31-25-0139333-00

MAHESHWARAM PRAMOD KUMAR

H NO- 3-116
IPPARTHY VILLAGE
NA Munugode
TELANGANA
INDIA
508244
7799885624

04/07/2025
Empowering people

Dear MAHESHWARAM PRAMOD KUMAR,

Thank you for choosing us. In our journey together, we promise to offer you the Up to 100% of your
best insurance and assurance of good health. Premium as Health
ReturnsTM
Together, we will achieve our goals by making every small step count. Every ladder
you climb, every calorie you burn, every lap you swim, every song you dance on -
every little act will move the needle towards a healthier you. 90 days pre and
180 days post
Excited? So are we! Get ready to make the most out of your new insurance plan Hospitalization Coverage
Activ One - NXT

Thank you once again for partnering with us. With our purpose of Empowering You Any Room of your
To Lead A Healthier Life, we ensure you a fruitful and healthful journey. Choice up to
Base Sum Insured
Warm regards,

Cashless Home
Mayank Bathwal Healthcare
Chief Executive Officer Coverage
Aditya Birla Health Insurance Co. Limited.

Super Reload: 2x Cover

From day 1 and unlimited refill
POLICY NUMBER: 31-25-0139333-00
up to 100% Sum Insured
Name Membership No DOB from 2nd Claim onwards
MAHESHWARAM PRAMOD PT29631089 29/Dec/2000
Introducing The Activ Health

Your health and your

For assistance, connect with us via the following channels: policy, all in one place

Follow us on: Product Name: Activ One, Product UIN: ADIHLIP24097V012324

 Activ One NXT
Policy Schedule
This document will serve as a quick guide for you to understand important information regarding your health insurance
policy including its key features, coverage limits, premium details and nominee details, among others.

Unit no 1101 & 1104 11th floor, Unit

Unit no 1101 & 1104 11th floor, Unit no
no 1501& 1502, 15th floor, G Corp
1501 & 1502 ,15th floor, G Corp Tech
Policy Issuing Office Tech Park, Kasarwadavali, Policy Servicing Office
Park Kasarvadavali Mumbai
Ghodbunder Road, Thane
MAHARASHTRA 400001
West-400615
POLICYBAZAAR INSURANCE
Intermediary Name Intermediary Code 5100357
BROKERS PRIVATE LIMITED
Intermediary Contact Details 18002585970 Intermediary E-mail ID [email protected]
Toll Free Number 18002707000

Policyholder Name MAHESHWARAM PRAMOD KUMAR

Policyholder Address H NO- 3-116 IPPARTHY VILLAGE Munugode, 508244, Nalgonda, TELANGANA
Contact Number 7799885624
Email Id [email protected]
GSTIN NA

Product Name Activ One

Plan NXT
Policy Number 31-25-0139333-00
First Policy Start date 04/07/2025
Start Date of Policy & Time 00:00 hrs on 04/07/2025 Expiry Date & Time of Policy 23:59 hrs on 03/07/2026
Policy Type Individual Policy Tenure 1 Year
Enrollment for Automatic renewal
Policy Category New Business NO
premium payment facility
Mode of Premium payment Single
Portability/Migration No Previous Policy Number NA
GSTIN NA GSTIN Account Type NA
New Business

Start date of
Policy of
Insured Pre-Existing Start date of
Relationship Age
Person (only DOB Diseases first policy with
Name of Insured person with Member ID (completed Gender
in case of new (DD-MM-YYYY) (PED) us(applicable at
Proposer birthday)
member (if applicable) policy renewal)
additions mid
term)
MAHESHWARAM PRAMOD
NA Self PT29631089 24 Male 29/12/2000 NA 04/07/2025
KUMAR

Continued and to be read in conjunction of the table above

Specific disease Waiting Pre-Existing Disease Super Credit

Base Sum Insured Initial Waiting Period Super Credit %
period Waiting Period Amount
500000 30 Days 2 Years 3 Years 0 NA

Continued and to be read in conjunction of the table above optional cover opted.

Product Name: Activ One, Product UIN: ADIHLIP24097V012324

0 0
1 0 Name of Insured Person Claim Protect (Non-Medical Expense Waiver)
Non-payable items will be covered (all 4 lists of
0 0 MAHESHWARAM PRAMOD KUMAR
Annexure I)

Waiting Period from Start Date of Chronic Management Program

Name of the Insured Person Chronic Condition
Start Date of First Policy Coverage Applicability
MAHESHWARAM PRAMOD
No NA NA No
KUMAR

Name of the Insured Person Special Condition (if applicable)

MAHESHWARAM PRAMOD KUMAR No

Name of the Insured Person Pre-Existing Disease Details (if applicable)

MAHESHWARAM PRAMOD KUMAR NA

HealthReturnsTM (Applicable for Renewal Policy)

Name of the Insured Person HealthReturnsTM carried forward from Previous Year -Total HealthReturnsTM available for utilization

MAHESHWARAM PRAMOD KUMAR NA 0

Trademarks - HealthReturnsTM, Healthy Heart Score and Active Dayz are owned by MMI Group Limited and used under license by
Aditya Birla Health Insurance Co. Limited.

