Overview of Activ Health Platinum Essential
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 of Activ Health Platinum Essential
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.
You can pick any room you like, a highly valued feature.
Free Health Checkups every year, which adds significant value to the policy.
Cons
Premiums are relatively high.
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 10 years ago, making it a relatively new entrant with a developing track record.
Claims Experience
96% CSR, calculated as a 3-year average
Aditya Birla settles 96% of all claims it receives demonstrating strong credibility.
Network Hospitals
16,500+
Aditya Birla has a strong network with over 16,500 hospitals, ensuring wide accessibility and convenience for policyholders.
Complaints
19 complaints per 10,000 claims registered
Aditya Birla experiences a moderate number of complaints, indicating room for improvement in addressing customer concerns.
The aforementioned ratios have been averaged over three years (FY24-FY26)
Features of Activ Health Platinum Essential
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
Shared room, single room, deluxe room or any room that's available. The insurer won't nitpick on your choice of room since the policy has no restrictions on 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 of Activ Health Platinum Essential
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.
Exclusions in Activ Health Platinum Essential
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.