especially individuals or couples seeking senior-focused hospitalization
OPD
home treatment
wellness and recovery support.
What Works Well
100% reload of Sum Insured once per policy year
Domiciliary hospitalization covered up to Sum Insured
Organ donor expenses covered up to Sum Insured
586 listed day care procedures covered
OPD treatment available up to ₹2
500 over and above Sum Insured
Cashless home treatment available
Personal Health Coach available
HealthReturns up to 21% of premium
Comprehensive health check-up once per policy year
Watch Out For
10% co-payment applies when entry age is 61 years or above
Base room eligibility is Single Private AC Room
Only 586 listed day care procedures are covered
Reload is available only once per policy year and for subsequent unrelated claims
Plan is comparatively expensive
Non-medical expenses are not fully covered in the base policy
10% co-pay for entry age 61 years or above
Single Private AC Room base restriction
Reload restricted to subsequent unrelated claims
Listed day care procedures rather than all day care procedures
Plan pricing is relatively expensive
Multiple specific exclusions and benefit conditions
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Data Not Available
⚡ At a Glance
Cashless Available Online Claim Tracking Home Sample Pickup Personal Claim Manager Domiciliary Cover Family Floater Modern Treatments Reset Benefit Organ Donor Health Coaching Preventive Checkups Co-payment Applies Room Rent Cap Disease Sub-limits Complex Exclusions Restore Restrictions Claim Restrictions
Road Ambulance
₹5,000
Day Care
586
Home Care
₹50,000
Cum. Bonus
10%/yr (max 50%)
Special Benefits
•Restore Benefit
Wellness Benefits
•HealthReturns up to 21% of premium
•Health Assessment
•Comprehensive Health Check-up
•Personal Health Coach
•Healthy Heart Score
•Active Dayz
•Health and Wellness discounts
•Second E-Opinion on major illnesses
Modern Treatments
•Data Not Available
Optional Add-ons
•Room Upgrade
•PPN Discount
•Nursing at Home
•Lifestyle Support Equipment
•Portable Medical Equipment
•Advance Health Check-up
•Non-medical Expenses Cover
Domiciliary Exclusions
•Asthma
•bronchitis
•tonsillitis and upper respiratory tract infection including laryngitis and pharyngitis
•cough and cold
•influenza
•Arthritis
•gout and rheumatism
•Chronic nephritis and nephritic syndrome
•Diarrhea and all types of dysenteries including gastroenteritis
•Diabetes mellitus and insipidus
•Epilepsy
•Hypertension
•Psychiatric or psychosomatic disorders of all kinds
•Pyrexia of unknown origin
Key Benefits (Pros)
•Fewer claim settlement complaints
•Fewer after-sales complaints
•High claim settlement ratio
•Low claim repudiation ratio
Policy Drawbacks
•Average response time on X (Twitter)
•Premium is expensive compared with competing products
Day 31 Covered Diseases
•Data Not Available
Insurer Positives
•Fewer claim settlement complaints
•Fewer after-sales complaints
•High claim settlement ratio
•Low claim repudiation ratio
Insurer Negatives
•Average response time on X (Twitter)
•Premium is expensive compared with competing products
Eligibility
•Minimum entry age: 55 years
•Maximum entry age: 80 years
•Individual policy available
•Family floater available for self and spouse only
•Premier Sum Insured options: ₹5 lakh, ₹7.5 lakh, ₹10 lakh and ₹25 lakh
Care & Wellness Benefits
•Health Assessment once per policy year
•Comprehensive Health Check-up once per policy year
•Personal Health Coach
•HealthReturns up to 21% of premium
•Second E-Opinion on major illnesses
•Health and Wellness discounts
Optional Covers / Care Benefits
•Room Upgrade: Single Private AC Room to Any Room except Suite & above
•Source: Uploaded Activ Care Policy Terms & Conditions and Activ Care Product Benefit Table/Brochure; FY2025-26 market metrics supplied by user; current Aditya Birla official product/claims pages; official Activ Care premium prospectus
•Founded Year: 2015
•Gross Written Premium Crore: 5901.52
•Number Of Policies: 43737602
•Number Of Claims: 2846356
•Financial Year: 2025-26
•Claims Settled 30 Days Percent: 98.82
•Claim Settlement Time Days: 15
🤖 AI Policy Analysis
Powered by MyInsureBuddy AI - Automatically analysed from official IRDAI documents.
Summary
Senior-focused health policy for ages 55-80 with ₹5 lakh to ₹25 lakh Sum Insured, 30/60 day pre-post hospitalization, 586 listed day care procedures, OPD benefit, home treatment, organ donor cover, wellness rewards and a 100% reload once per policy year. Important restrictions include age-linked co-payment, Single Private AC Room eligibility, disease sublimits and reload restrictions.