Nominee Name Nominee Relationship with Policyholder Nominee Contact Number

MAHESHWARAM HEMALATHA Mother NA
Appointee Details: (Required only if Nominee is a Minor)
Appointee Name Relationship with Nominee
NA NA
Note - A Minor should not be declared as Appointee.

No

Product Name: Activ One, Product UIN: ADIHLIP24097V012324

 Product Name Activ One
Plan Variant NXT
Base Sum Insured Refer Base Sum Insured column under Insured
Basic Covers Hospitalization Room Rent Any Room - Actuals up to Sum Insured
Treatment ICU Charges Actuals up to Sum Insured
Road Ambulance Cover (per hospitalization) Actuals up to Sum Insured
Day Care Treatments Actuals up to Sum Insured
Modern Procedures / Treatments Actuals up to Sum Insured for listed procedures
HIV / AIDS and STD Cover Actuals up to Sum Insured
Mental Illness Hospitalization Actuals up to Sum Insured
Obesity Treatment Actuals up to Sum Insured
Pre-Hospitalization Expenses (up to Sum Insured) 90 Days
Post-Hospitalization Expenses (up to Sum Insured) 180 Days
Domiciliary Hospitalization Actuals up to Sum Insured
Home Health Care Actuals up to Sum Insured
AYUSH Treatment Actuals up to Sum Insured
Organ Donor Expenses Actuals up to Sum Insured
Super Reload 2X Cover Covered from Day 1
Unlimited Refill [2nd Claim onwards - 2nd Claim Onwards - unlimited times (up to Base
Unlimited Times (upto Base Sum Insured)] Sum Insured)
Health Management Program Health AssessmentTM Available once in a policy year undertaken at our
Network Providers / Empaneled Service Providers
on a cashless basis only / on digital basis

HealthReturnsTM Available up to 100% of the Premium

Premium for
Premium for
Other Optional Loading Discounts CGST SGST/UTGST IGST Other taxes/Cess
Base and Total Premium
Covers (if applicable) (if applicable) (9%) (9%) (18%) (1%)
Related Covers
(If Opted)

5079.35 0 0 0 NA NA 914.28 NA 5994.00

GST Registration No: 27AANCA4062G1ZN PAN Number :AANCA4062G Category: General Insurance SAC Code: 997133

We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate turnover
notified under sub-rule (4) of rule 48, we are not required to prepare an invoice in terms of the provisions of the said sub-rule.

Consolidated Stamp Duty paid vide E-challan GRN no. MH001265008202526E & 25/04/2025

For and on behalf of Aditya Birla Health Insurance Co. Ltd

Date : 04/07/2025

Location : Mumbai
Authorized Signatory

Product Name: Activ One, Product UIN: ADIHLIP24097V012324

 Premium Certificate
We confirm the receipt of premium amount of INR 5994.00 as per below details paid by Mr. MAHESHWARAM PRAMOD KUMAR for Self
and/or Family and/or Parents:

Policy Number: 31-25-0139333-00 Plan Name: NXT

Type of Plan: Individual Proposer Name: MAHESHWARAM PRAMOD KUMAR

Policy Start Date: 00:00 hrs on 04/07/2025 Policy End Date: 23:59 hrs on 03/07/2026

Premium Details:

Premium Date Net Premium Amount CGST SGST IGST Total Premium (incl. of taxes) Total Premium Paid

04-07-2025 5079.35 0.00 0.00 914.28 5994.00 5994

Mode of Premium payment Single

Year wise breakup of premium for the purpose of claiming Income Tax deduction u/s 80D (subject provisions of Income Tax Act) is
provided as under:
Financial Year Year wise proportionate Premium amount*
2025-26 5,994.00

0 • Premium paid in cash(Rs. 0), premium paid using HealthReturnsTM, and premium paid towards Personal Accident, Wellness Coach do not
qualify for deduction u/s 80D. Further premium paid for person other than family member & parents (as defined under Income Tax Act)
also don’t qualify for deduction under section 80D.

