Super Health Plus Top Up - Customer Information Sheet

Description is illustrative and not exhaustive

SI TITLE DESCRIPTION POLICY

No. CLAUSE
NUMBER
1. Product Name Super Health Plus Top Up

Basic Covers Section

a. In-patient hospitalization - Covers Medical Expenses arising out of Hospitalization B.I.(a)
for period more than 24 hours, up to the limits specified in the Policy
Schedule / Product Benefit Table.
b. Pre-hospitalization medical expenses - Covers Medical Expenses incurred up to B.I.(b)
the number of days specified in the Policy Schedule / Product Benefit Table
immediately before admission to a Hospital or Day Care Center.
c. Post-hospitalization medical expenses - Covers Medical Expenses incurred up to B.I.(c)
the number of days specified in the Policy Schedule / Product Benefit Table
immediately post discharge from Hospital or Day Care Center.
d. Day care treatment - Covers Medical Expenses for listed Day Care Treatments, up to B.I.(d)
the limits specified in the Policy Schedule / Product Benefit Table, where such
procedures are undertaken by an Insured Person as an In-patient in a Hospital / Day
Care Center for a continuous period of less than 24 hours. Any procedure undertaken
on an OPD Treatment basis in a Hospital / Day Care Center will not be covered.
e. Domiciliary Hospitalization - Covers Medical Expenses, up to the limits specified B.I.(e)
in the Policy Schedule / Product Benefit Table, for Medically Necessary Treatment
taken at home if the treatment continues for an uninterrupted period of 3 days and
the condition for which treatment is taken would otherwise have necessitated
hospitalization.
f. Road ambulance cover - If claim is payable under In-patient hospitalization, and it B.I.(f)
is medically necessary to transport the Insured Person following an Emergency to the
nearest Hospital, covers the ambulance expenses, up to the limit specified in Policy
Schedule / Product Benefit Table.
g. Organ donor expenses - Covers Medical Expenses, up to the limits specified in the B.I.(g)
Policy Schedule / Product Benefit Table towards the organ donor, incurred towards
harvesting the organ from such donor for organ transplantation wherein the
Insured Person is the recipient of the organ.
h. Ayush (In-patient hospitalization) - Covers the Medical Expenses for In-patient B.I.(h)
2. What am I covered for hospitalization towards Ayush treatment(s) of the Insured Person, up to the limits
specified in the Policy Schedule / Product Benefit Table.
i. Home Treatment - Covers the Medical Expenses for the Insured Person’s treatment
at home for Illnesses / Injuries availed through our Network Provider / Empanelled B.I.(i)
Service Providers, only on a cashless basis, up to the limits as specified in the Policy
Schedule / Product Benefit Table.
Other Benefits
J. Domestic Emergency Assistance Services (including Air Ambulance) –
Covers medical assistance in case of an Emergency occurring in India such as an B.II.(j)
emergency medical evacuation to a nearest Hospital and transportation of the Insured
Super Health Plus Top Up, Product UIN: ADIHLIP21061V022021.

Person to his / her residential address in the event he / she is medically cleared for
travelvia a commercial carrier.
K. International Emergency Assistance Services (including Air Ambulance) – B.II.(k)
Covers medical assistance in case of an Emergency occurring outside India such as an
emergency medical evacuation to a nearest Hospital and transportation of the Insured
Person to his / her residential address in the event he/she is medically cleared for
travel via a commercial carrier.
I. HealthReturnsTM – An Insured Person can earn HealthReturns™ (if applicable in plan B.II.(l)
chosen), during the Policy Period by looking after his / her health and being physically
active on a regular basis. It is earned by way of a percentage of the Premium paid
(maximum up to 30%) through Healthy Heart Score™ and Active Dayz™.
M. Health and Wellness discount - The Insured Person(s) may be eligible to avail B.II.(m)
discounts primarily on the OPD consultations, diagnostics services and pharmacies
offered through our Network Providers and / or Empanelled Service Providers listed on
Our website.
 Permanent Exclusions Section
o Treatment directly or indirectly arising from or consequent upon war or any act of war, C.A.(v)
invasion, act of foreign enemy or nuclear waste.
o Wilful or deliberate exposure to danger, intentional self injury.
What are the major
3. exclusions in the o Any Illness / Injury / Accident due to the abuse of intoxicants, smoking cessation
policy: programs and the treatment of nicotine addiction, unless prescribed by a Medical
o Obesity / Weight Control.
(Note: The above is a partial listing of the policy exclusions. Please refer to the
policy clauses for the full listing.)