Recommendation
Suitable for senior citizens who value OPD, home treatment, wellness and recovery-support benefits and are comfortable with the 10% co-payment applicable from entry age 61+, room-category limits and once-per-year unrelated-claim reload restriction.
Coverage & Benefits
In-patient Hospitalisation
Covered up to Sum Insured
ICU
Covered up to Sum Insured
Pre-Hospitalization
Covered for 30 days before hospitalization
Post-Hospitalization
Covered for 60 days after discharge
Day Care Treatment
586 listed day care procedures covered
Domiciliary Hospitalization
Covered up to Sum Insured, subject to listed exclusions
Road Ambulance
Network provider: actual expenses; non-network provider: up to ₹5,000 per hospitalization
Organ Donor Expenses
Covered up to Sum Insured for organ harvesting; donor pre/post hospitalization and screening excluded
Reload of Sum Insured
100% of Sum Insured once per policy year for subsequent unrelated claims
AYUSH In-patient Hospitalization
Covered up to 25% of Sum Insured
Home Treatment
Up to ₹50,000 for Premier; cashless through eligible network/empanelled providers
OPD Treatment
Up to ₹2,500 over and above Sum Insured
No Claim Bonus
10% of Sum Insured per claim-free year, maximum 50%
Domestic Emergency Assistance
Available, including air ambulance assistance
International Emergency Assistance
Available, including air ambulance assistance subject to policy conditions
Comprehensive Health Check-up
Available once per policy year
Personal Health Coach
Available for Premier
Terms & Conditions (Simplified)
MyInsureBuddy translates
complex insurance language into plain English so you actually understand what you're signing.
Entry Age
Minimum 55 years and maximum 80 years.
Policy Type
Individual or Family Floater for self and spouse only.
Co-payment
10% per claim for applicable hospitalization, day care, domiciliary, AYUSH and home treatment claims when age at entry is 61 years or above.
Room Rent
Single Private AC Room under Premier. Paid Room Upgrade can enhance eligibility to Any Room except Suite & above.
Initial Waiting Period
30 days except claims arising from accidents and subsequent renewals.
Pre-existing Disease Waiting Period
24 months of continuous coverage.
Specified Disease/Procedure Waiting Period
24 months.
Reload
100% of Sum Insured once in a policy year, only for subsequent unrelated claims.
Grace Period
15 days for monthly premium mode and 30 days for other modes.
PPN Discount
10% premium discount; if treatment is taken outside Preferred Provider Network, additional 15% co-payment applies.
What's Not Covered
Standard and specific exclusions under
this policy.
Maternity
Childbirth expenses including complicated delivery and caesarean section except ectopic pregnancy
Miscarriage unless due to an accident
Lawful medical termination of pregnancy
Specific Exclusions
War
invasion
acts of foreign enemy
warlike operations and related events
Intentional self-injury and participation in naval
military or air force operations
Abuse of intoxicants and nicotine addiction treatment unless medically prescribed
Circumcision unless medically necessary for illness or injury
Investigational or experimental treatments and drugs under trial
Convalescence and general weakness-related care
Admission for nutritional and electrolyte supplements unless medically necessary
Hearing aids
spectacles
contact lenses and optometric therapy
Alopecia
baldness
wigs and related treatment
Medical supplies such as elastic stockings and diabetic test strips
External durable medical equipment unless specifically covered under an optional benefit
Parkinson disease
External congenital anomalies
Stem cell therapy except hematopoietic stem cells for bone marrow transplant for haematological conditions
Venereal and sexually transmitted diseases other than HIV/AIDS
Organ donor screening expenses
Spinal/skeletal manipulation and muscle stimulation except specified fracture/dislocation treatment
Dental treatment except when hospitalization is required due to an accident
Certain therapies including EECP
hyperbaric oxygen therapy
magnetic therapies
KTP laser and similar specified procedures
Organ Donor Limitations
Donor pre-hospitalization expenses are not covered
Donor post-hospitalization expenses are not covered
Donor screening expenses are not covered
Organ transportation and preservation expenses are not covered
Post-harvesting donor complications are not covered under the organ donor benefit
Domiciliary Exclusions
Asthma
bronchitis
tonsillitis and upper respiratory tract infection including laryngitis and pharyngitis
cough and cold
influenza
Arthritis
gout and rheumatism
Chronic nephritis and nephritic syndrome
Diarrhea and all types of dysenteries including gastroenteritis
Diabetes mellitus and insipidus
Epilepsy
Hypertension
Psychiatric or psychosomatic disorders of all kinds
Pyrexia of unknown origin
Official Policy PDF
Download the official
IRDAI-filed brochure from Aditya Birla Health Insurance Company Limited.