Amount is rounded off to nearest rupee and is inclusive of all taxes and cesses as applicable. For exact premium, please refer to Section
VII of Policy schedule
Note:
1. The year wise deductions as mentioned above are as per provision of Section 80D and this would be subjected to the specified annual
limits and other provisions as applicable for respective years as per applicable provisions of Income Tax Act.
2. Deduction under section 80D of the Act is allowed to the person who pays premium out of his/her income chargeable to tax.
3. Deduction under section 80D of the Act is available on realization of premium paid by Policyholder.
4. Tax laws are subject to change and any such change could have a retrospective effect. This letter should not be construed as tax,
legal or investment opinion from us. For specific suitability, you are requested to consult your tax advisor.
5. This receipt must be surrendered to the company, in case of cancellation of this policy. In event of incorrect representation of this
declaration the liability shall be upon the policy holder.

For and on behalf of Aditya Birla Health Insurance Co.

Limited

Date : 04/07/2025

Place : Mumbai
Authorized Signatory

Product Name: Activ One, Product UIN: ADIHLIP24097V012324

POLICY NO. 31-25-0139333-00
Name Membership No. DOB
MAHESHWARAM PRAMOD KUMAR PT29631089 29/Dec/2000
 Activ One NXT

CUSTOMER INFORMATION SHEET /

KNOW YOUR POLICY

This document provides key information about your policy. You are also advised to go through your policy document.

POLICY CLAUSE
SR. No. TITLE DESCRIPTION
NUMBER
01. Product Name Activ One NXT
02. Policy Number 31-25-0139333-00
Type of Insurance Indemnity basis:
Product/Policy 1. Hospitalization Treatment
2. Pre-Hospitalization Expenses
3. Post-Hospitalization Expenses
4. Domiciliary Hospitalization
5. Home Health Care
6. AYUSH Treatment
7. Organ Donor Expenses
8. Super Reload
9. Health AssessmentTM
10. HealthReturnsTM
11. Reduction in Pre-Existing Disease Waiting Period
12.Reduction in Specific Disease Waiting Period
03. 13. Claim Protect (Non-Medical Expense Waiver)
14. Room Rent Type Options
15. Per Claim Deductible
16. Preferred Provider Network (PPN) Discount
17. Super Credit
18. Chronic Care (Day 1 In-patient Hospitalization)
19. Chronic Management Program (OPD)
20. Cancer Booster
Individual 21. Durable Medical Equipment Cover
22. Compassionate Visit
23. Second Medical Opinion for listed Major Illness
24. Annual Screening Package for Cancer Diagnosed Patients
25. Annual Health Check-up
Fixed Benefit basis for all claims under:
04. Sum Insured (Basis) Individual Sum insured – Each member has separate sum
(Along with amount) Insured under the policy
Floater Sum Insured-where all member under the policy have a
single sum insured limit which may be utilized by any or all
members

Insured Person Individual Sum Insured

MAHESHWARAM PRAMOD KUMAR 500000
05. Policy Coverage I. Basic covers
(What the policy 1. Hospitalization Treatment C.1
covers?) a. 1.a. In-Patient Treatment C.1.1
1.b. Other expenses covered C.1.1.1
1.b.1. Road Ambulance (domestic only) C.1.1.1.a
1.b.2. Dental Treatment C.1.1.1.b
1.b.3. Plastic Surgery C.1.1.1.c
1.b.4. All Day Care Treatments C.1.1.1.d
1.b.5. Modern Procedures/Treatments C.1.1.1.e
1.b.6. HIV / AIDS and STD Cover C.1.1.1.f
1.b.7. Mental Illness Hospitalization C.1.1.1.g
1.b.8. Obesity Treatment C.1.1.1.h
2. Pre-Hospitalization Expenses C.2
3. Post-Hospitalization Expenses C.3
4. Domiciliary Hospitalization C.4
5. Home Health Care C.5
6. AYUSH Treatment C.6
7. Organ Donor Expenses C.7
8. Super Reload C.8
9. Health Management Program (In-built) C. 9
9.1. Health Assessment TM
C.9.1
9.2. HealthReturns TM
C.9.2

II. Optional Covers: (Available if opted by paying additional C.10

premium)
10. Reduction in Specific Disease waiting period C.10.1
11. Reduction in Pre-Existing Disease waiting period C.10.2
12. Claims Protect (Non-Medical Expense Waiver) C.10.3
13. Room Rent Type Options C.10.4
14. Per Claim Deductible C.10.5
15. Preferred Provider Network (PPN) Discount C.10.6
16. Critical Illness cover C.10.7
17. Personal Accident Cover(AD+ PTD+PPD) C.10.8
18. Super Credit C.10.9
19 Chronic Care (Day 1 In-patient Hospitalization) C.10.10
20. Chronic Management Program (OPD) C.10.11
21. Cancer Booster C.10.12
22. Durable Medical Equipment Cover C.10.13
23. Compassionate Visit C.10.14
24. Second Medical Opinion for listed Major Illness C.10.15
25. Annual Screening Package for Cancer Diagnosed Patients C.10.16
26. Annual Health Check-up C.10.17

06. Exclusions Standard Exclusion:

(What the policy 1. Investigation & Evaluation (Code- Excl04) D.1.4

does not cover) a) Expenses related to any admission primarily for diagnostics
and evaluation purposes only are excluded.

