Health Check-up (Listed & Cashless) | Covered |
|
Super Reload (Unlimited Refill) From 2nd claim of Policy Life – Unlimited times |
Covered (up to Base Sum Insured) |
| Super Credit (Increases Irrespective of Claim) |
100% of Base Sum Insured per year, up to 500% of Base Sum Insured (up to Max of 3 Cr under this benefit) |
|
Durable equipment cover i. Ventilator ii. Wheelchair iii. Prosthetic device iv. Suction Machine v. Commode Chairs vi. Infusion pump vii. Continuous Passive motion devices in case of Knee Replacement viii. Oxygen concentrator |
Combined Sub-limit of INR 5 Lacs or up to BSI, whichever is lower |
|
Advanced Health Check-up (90 days waiting period) List of Test 1. Computed tomography angiography (CTA) 2. Positron emission tomography (PET) Scan |
Listed & Cashless |
Health Management Program (In-built Covers)
| Health Assessment™ | Applicable once in a policy year undertaken at Our Network Providers / Empanelled Service Providers on a cashless basis or on digital basis |
| HealthReturns™ | Applicable up to 100% of the premium |
Optional Covers
| Reduction in Specific Disease waiting period | 2 years to 1 year |
| Reduction in Pre-Existing Disease waiting period | Option 1 – 3 years to 2 years | Option 2 – 3 years to 1 year |
| Room Rent Type Options | Option 1 – Single Private Room | Option 2 – Shared Accommodation |
| Per Claim Deductible | Option 1 – INR 15,000 | Option 2 – INR 25,000 |
| Preferred Provider Network (PPN) Discount | 10% discount applicable |
| Critical Illness cover [Initial Waiting Period – 60 Days and Survival Period – 15 Days] |
Critical Illness SI Options – INR 10 Lacs, 15 Lacs, 20 Lacs and 25 Lacs |
| Personal Accident Cover [AD+PTD+PPD] | Personal Accident SI Options – INR 10 Lacs, 15 Lacs, 20 Lacs, 25 Lacs, and 50 Lacs |
|
Chronic Care (Day 1 In-patient Hospitalization) Applicable for Listed Chronic Conditions: 1. Diabetes 2. Hypertension 3. Asthma 4. Hyperlipidemia 5. COPD 6. Obesity 7. Coronary Artery Disease (PTCA done prior to 1 year) |
PED waiting period and Initial waiting period will be waived for the listed and accepted Chronic conditions |
| Chronic Management Program (OPD) | Applicable on Cashless Basis |
|
Cancer Booster i. Covers Pre and Post hospitalization medical expense ii. Covers Day Care Treatment up to Sum Insured |
Up to 100% of Base Sum Insured |
| Compassionate Visit | up to INR 50,000 for two-way travel fare if hospitalization exceeds 10 days |
| Second Medical Opinion for listed Major Illness | Applicable |
| Annual Screening Package for Cancer Diagnosed Patients | INR 10000 / Member / Policy Year |
Waiting Period – Inbuilt Cover
| Pre Existing Disease (PED) Waiting Period | 3 years |
| Specific Disease waiting period | 2 years |
| Initial Waiting Period (Excluding Accidental Hospitalization) | 30 Days |
Desclaimer
Aditya Birla Health Insurance Co. Limited. Product Name: Activ One, Product UIN: ADIHLIP2409V012324. 1800 270 7000 | Email: care.healthinsurance@adityabirlacapital.com | Website: adityabirlahealthinsurance.com. Trademark/Logo Aditya Birla Capital is owned by Aditya Birla Management Corporation Private Limited and Trademark/Logo HealthReturns, Healthy Heart Score and Active Dayz are owned by Momentum Metropolitan Life Limited (Formerly known as MMI Group Limited). These trademarks/logos are being used by Aditya Birla Health Insurance Co. Limited under licensed user agreement(s).
Registered Office: 9th Floor, Tower 1, One World Centre, Jupiter Mills Compound, 841, Senapati Bapat Marg, Elphinstone Road, Mumbai 400013. CIN No. U66000MH2015PLC263677. IRDAI Reg.153.