Disclaimer
Si Creva acts as a facilitator for the services, while the insurance services are provided by Aditya Birla Health Insurance Co. Ltd, and the wellness services are offered by Aditya Birla Wellness Private Limited.
Declarations
I declare that I am not suffering from or have been diagnosed with advised taken treatment or observation is suggested or undergone any investigation or consulted a doctor or undergone or advised surgery for any one or more from the following:
- Heart Attack or any other heart disease;
- Stroke, Paralysis in any form, or any other Cerebrovascular Disease;
- Chronic/Acute Kidney Disease;
- Acute / Chronic Liver (Failure/ Disease), Cirrhosis of Liver, Alcoholic liver disease; any pancreatic disease
- Any Lung Disease (e.g. Chronic Obstructive Pulmonary Diseases, Parenchymal lung Disease, Pulmonary Embolism etc.).
- Blood Disorders, Gastro-Intestinal Diseases like peptic Ulcer
- Any Cancer or Cancerous growth (benign or malignant tumours);
- Autoimmune or any disease related to central nervous system (disease related to brain);
- HIV / AIDS or AIDS related complications
- Any h/o sudden loss of weight in last 1 yr.
- Head injury/major trauma.
- Major Burns
- Loss of Hearing (Deafness)/speech.
- I hereby advise SI Creva Capital Services Private Limited to transfer the applicable premium for my health insurance policy to Aditya Birla Health Insurance Co. Ltd., as a part of loan disbursal.
- In the event of claims as per the terms and conditions of the cover from Aditya Birla Health Ins. Limited, I hereby express my free will and consent to remit the claim amount to SI Creva Capital Services Private Limited and I do not have any objection for the same and the balance, if any, to be paid to myself/Legal heirs as per the terms and conditions of the cover.
Terms & Conditions:
The insurance policy is only valid for Indian citizens.
All Insured should be 18-55 years of age at the time of policy inception. Policy will be issued by the Insurer for a tenure equal to the loan amount, as specified in the Policy Certificate.
Policy is applicable only for lives that are associated with Si Creva Capital Services Private limited and it will be issued subject to the above declarations.
No change in sum insured allowed after commencement of policy. No addition of new slabs for Sum insured allowed after commencement of policy.
This Policy will be issued on the basis of the Disclosure to information norm, including the information provided by You in respect of the Insured Persons in the Proposal Form, any application for insurance cover in respect of any Insured Person and any other information or details submitted in relation to the Proposal Form. This Policy is a contract of insurance between You and Aditya Birla Health Insurance Ltd which is subject to receipt of premium in full in respect of the Insured Persons and the terms, conditions and exclusions of this Policy.
This Policy is offered by Aditya Birla Health Insurance Ltd. (“Insurer”) and covers the following benefits:
Sr. No | Coverage | Benefits | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
1 | Protect Benefit (Sum Insured: Up to Rs. 24,000) | Following number of EMIs will be paid by Aditya Birla Health Ins. in case of hospitalization due to illness/injury as per the below table:
Initial waiting period: 0 days Maximum limit: 1 time in a month Specific illness and pre-existing disease waiting period is applicable |
Protect Benefit – Group Activ Health:
If the Insured Person is hospitalized for In-patient Care due to an Injury/Illness during a Policy year, then We shall pay the equated monthly instalment due under the Insured Person’s existing liability as specified against this benefit in the Policy Schedule / Certificate of Insurance for each continuous and completed period of hospitalisation as defined and specified in the Policy Schedule / Certificate of Insurance provided that
- This Benefit shall not be payable for more than the number of Hospitalization days per Policy Year as specified in the Policy Schedule or Certificate of Insurance.
- The benefit amount will be paid as a lump sum amount post the Insured Person’s discharge from the Hospital.
All other terms and conditions including exclusions, waiting period etc mentioned in the Policy wordings of Group Activ Health shall be applicable
Policy Cancellation:
The Insured Member may cancel the policy during the Free Look Period of 30 Days i.e within the first 30 days from the date of receipt of policy and shall be eligible for a full refund of premium subject to no claim. Policy cancellation must be initiated accompanied by a valid reason for cancellation.by submitting requests to:
Aditya Birla Health Insurance Co Ltd | care.healthinsurance@adityabirlacapital.com |
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The Insured Member may choose to cancel the policy mid-term by submitting a written notice to the insurer accompanied by a valid reason for cancellation.
The premium shall be refunded as per the below table:
Refund Grid | |
In-forced period of Policy (in Months) | Refund amount |
1 | 73% |
3 | 60% |
6 | 40% |
12 | Nil |
- The refund amount will be credited to the lender and the lender may adjust the premium amount against any overdue against the loan amount. Any amount remaining after clearing overdue will be refunded to the customer by the lender.
- Notwithstanding anything contained herein or otherwise, no refunds of premium shall be made in respect of Cancellation where, any claim has been admitted or has been lodged or any benefit has been availed by the insured person under the policy.
- The Insurance Company may cancel the policy at any time on grounds of misrepresentation, non-disclosure of material facts, fraud by the insured person by giving 15 days' written notice. There would be no refund of premium on cancellation on grounds of misrepresentation, non-disclosure of material facts or fraud.