Product Name: Activ One, Product UIN: ADIHLIP24097V012324

 b) Any diagnostic expenses which are not related or not
incidental to the current diagnosis and treatment are excluded.

2. Rest Cure, rehabilitation and respite care (Code- Excl05) D.1.5

a) Expenses related to any admission primarily for enforced
bed rest and not for receiving treatment. This also includes:
i. Custodial care either at home or in a nursing facility for
personal care such as help with activities of daily living
such as bathing, dressing, moving around either by
skilled nurses or assistant or non-skilled persons.
ii. Any services for people who are terminally ill to address
physical, social, emotional and spiritual needs.

3. Obesity/ Weight Control (Code- Excl06) D.1.6

Expenses related to the surgical treatment of obesity that does
not fulfil all the below conditions:
1) Surgery to be conducted is upon the advice of the Doctor
2) The surgery/Procedure conducted should be supported by
clinical protocols
3) The member has to be 18 years of age or older and
4) Body Mass Index (BMI);
a) greater than or equal to 40 or
b) greater than or equal to 35 in conjunction with any of
the following severe co-morbidities following failure
of less invasive methods of weight loss:
i. Obesity-related cardiomyopathy
ii. Coronary heart disease
iii. Severe Sleep Apnea
iv. Uncontrolled Type2 Diabetes

4. Change-of-Gender treatments: (Code- Excl07) D.1.7

Expenses related to any treatment, including surgical
management, to change characteristics of the body to those
of the opposite sex.

5. Cosmetic or plastic Surgery: (Code- Excl08) D.1.8

Expenses for cosmetic or plastic surgery or any treatment to
change appearance unless for reconstruction following an
Accident, Burn(s) or Cancer or as part of medically necessary
treatment to remove a direct and immediate health risk to the
insured. For this to be considered a medical necessity, it must
be certified by the attending Medical Practitioner.

6. Hazardous or Adventure sports: (Code- Excl09) - Expenses D.1.9

related to any treatment necessitated due to participation as
a professional in hazardous or adventure sports, including but
not limited to, para-jumping, rock climbing, mountaineering,
rafting, motor racing, horse racing or scuba diving, hand gliding,
sky diving, deep-sea diving.

Product Name: Activ One, Product UIN: ADIHLIP24097V012324

7. Breach of law: (Code- Excl10) - Expenses for treatment directly D.1.10
arising from or consequent upon any Insured Person committing
or attempting to commit a breach of law with criminal intent.

8. Excluded Providers: (Code- Excl11) D.1.11

Expenses incurred towards treatment in any hospital or by
any Medical Practitioner or any other provider specifically
excluded by the Insurer as disclosed in website
(www.adityabirlahealth.com/healthinsurance)
/ notified to the policyholders are not admissible. However, in
case of life threatening situations or following an accident,
expenses up to the stage of stabilization are payable but not
the complete claim.

9. Treatment for, Alcoholism, drug or substance abuse or any D.1.12

addictive condition and consequences thereof. (Code- Excl12).

10. Treatments received in heath hydros, nature cure clinics, spas D.1.13
or similar establishments or private beds registered as a nursing
home attached to such establishments or where admission is
arranged wholly or partly for domestic reasons. (Code- Excl13)

11. Dietary supplements and substances that can be purchased D.1.14

without prescription, including but not limited to Vitamins,
minerals and organic substances unless prescribed by a
medical practitioner as part of hospitalization claim or day
care procedure (Code- Excl14)

12. Refractive Error:(Code- Excl15) - Expenses related to the D.1.15

treatment for correction of eye sight due to refractive error
less than 7 .5 dioptres.

13. Unproven Treatments:(Code- Excl16) D.1.16

Expenses related to any unproven treatment, services and
supplies for or in connection with any treatment. Unproven
treatments are treatments, procedures or supplies that lack
significant medical documentation to support their effectiveness.