1. 30-day waiting period (Code- Excl03): Section

30 days for all illnesses (except accident) in the first year and is not applicable in C.A.(i)
subsequent renewals and policies accepted under Portability.
2. Specified disease / procedure waiting period (Code- Excl02):
24 months for specific illness / conditions and their complications in the first two years C.A.(ii)
and is not applicable in subsequent renewals.
4. Waiting period
3. Specified disease / procedure waiting period (Code- Excl02):
48 months (depending on the plan chosen) for specific Illness/conditions and their C.A.(iii)
complications in the first four years and is not applicable in subsequent Renewals.
4. Pre-Existing Diseases (Code- Excl01):
Pre-Existing Diseases shall be covered after the waiting period specified in the Policy C.A.(iv)
Schedule / product Benefit Table.

Pay-out shall be on the reimbursement of actual expenses incurred either by way of C.B.(I)
5. Payment basis Cashless Facility to the Network Provider when a cashless facility is availed or directly to
the Insured Person as a reimbursement against the actual bills

Deductible: The Deductible specified in the Policy Schedule (as applicable under the plan C.BB
chosen) shall be applicable in each Policy Year on the aggregate of all admissible claims in
that Policy Year. After continuous Renewal of 5 consecutive years, and if the Insured & C.CC
6. Loss Sharing Person’s entry age during first issuance with us was less than / equal to 50 years, then the
Insured Person has an option to waive the Deductible and to opt for any indemnity health
insurance product (without any Deductible) offered by Us for the same Sum Insured without
re-evaluation of health status or any pre-policy check.

a. This Policy is ordinarily renewable for lifetime on mutual consent, subject to application Section
of Renewal and realization of Renewal premium
C.P
b. Continuity shall be provided if renewed within 30 days from the date of expiry of
previous policy. If there is a break in the policy, any claim occurring within the break in
period shall not be covered under the Policy
c. Renewals shall not be denied except on grounds of misrepresentation, fraud,
non-disclosure or non-co-operation from the Insured

7. Renewal Conditions d. Alterations in the policy such as Increase / decrease in Sum Insured or Change in
Plan/Product, addition / deletion of members shall be allowed at the time of Renewal
of the Policy. We reserve Our right to carry out underwriting in relation to any request
for changes on the Policy. The terms and conditions of existing policy shall not be
altered
e. In case of Family Floater Policies, children attaining 25 years at the time of Renewal
shall be moved out of the floater into an individual cover. However, all continuity
benefits for such Insured Person on the Policy shall remain intact.

Policy is renewed with Us in accordance with the Renewal Terms under the Policy. Section
Super Health Plus Top Up, Product UIN: ADIHLIP21061V022021.

8. Renewal Benefits a. Earned HealthReturns (if applicable in plan chosen) once accrued in the Policy can
TM
B.II.(l)
be carried forward each month / each Policy Year as long as the Policy is renewed with
Us in accordance with the Renewal Terms under the Policy

Cancellation by you: Section

a. Cancellations can be intimated to Us by giving 15 days notice, we shall refund the C.M
premium for the unexpired term on the short period scale as mentioned in the Policy
wordings enclosed in the kit. Premium shall only be refunded provided there is no claim
9. Cancellation under the Policy.
Cancellation by us:
b. This Policy can be cancelled on grounds of misrepresentation, fraud or non-disclosure
of material fact by You, without refund of premium. This policy can also be cancelled
due to non-cooperation by you.
 a. Cashless Facilities can be availed only at Our Network Providers. The Authorization Section
letter shall be issued to the Network Provider within 24 hours of receiving the
complete information. C(B)(I)(a)

(i) In case of Planned Hospitalization please intimate Us at least 3 days prior to the C(B)(I)(b)
planned date of admission.
(ii) In case of Emergency Hospitalization, please intimate us within 24 hours of such C(B)(I)(c)
admission but not later than discharge.

