Aditya Birla Group Health Insurance

How to buy Aditya Birla group health insurance from Pazcare?

Aditya Birla group health insurance plan types

The Aditya Birla group health insurance has 3 plan types. They are

Group Activ Health

It is a comprehensive and fully customizable corporate health insurance plan. This plan has features like cover for hospitalisation expenses and daycare treatments for critical illnesses taken outside of India, and cover for AYUSH treatments like Ayurvedic, Unani and Homeopathic treatments. Moreover, all the pre-existing diseases are covered from day 1 without any waiting period. These include cover for hypertension, cholesterol, diabetes, asthma, etc. Under this plan, cashless treatment is provided at all network hospitals.

Group Activ Secure

This plan is designed in such a way as to manage an injury or medical treatment in a foreign country. Cashless claims are available at all Aditya Birla network hospitals. In-patient hospitalisation expenses like doctor’s fees, room rent, diagnostic test charges, etc are covered by this policy. Furthermore, the plan has road ambulance cover and an option to include add-ons like accidental hospital cash, coma benefit, etc.

Group Activ Travel

This is the perfect travel insurance for the employees of your organisation. This policy covers the in-patient hospitalisation and out-patient treatment expenses of the insured during the travel. This includes expenses due to injury, illness, etc. This plan can be customized and made region-specific. The expenses for ambulance services, miscellaneous expenses like the cost of medicine, nursing charges, blood storage charges, and many more are covered in this plan.

Why choose Aditya Birla group health insurance?

With more than 20 health insurance players in the market, here is why you have to choose the Aditya Birla group health insurance from Pazcare.

Easy claim settlement

With Aditya Birla group health insurance, you do not have to depend on the external TPA. The claim settlement is easy and quick with their in-house claim settlement team. The claims can be raised by calling their toll-free number or by just dropping an email.

Larger health network

With a presence in around 2300+ cities and 10,000+ cashless network hospitals, Adiya Birla health insurance has a large healthcare network. A large network of cashless hospitals means the probability of one undergoing cashless treatment is higher.

High claim settlement ratio

The claim settlement ratio of the insurer has always been consistent. The claim settlement ratio of Aditya Birla health insurance is 70.81% for the year 2019-2020. A higher claim settlement ratio indicates that the insurer is more reliable and more credible. It also means high customer satisfaction.

No medical check-up is needed

Unlike your retail health insurance policy, the Aditya Birla group health insurance policy does not require a medical check-up before the policy purchase.

Aditya Birla group health insurance claim settlement ratio

A health insurance claim settlement ratio (CSR) is the ratio between the number of claims settled to the number of claims made or requested in a financial year by the health insurance company. Hence, a CSR ratio can be calculated as

Claim settlement ratio = Number of claims settled/Number of claims made*100

Network hospitals of Aditya Birla group health insurance

All health insurance companies have a list of network hospitals or cashless hospitals, where one can claim cashless treatment. Larger the list of network hospitals, the higher the chances of finding a cashless network hospital near your location. Aditya Birla group health insurance has around 10,000+ network hospitals located in pan India. This makes sure that you can get high-quality treatment near your location and you will be able to file for a cashless claim.

Claim Aditya Birla group health insurance

Aditya Birla group health insurance cashless claim

With Aditya Birla group health insurance you can make a cashless claim using the following steps.

1. Go to the nearest network hospital
The cashless claim facilities are available at a network hospital only. Hence, get to the nearest network hospital for treatment.

2. Confirm your identity
The next step is to confirm your identity using the health insurance ID card or policy number, a valid photo ID like an Aadhar card, voter ID, driving license, etc and the company ID at the hospital.

3. Submitting the pre-authorisation form
Once the above proof is verified, the next step is to submit the pre-authorization form to Aditya Birla health insurance. For emergency hospitalization the form is submitted within 48 hours of hospitalisation. In the case of planned hospitalisation, it is submitted 3 days before the hospitalisation.

4. Review of request
After the form submission, Aditya Birla health insurance will review the cashless claim request and the network hospital will be notified about the claim decision. You will be notified through an email or a message.

5. Claim settlement
Once all of this is done and the insurer accepts your claim request. The claim is settled directly with the network hospital according to the terms and conditions of your policy.

Aditya Birla group health insurance reimbursement claim

In case you get hospitalised at a non-network hospital, the reimbursement claim from Aditya Birla group health insurance can be carried out by the following steps.

1. Inform your insurance company
The first step is to inform your insurer about the hospitalisation. In case of emergency hospitalisation, inform the insurer within 48 hours of hospitalisation. Whereas, in case of a planned hospitalisation inform at least 3 days before the hospitalisation.

2. Settle the bills at the hospital
After you get treated at a non-network hospital, settle all the bills out of your pockets at the hospital.

3. Collect all the documents
After you settle all the bills, make sure you have all the original copies of all the required documents to file for a reimbursement claim.

The documents required to file a reimbursement claim

• A duly filled claim form • Policy copy/health insurance ID card
• A valid unique identity card (Aadhar card, driving license, etc.)
• All original medical bills and pharmacy bills, discharge summary, doctor consultation report and prescription papers.
• A medical certificate specifying the duration, past medical history and treatment details signed by the doctor in charge.
• For accidents, FIR or MLC (Medico-Legal Certificate) copy
• Other relevant documents.

4. Submit the documents
After collecting all the relevant documents, submit them to the nearest Aditya Birla health insurance branch within 15 days of discharge. Alternatively, you can also send the documents via post to

Aditya Birla Health Insurance Co. Limited,
5th floor, Modi Business Centre,
Kasarvadavali, Mumbai, Thane West 400615.