14. Sterility and Infertility: (Code- Excl17) D.1.17

Expenses related to sterility and infertility. This includes:
i. Any type of contraception, sterilization
ii. Assisted Reproduction services including artificial
insemination and advanced reproductive technologies
such as IVF, ZIFT, GIFT, ICSI
iii. Gestational Surrogacy
iv. Reversal of sterilization

Product Name: Activ One, Product UIN: ADIHLIP24097V012324

15. Maternity Expenses (Code - Excl18) : D.1.18
i. Medical treatment expenses traceable to childbirth (including
complicated deliveries and caesarean sections incurred during
hospitalization) except ectopic pregnancy;
ii. Expenses towards miscarriage (unless due to an accident)
and lawful medical termination of pregnancy during the policy
period.

Specific Exclusions

1. Circumstantial Exclusion D.2.1

a) Treatment resulting from war, invasion, civil war, revolt, or
military involvement: Medical treatment that arises from or
is related to acts of war, military operations, or involvement
in armed forces activities
b) Exclusion of certain acts and substances: Treatment or
consequences related to unlawful acts, nuclear weapons /
materials, chemical and biological weapons, radiation
exposure, or contamination by radioactive materials or
substances.
c) The Insured Person’s direct participation in terrorist acts;

2. Behavioural Exclusions D.2.2

a) Suicide or attempted suicide, intentionally hurting oneself
on purpose;
b) Illegal act of the Insured Persons
c) Any treatment for Injury resulting from the consumption of
alcohol or any intoxicating substance, its intake or abuse
thereof
d) The use of drugs (other than drugs taken under treatment
prescribed and directed by a Medical Practitioner but not for
the treatment of drug addiction);

3. Medical Exclusions D.2.3

a) All routine examinations and Health Check-ups except as
per terms and conditions mentioned under Section C.9 –
Annual Health Check-up
b) Circumcisions (unless required for medical reasons or as
part of a treatment plan for an illness or injury);
c) Conditions for which treatment could have been done on an
outpatient basis without any Hospitalization
d) Preventive care, vaccinations and immunizations (except in
case of post-bite treatment); any physical, psychiatric or
psychological examinations or testing
e) Admission for nutritional and electrolyte supplements unless
certified by the attending medical practitioner that they are
necessary as a direct result of a covered claim
f) Any conditions or abnormalities that are present at birth
and are visible on the outside of the body, as well as any
related diseases or defects,

Product Name: Activ One, Product UIN: ADIHLIP24097V012324

 g) Stem cell therapy except Hematopoietic stem cells for
bone marrow transplant for haematological conditions)
or Surgery, or growth hormone therapy or Hormone
Replacement Therapy.
h) Dental / oral treatment: Treatment, procedures and
preventive, diagnostic, restorative, cosmetic services
related to disease, disorder and conditions related to
natural teeth and gingiva except if required by an
Insured Person while Hospitalized due to an Accident
i) AYUSH Treatment Any form of AYUSH Treatments,
except as mentioned under Section C.7

4. Prosthesis and Devices D.2.4

a) Hearing aids, spectacles or contact lenses including
optometric therapy, multifocal lens
b) Wigs, or toupees, and related expenses.
c) Expenses for prosthesis (artificial body parts), corrective
devices, external durable medical equipment, wheelchairs,
crutches, or instruments used in the diagnosis / treatment of
sleep apnea syndrome and other sleep disorders or
continuous ambulatory peritoneal dialysis (C.A.P.D.),
Devices used for ambulatory monitoring of blood pressure,
blood sugar, glucometers, nebulizers and oxygen concentrator
for bronchial asthma/ COPD conditions, cost of cochlear
implant(s) unless necessitated by an Accident.

5. Non-Medical expenses D.2.5

As mentioned under Annexure (I), items in List I II, III & IV will
be excluded unless forms a part of In-patient hospitalization.

6. Specific treatment Exclusion D.2.6

Treatment involving Rotational Field Quantum Magnetic
Resonance (RFQMR), External Counter Pulsation (ECP),
Enhanced External Counter Pulsation (EECP), Hyperbaric
Oxygen Therapy, KTP Laser Surgeries, cyber knife treatment,
Femto laser surgeries, bioabsorbable stents, bioabsorbable
valves, bioabsorbable implants, Use of Radio Frequency (RF)
probe for ablation.

7. Activities and Profession Exclusions D.2.7

a) Treatment received from a person who is not recognized
as a registered Medical Practitioner by any state medical
council or the medical council of India.
b) Medical or treatment fees charged by unlicensed and
unauthorized practitioners are not covered
c) Treatments provided by a Medical Practitioner who is a family
member of the Insured Person or resides in the same
household, unless pre-approval is obtained from Us.