Claims The complete list of Network Providers is available on Our website and at Our branches
10. and can also be obtained by contacting Us over the telephone.
b. For Reimbursement claims a written notice of the claim shall be submitted within 48 C(B)(I)(d)
hours of admission to the Hospital or before discharge from the Hospital.
(i) If the claim is not notified to Us within such time interval, then We shall be
provided the reasons for the delay in writing. All required claims documents shall
be submitted within 30 days of the Insured Person’s discharge from Hospital.
(ii) We shall settle or repudiate a claim within 30 days of the receipt of the last
necessary information.

In case of a grievance, the Insured / Policyholder can contact Us with the details through: Section
Our website:, https://www.adityabirlacapital.com/healthinsurance C.V
Toll Free : 1800 270 7000
Email: care.healthinsurance@adityabirlacapital.com
Address: Aditya Birla Health Insurance Company Limited, 9th Floor, Tower 1, One World
Centre, Jupiter Mills Compound, 841, Senapati Bapat Marg, Elphinstone Road, Mumbai
400013.

Policy Servicing / lnsured person may also approach the grievance cell at any of the company's branches
11. Grievances / with the details of grievance
Complaints
lf lnsured person is not satisfied with the redressal of grievance through one of the above
methods, insured person may contact the grievance officer.

For updated details of grievance officer, refer the link https://www.adityabirlacapi-

tal.com/healthinsurance/#!/homepage

For senior citizens, please contact the respective branch office of the Company or call at
1800 270 7000 or may write an e- mail at seniorcitizen.abh@adityabirlacapital.com>>

lf lnsured person is not satisfied with the redressal of grievance through above methods,
the insured person may also approach the office of lnsurance Ombudsman of the
respective area / region for redressal of grievance as per lnsurance Ombudsman Rules
2017. The contact details of the Ombudsman offices are provided on Our website and in
this Policy at Annexure A

Grievance may also be lodged at IRDAI lntegrated Grievance Management System -

https:/ligms. irda.qov.in

a. Free Look period - Section

The Free Look Period shall be applicable on new individual health insurance policies and not C.E
on renewals or at the time of porting/migrating the policy.
The insured person shall be allowed free look period of fifteen days (30 days in case of
contracts with a term of 3 years, offered over distance marketing mode) from date of
receipt of the policy document 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
12. Insured’s Rights i. a refund of the premium paid less any expenses incurred by the Company on medical
examination of the insured person and the stamp duty charges or
Super Health Plus Top Up, Product UIN: ADIHLIP21061V022021.

ii. where the risk has already commenced and the option of return of the policy is
exercised by the insured person, a deduction towards the proportionate risk premium
for period of cover or
Where only a part of the insurance coverage has commenced, such proportionate premium
commensurate with the insurance coverage during such period

b. Renewability C.P1
The Policy may be renewed by mutual consent for life. Renewals shall not be denied
except on grounds of misrepresentation, moral hazard, fraud, non-disclosure of
material facts or non-co-operation by the Insured Person.
 c. Portability C.C
The insured person will have the option to port the 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 as per
IRDAI guidelines related to portability. lf such person is presently covered and has been
continuously covered without any lapses under any health insurance policy with an lndian
General/Health insurer, the proposed insured person will get the accrued continuity
benefits in waiting periods as per IRDAI guidelines on portability.
d. Migration C.D
The insured person will have the option to migrate the policy to other health insurance
products/plans offered by the company by applying for migration of the policy atleast 30
days before the policy renewal date as per IRDAI guidelines on Migration. lf 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 in waiting periods as per IRDAI guidelines on migration.
In case the Insured Person wants to port their Health Insurance Policy from Aditya Birla
Health Insurance to any other Company, then contact Us with the details through:
E-mail ID: care.healthisnurance@adityabirlacapital.com
Toll Free : 1800 270 7000
Address: Any of Our Branch office or Corporate office
e. Sum Insured Enhancement C.P.2
You may opt for modification of cover(s) at the time of Renewal of Policy. Acceptance (viii), (ix)
for the same shall be subject to Underwriter’s approval. In case of Sum Insured
Enhancement, all waiting periods as mentioned in the Policy shall apply afresh for this
enhanced limit from the effective date of such enhancement.