Exclusions:
We shall not be liable to make any payment for any claim under any Benefit in respect of any Insured Person directly or indirectly caused by, based on, arising out of, relating to or howsoever attributable to any of the following:
Standard Exclusion
Investigation & Evaluation (Code- Excl04):
- Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded.
- Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment are excluded.
Rest Cure, rehabilitation and respite care (Code- Excl05):
Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. This also includes:
- 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.
- Any services for people who are terminally ill to address physical, social, emotional and spiritual needs.
Obesity/ Weight Control (Code- Excl06):
Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions:
- Surgery to be conducted is upon the advice of the Doctor
- The surgery/Procedure conducted should be supported by clinical protocols
- The member has to be 18 years of age or older and
Body Mass Index (BMI);
- greater than or equal to 40 or
greater than or equal to 35 in conjunction with any of the following severe comorbidities following failure of less invasive methods of weight loss:
- Obesity-related cardiomyopathy
- Coronary heart disease
- Severe Sleep Apnea
- Uncontrolled Type2 Diabetes
Change-of-Gender treatments: (Code- Excl07):
Expenses related to any treatment, including surgical management, to change characteristics of the body to those of the opposite sex.
Cosmetic or plastic Surgery: (Code- Excl08):
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.
Hazardous or Adventure sports: (Code- Excl09):
Expenses 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, deepsea diving.
Breach of law: (Code- Excl10):
Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a breach of law with criminal intent.
Excluded Providers: (Code- Excl11):
Expenses incurred towards treatment in any hospital or by any Medical Practitioner or any other provider specifically excluded by the Insurer as per Annexure VI and 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.
- Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. (Code- Excl12)
- Treatments received in heath hydros, nature cure clinics, spas 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).
- Dietary supplements and substances that can be purchased 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).
- Refractive Error - Expenses related to the treatment for correction of eye sight due to refractive error less than 7 .5 dioptres. (Code- Excl15)
Unproven Treatments (Code- Excl16)
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.
Sterility and Infertility: (Code- Excl17)
Expenses related to sterility and infertility. This includes:
- Any type of contraception, sterilization
- Assisted Reproduction services including artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI
- Gestational Surrogacy
- Reversal of sterilization
Maternity Expenses (Code - Excl18):
- Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during hospitalization) except ectopic pregnancy;
- Expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy during the policy period.
Specific Exclusions
Circumstantial Exclusion
- Treatment arising from or consequent upon war or any act of war, invasion, act of foreign enemy, war like operations (whether war be declared or not or caused during service in the armed forces of any country), civil war, public defence, rebellion, uprising, revolution, insurrection, military participation or involvement in naval, military or air force operation
- Usurped acts, nuclear weapons / materials, chemical and biological weapons, ionizing radiation, contamination by radioactive material or radiation of any kind, nuclear fuel, nuclear waste.
- The Insured Person’s direct participation in terrorist acts;
Behavioural Exclusions
- Suicide or attempted suicide, wilfully self-inflicted injury;
- Illegal act of the Insured Persons
- Any treatment for Injury resulting from the consumption of alcohol or any intoxicating substance, its intake or abuse thereof 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); 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);
Medical Exclusions
- All routine examinations and preventive health check-ups.
- Circumcisions (unless necessitated by Illness or Injury and forming part of treatment).
- Unless “OPD Expenses” Benefit is opted under the Policy, all treatments that are availed as an out-patient basis (without any Hospitalization) shall be excluded
- Preventive care, vaccination including inoculation and immunizations (except in case of post-bite treatment); any physical, psychiatric or psychological examinations or testing
- Admission for nutritional and electrolyte supplements unless certified to be required by the attending Medical Practitioner as a direct consequence of an otherwise covered claim.
- External Congenital Anomalies, diseases or defects.
- Stem cell therapy or surgery (except Hematopoietic stem cells for bone marrow transplant for hematological conditions), or growth hormone therapy or Hormone Replacement Therapy.
- Dentures, implants and artificial teeth
- Cost incurred for any health check-up or for the purpose of issuance of medical certificates and examinations required for employment or travel or any other such purpose
Prosthesis and Devices
- Hearing aids, spectacles or contact lenses including optometric therapy, multifocal lens.
- Wigs, or toupees, and related expenses.
- Any expenses incurred on prosthesis, corrective devices external durable medical equipments, wheelchairs crutches, instruments used in 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 asthmatic condition / COPD conditions, cost of cochlear implant(s) unless necessitated by an Accident. Cost of artificial limbs, crutches, external appliance and/or device used for diagnosis or treatment.
Non-Medical expenses
- As mentioned under Annexure (V) List II, III & IV will be excluded unless forms a part of In-patient hospitalization.
Specific treatment Exclusion
- Treatment for 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.
Activities and Profession Exclusions
- Treatment taken from a person not falling within the scope of definition of Medical Practitioner with any state medical council/ medical council of India.
- Treatment charges or fees charged by any Medical Practitioner acting outside the scope of license or registration granted to him by any medical council.
- Treatments rendered by a Medical Practitioner who is a member of the Insured Person’s family or stays with him in the same residence, except if pre-approved by Us.
Geographical Exclusion
- Treatment taken outside India.
For any further queries, the policy holder should reach out to Aditya Birla Health Insurance Ltd. on their toll free number, official email ID or offices as mentioned in the policy document.
The insurance policy is a contract between Aditya Birla Health Insurance Ltd. and the customer.