Product Name: Activ One, Product UIN: ADIHLIP24097V012324

 8. Geographical Exclusion D.2.8
Treatment taken outside India, unless specified to be covered
in the Policy Schedule.

07. Waiting period Section D.1

• Time period during 1. Pre-Existing Diseases (Code- Excl01) : D.1.1
which specified Pre-existing Diseases shall be covered after a waiting period
disease / treatment
is not covered of 36 months as specified in Product Benefit Table / Policy
Schedule

• It is counted from
2. Specified disease / procedure waiting period (Code- Excl02): D.1.2
the beginning of the
24 months for specific illness/conditions and their complications
policy coverage
in the first two years and is not applicable in subsequent renewals

Body System Illness Treatment/ Surgery

1. Eye Cataract Cataract Surgery
Glaucoma Glaucoma Surgery
Refractive Error Correction Correction Surgery
2. Ear Nose Throat Sinusitis Medical & Surgical Treatment
Rhinitis Medical & Surgical Treatment
Tonsillitis & Adenitis Medical & Surgical Treatment
Tympanitis & Non Traumatic Perforation Medical & Surgical Treatment
Deviated Nasal Septum Medical & Surgical Treatment
Otitis Media Medical & Surgical Treatment
Adenoiditis Medical & Surgical Treatment
Mastoiditis Medical & Surgical Treatment
Cholesteatoma Medical & Surgical Treatment
3. Gynecology All Cysts, Mass, Swelling, Lump, Granulomas, Polyps, Fibroids & Medical & Surgical treatment
Benign Tumour of the female genito urinary system
Polycystic Ovarian Disease Medical & Surgical treatment
Uterine Prolapse Medical & Surgical treatment
Fibroids (Fibromyoma) Medical & Surgical treatment
Breast lumps (excluding Malignant) Medical & Surgical treatment
Dysfunctional Uterine Bleeding (DUB) Medical & Surgical treatment
Endometriosis Medical & Surgical treatment
Menorrhagia Medical & Surgical treatment
Pelvic Inflammatory Disease Medical & Surgical treatment
4. Orthopedic / Gout Medical & Surgical treatment
Rheumatological Rheumatism, Rheumatoid Arthritis Medical & Surgical treatment
Non infective arthritis Medical & Surgical treatment
Osteoarthritis Medical & Surgical treatment
Osteoporosis Medical & Surgical treatment
Prolapse of the intervertebral disc Medical & Surgical treatment
Spondilosis, Spondioarthritis, Spondylopathies Medical & Surgical treatment
Ankylosing Spondilitis / Spondylopathies Medical & Surgical treatment
Psoriatic Arthritis / Arthropathy Medical & Surgical treatment
Internal Derangement of Knee / Ligament or Tendon or Meniscus Tear Medical & Surgical treatment
Joint Replacement Surgery Medical & Surgical treatment
Non Specific Arthritis Medical & Surgical treatment

Product Name: Activ One, Product UIN: ADIHLIP24097V012324

 5. Gastroenterology Stone in Gall Bladder, Bile duct & other parts of Biliary System Medical & Surgical treatment

(Alimentary Canal Cholecystitis Surgical treatment

and related Pancreatitis Surgical treatment

Organs) Fissure, Fistula in ano, hemorrhoids (piles), Pilonidal Sinus, Medical & Surgical treatment
Ano-rectal & Perianal Abscess
Rectal Prolapse Medical & Surgical treatment
Gastric or Duodenal Erosions or Ulcers + Gastritis & Duodenitis & Colitis Medical & Surgical treatment
Gastro Esophageal Reflux Disease (GERD) Medical & Surgical treatment
Cirrhosis Medical & Surgical treatment
Chronic Appendicitis Surgical treatment
Appendicular lump, Appendicular abscess Medical & Surgical treatment
6. Urogenital Stones in Urinary system (Stone in the Kidney, Ureter, Urinary Bladder) Medical & Surgical treatment
(Urinary and Benign Hypertrophy / Enlargement of Prostate (BHP / BEP) Medical & Surgical treatment
Reproductive
System) Hernia, Hydrocele Medical & Surgical treatment
Varicocoele / Spermatocoele Medical & Surgical treatment
7. Skin Skin tumour (unless malignant) Medical & Surgical treatment
All skin diseases
8. General Surgery Any swelling, tumour, cyst, nodule, ulcer, polyp Mass , Swelling, Lump, Medical & Surgical treatment
Granulomas, Benign Tumour anywhere in the body (unless malignant)
Varicose veins, Varicose ulcers Medical & Surgical treatment

3. 30-day waiting period (Code- Excl03): D.1.3

30 days for all illnesses (except accident) in the first year and is
not applicable in subsequent renewals and policies accepted
under Portability

4. Initial waiting period (Applicable for Critical Illness Cover)

• For Personal Accident Cover (AD,PTD), no initial waiting period
applicable.
• For Critical Illness Cover, We shall not be liable to make any C.10.7
payment in respect of any Critical Illness whose signs or
symptoms first occur within 60 days from the Inception Date
of cover.