5. Claim processing
Once the documents are submitted, the insurer will review your documents and reject or approve the reimbursement claim request. This will be done as per the terms and conditions of your policy. Once approved, the claim will be settled in your bank account. You will be notified about the claim approval/rejection via SMS or your registered email.

You can also contact us at support@pazcare.com, to guide you through the whole process. We provide 24X7 claim assistance for your employees.

Aditya Birla group health insurance renewal process

The Aditya Birla group health insurance can be renewed easily with Pazcare at end of your policy term. Here are the steps to renew your Aditya Birla group health insurance plan.

Step 1: Get in touch with Pazcare. Submit a form containing details like your name, name of the company, number of employees you wish to insure, work email address and phone number.

Step 2: Once the form is submitted, our consultants will get in touch with you. Since this is not a fresh policy, you will have to submit the following documents.

• Active data of the employees - name, age, gender • Claim analysis report
• Claim dump report from the insurer/TPA
• Policy copy

Step 3: You can choose additional add-ons to your existing policy like dental insurance riders, maternity insurance riders to your existing policy. Furthermore, with Pazcare one can choose additional health and wellness add-ons to your Aditya Birla group health insurance. These add-ons include wellness and therapy sessions, unlimited doctor consultations, comprehensive check-ups, and many more.

Step 4: Our consultants will get back to you with the competitive quotes for your Aditya Birla group health insurance. Based on your claims report and the add-ons you choose, your health insurance premium may vary from the previous financial year.

Step 5: The next step is to agree to the terms and conditions of the policy and pay the premium for your Aditya Birla group health insurance policy. The policy will be usually valid for a year after the renewal.

Step 6: In case, you are purchasing your Aditya Birla group health insurance for the first time with Pazcare, the onboarding process will be carried out in 24 hours. During this period, our associate will get in touch with you and provide you with all the essential information to get started with your group health insurance.

We make sure that your Aditya Birla group health insurance experience will be seamless using our Pazcare dashboard. Your employees can access their policy using Pazcare’s employee app which is available on both the app store and the play store.

Aditya Birla group health insurance premiums

The Aditya Birla group health insurance premium is directly proportional to the risks involved. There are also certain factors which influence the premium for your group health insurance policy is calculated. They are

Average age

The premium is calculated based on the average age of the people insured. The younger the age, the lower the premium. This is because the younger generation poses lesser health risks.

Type of plan opted

Different types of group health insurance policies opted are employee only (E), employee+spouse+children (ESC) and employee+spouse+children+parents (ESCP) plans. The number of people covered under the ESCP plan is higher than the ones covered in the E plan. Hence, the premium will be higher when the scope of coverage is higher.

Nature of the job

The nature of the job one performs is also a factor considered to decide the annual premium. Jobs associated with more risks will have a higher premium compared to the lower-risk jobs. For instance, employees working in a factory will have higher group health insurance premiums than the ones working in the IT industry.

Sum insured

Sum insured is the maximum amount that an insurance company will pay you in case of any hospitalisation in a particular year. If the hospital expenses cross the sum insured, it will be paid by the policyholder itself. So the higher the sum insured, the higher the premiums paid towards the group health insurance policy.

Add-ons opted

The add-ons opted for say, maternity insurance riders, dental insurance riders along with the existing group health insurance policy will increase your group health insurance premium. The premium increases depending on the type of add-ons opted for.

Claims history

In the case of a group health insurance policy renewal, the claim history is considered to calculate the premium for that particular financial year. If the number of claims raised in a previous financial year is higher, then the premium towards the policy will increase during the policy renewal.

For instance, let a company named XYZ wants to renew their Aditya Birla group health insurance policy for 2022. The premiums paid by them for 2021 were ₹30,000. If the number of claims raised during 2021 is higher than that of 2020, then the premiums for 2022 will be greater than ₹30,000.

What is covered in your Aditya Birla group health insurance?

Your group health policy is tailor-made according to your preferences. Here is what your Aditya Birla group health insurance covers.

All your pre-existing diseases

Your policy will cover all of your pre-existing diseases from diabetes, cancer, asthma, hypertension, etc from day 1 of your policy coverage. This means there is no waiting period to cover these illnesses.

Pre and post-hospitalisation expenses

With Aditya Birla group health insurance cover your pre and post-hospitalisation expenses. This depends on the terms of your policy usually ranging between a period of 30 to 60 days.

Maternity-related expenses

By opting for a maternity insurance rider, you can cover the maternity-related expenses for normal and c-section delivery.

Covid -19 cover

The group health insurance policy covers all hospitalisation expenses related to Covid-19.

Accidental hospitalisations coverage

In case of any hospitalisation expenses due to accidents, your group health insurance policy covers these medical expenses. These hospitalisations must be for more than 24 hours and coverage is limited to India only.

What is not covered in your Aditya Birla group health insurance?

Cosmetic treatments

Cosmetic treatments like plastic surgery, liposuction, and botox are not generally covered in your group health insurance plan.

Gender-changing surgeries

Expenses due to gender-changing treatments or surgeries are excluded from your group insurance policy.

Self-harm injuries

Injuries due to self-harm, like suicide and hospitalisation expenses for the same are not covered in this policy.

Treatments for substance abuse

Treatment expenses due to substance abuse like drugs or alcohol are exempted from coverage in your Aditya Birla group health insurance.

Health supplements

Cost of supplements like protein powders and other health tonics which are taken by individuals cannot be claimed in your group medical policy. However, these can be covered if the doctor recommends it as part of treatment during your hospitalisation. These are covered as per your policy terms.