08. Financial limits of

coverage

(i) Sub-limit (It is a Nil

pre-defined limit
and We will not pay
any amount in
excess of this limit)

(ii) Co-payment (It Nil

is a specified
amount / percentage
of the admissible
claim amount to be
paid by Insured)

(iii) Deductible Nil

(iv) Any other limit Nil

Product Name: Activ One, Product UIN: ADIHLIP24097V012324

09. Claims / Claims a. For Cashless Service: E.2.7.1.a
Procedure Kindly contact us 48 hrs prior for planned hospitalisation or within
24 hours of hospitalisation in case of emergency hospitalisation.

Link for Hospital Network details:

https://www.adityabirlacapital.com/healthinsurance/locate-care/hospital-listing

b. For Reimbursement of Claim: E.2.7

Type of claim Prescribed Time Limit

Reimbursement of Within 30 days of date of

Hospitalization, Day Care discharge from Hospital.
Treatment or Pre Hospitalization
Expenses

Reimbursement of Post Within 15 days from completion

Hospitalization Expenses of post Hospitalization treatment.

c. For Personal Accident: We shall be given an intimation of the E.2.7.2

claim along with the following details within 7 days from the
date of Accident.

d. For Critical Illness: We shall be given intimation of the claim E.2.7.2

along with the following details within 30 days of the diagnosis
of the Critical Illness.

10. Policy Servicing ln case of any Policy services the insured person may contact the
Website: https://www.adityabirlacapital.com/healthinsurance/faqs
Toll- Free: 1800 270 7000
E-mail: [email protected]
(Senior citizens may write to us at:
[email protected])
In case you are not satisfied with the resolution you may write to
Head – Customer Care :
[email protected]

Courier:
Write to our HO at below address
Unit no 1101 & 1104 11th floor, Unit no 1501 & 1502 15th floor, G Corp
Tech Park, Kasarwadavali, Ghodbunder Road,Thane West - 400601
lnsured person may also approach the grievance cell at any of the
company's branches with the details of grievance.

If lnsured person is not satisfied with the Redressal of grievance

through one of the above methods, insured person may contact the
grievance officer at: [email protected]
If Insured Person is not satisfied with the Redressal of grievance
through above methods, the Insured Person may also approach the
office of Insurance Ombudsman of the respective area/region for
Redressal of grievance as per Insurance Ombudsman Rules 2017
(at the addresses given in Annexure II)
Grievance may also be lodged at IRDAI Integrated Grievance
Management System-https://bimabharosa.irdai.gov.in/

Product Name: Activ One, Product UIN: ADIHLIP24097V012324

11. Grievances / ln case of any grievance the insured person may contact the E.1.8
Complaints Website: https://www.adityabirlacapital.com/healthinsurance/faqs
Toll- Free: 1800 270 7000
E-mail: [email protected]
(Senior citizens may write to us at:
[email protected])
In case you are not satisfied with the resolution you may write to
Head – Customer Care :
[email protected]

Courier:
Write to our HO at below address
Unit no 1101 & 1104 11th floor, Unit no 1501 & 1502 15th floor,
G Corp Tech Park, Kasarwadavali, Ghodbunder Road,Thane
West - 400601

lnsured person may also approach the grievance cell at any of the
company's branches with the details of grievance.

If lnsured person is not satisfied with the Redressal of grievance

through one of the above methods, insured person may contact
the grievance officer at: [email protected]

If Insured Person is not satisfied with the Redressal of grievance

through above methods, the Insured Person may also approach
the office of Insurance Ombudsman of the respective area/region for
Redressal of grievance as per Insurance Ombudsman Rules 2017
(at the addresses given in Annexure II) Grievance may also be lodged
at IRDAI Integrated Grievance Management
System-https://bimabharosa.irdai.gov.in/

12. Things to a. Free Look period: The Free Look Period shall be applicable on E.1.1
remember
new individual health insurance policies, except for those policies
with tenure of less than a year. Free-Look shall not be applicable
on renewals or at the time of porting / migrating the policy.

The Insured Person shall be allowed Free Look Period of thirty

days from date of receipt of the policy document, whether received
electronically or otherwise, to review the terms and conditions
of the policy, and to return the same if not acceptable.

lf the Insured has not made any claim during the Free Look Period,
the Insured shall be entitled to:

i. A Refund of the premium paid less any expenses incurred by

the Company on medical examination of the Insured Person and
stamp duty charges, where the risk has not commenced or
ii. Where the risk has already commenced and the option of
return of the policy is exercised by the Insured Person, a deduction

Product Name: Activ One, Product UIN: ADIHLIP24097V012324

 towards the proportionate risk premium for period of cover,
expenses, if any incurred by the Company on medical examination
of the Insured Person and stamp duty charges or
iii. Where only a part of the insurance coverage has commenced,
such proportionate premium commensurate with the insurance
coverage during such period, expenses, if any incurred by the
Company on medical examination of the Insured Person and
stamp duty charges.
A request received by insurer for cancellation of the policy during
free look period shall be processed and premium shall be refunded
within 7 days of receipt of such request.

b. Policy Renewal : The policy shall ordinarily be renewable except E.1.3

on grounds of fraud, moral hazard, misrepresentation by the
insured person. Renewal shall not be denied on the ground
that the insured had made a claim or claims in the preceding
policy years.

c. Migration: The Insured Person will have the option to migrate the E.1.12
Policy to other health insurance products / plans, offered by the
Company, by applying for migration of the policy at least 30 days
before the policy renewal date. If such person is presently covered
and has been continuously covered without any lapses under
any health insurance product / plan offered by the Company, the
Insured Person will get the accrued continuity benefits to the
extent of the Sum Insured, No Claim Bonus if any, Specific
Waiting periods, waiting period for pre-existing diseases,
Moratorium period, provided the policy was renewed
continuously without break.

In case the Insured Person wants to migrate their Health

Insurance Policy, then contact Us with the details through:
E-mail ID: [email protected]
Toll Free: 1800 270 7000
Address: Any of Our Branch office or Corporate office

d. Portability: The Insured Person will have the option to port the E.1.13
Policy to other insurers by applying to such Insurer to port the
entire policy along with all the members of the family, if any, at
least 45 days before, but not earlier than 60 days from the policy
renewal date. If such person is presently covered and has been
continuously covered without any lapses under any health
insurance policy with an Indian General/Health insurer, the
proposed Insured Person will get the accrued continuity benefits
to the extent of the Sum Insured, Cumulative Bonus, if any,
specific waiting periods, waiting period for pre-existing disease,
Moratorium period, provided the policy was renewed continuously
without break.

Product Name: Activ One, Product UIN: ADIHLIP24097V012324

 In case the Insured Person wants to port their Health Insurance
Policy, then contact Us with the details through:
E-mail ID: [email protected]
Toll Free: 1800 270 7000
Address: Any of Our Branch office or Corporate office

e. Changes to Sum Insured on Renewal: You may opt for E.2.5.C

enhancement of Sum Insured at the time of Renewal, subject to
underwriting. All Waiting Periods as defined in the Policy shall
apply afresh for this enhanced limit from the effective date of
such enhancement.

f. Moratorium Period: After completion of sixty continuous months E.1.10

of coverage (including portability and migration) in health insurance
policy, no policy and claim shall be contestable by the insurer on
grounds of non-disclosure, misrepresentation, except on grounds
of established fraud This period of sixty continuous months is
called as moratorium period. The moratorium would be applicable
for the sums insured of the first Policy. Wherever, the sum insured
is enhanced, completion of sixty continuous months would be
applicable from the date of enhancement of sums insured only on
the enhanced limits. The accrued credits gained under the ported
and migrated policies shall be counted for the purpose of
calculating the Moratorium period.

13. Insured’s a. The Policy shall be void and all premium paid thereon shall be E.1.14
Obligations
forfeited to the Company in the event of misrepresentation,
mis-description or non-disclosure of any material fact by the
policyholder.

b. During the Policy Term any material information changes on

Occupation and/ or Medical Conditions shall be communicated
to Us in a Change Request Form. This form can be downloaded
from Our website or collected from Our branch office or can also
be obtained by contacting Us over the telephone.

Product Name: Activ One, Product UIN: ADIHLIP24097V012324

72

Declaration by the Policy Holder:

I have read the above and confirm having noted the details.

MAHESHWARAM PRAMOD KUMAR authenticated via

Place : Munugode OTP for QE0290346962507
On null at 00:00:01
Date :04-JUL-25

(Signature of the Policy Holder)

LEGAL DISCLAIMER NOTE:

The information must be read in conjunction with the product brochure and policy document. In case of any conflict between the
CIS and the policy document, the terms and conditions mentioned in the policy document shall prevail.

Please refer below link for Product related documents

Aditya Birla Health Insurance Download (adityabirlacapital.com)