13. Insured’s Obligations The Insured Person must disclose all Pre-Existing Disease/s and other condition/s before Section
buying a Policy. Non-disclosure may result in claim not being paid or cancellation of the C.G
Policy.
During the Policy Term any material information changes on occupation and / 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.

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.

Aditya Birla Health Insurance Co. Limited. IRDAI Reg.153. CIN No. U66000MH2015PLC263677.
Product Name: Super Health Plus Top Up, Product UIN: ADIHLIP21061V022021.
Address: 9th Floor, Tower 1, One World Centre, Jupiter Mills Compound, 841, Senapati Bapat Marg, Elphinstone Road,
Mumbai 400013. Email: care.healthinsurance@adityabirlacapital.com, Website: adityabirlahealthinsurance.com,
Telephone: 1800 270 7000. For more details on risk factors, terms and conditions please read terms and conditions
carefully before concluding a sale. Trademark/Logo Aditya Birla Capital is owned by Aditya Birla Management Contact us:
Corporation Private Limited and Trademark/logo HealthReturns, Healthy Heart Score and Active Dayz are owned by 1800 270 7000
Momentum Metropolitan Life Limited (Formerly known as MMI Group Limited). These trademark/ Logos are being used
by Aditya Birla Health Insurance Co. Limited under licensed user agreement(s).
 Health Insurance
Aditya Birla Health Insurance Co. Limited
(A subsidiary of Aditya Birla Capital Ltd.)

Super Health Plus Top Up

Benefit Illustration in respect of policies offered on individual and family floater basis

Age of Coverage opted on Coverage opted on individual basis Coverage opted on family floater basis
the individual basis covering multiple members of with overall Sum insured
members covering each member the family under a single policy (Only one sum insured is
insured of the family separately (Sum insured is available available for the entire family)
(Yrs) (at a single point in time) for each member of the family)

Premium or
Premium consolidated Premium
Sum Sum Floater Sum
Premium Premium Discou after premium for after
Insured Insured discount, Insured
(Rs.) (Rs.) nt, discount all members discount
(Rs.) (Rs.) if any (Rs.)
If any (Rs.) of family (Rs.)
(Rs.)

0-17 1,338 95,00,000 1,338 134 1,204 95,00,000 NA NA NA

18-25 4,051 95,00,000 4,051 405 3,646 95,00,000 8,083 NA 8,083

Product Name: Super Health Plus Top Up, Product UIN: ADIHLIP21061V022021.
26-35 4,303 95,00,000 4,303 430 3,873 95,00,000 8,367 NA 8,367

36-40 5,574 95,00,000 5,574 557 5,017 95,00,000 9,892 NA 9,892

41-45 6,430 95,00,000 6,430 643 5,787 95,00,000 11,331 NA 11,331

95,00,000
46-55 13,374 95,00,000 13,374 1,337 12,037 95,00,000 21,498 NA 21,498

56-60 20,193 95,00,000 20,193 2,019 18,174 95,00,000 36,062 NA 36,062

61-65 26,484 95,00,000 26,484 2,648 23,836 95,00,000 46,339 NA 46,339

66-70* 37,199 95,00,000 37,199 3,720 33,479 95,00,000 61,713 NA 61,713

>70* 48,397 95,00,000 48,397 4,840 43,557 95,00,000 79,436 NA 79,436

Total Premium for all members of the Total Premium for all members of the family is Total Premium when policy is opted on floater
family is Rs. 25,913, when each Rs. 22,674, when they are covered under a basis is Rs. 21,498.
member is covered separately. single policy.

Sum insured available for each Sum Insured available for each family member is Sum insured of Rs. 95,00,000, is available for
individual is Rs. 95,00,000. Rs. 95,00,000. the entire family.

Note: Premium rates specified in the above illustration are standard premium rates without considering any loading. The premium
rates are exclusive of taxes applicable.

Note:

1. The above are base premium for Super Health Plus Top-up (Plan-B) for one year policy tenure. Policy is opted by Self, Spouse, child
aged 55 years, 45 years, 18 years and 10 years respectively.

2. The Sum Insured is INR 95,00,000 and deductible is INR 5,00,000.

3. In case of a family floater policy premium to be calculated on the basis of age of eldest member.

4. Family Discount on multi individual policy: 4 members and above in a policy - 10%.

5. *Premium rates are for renewal only.

6. Please refer to Policy wordings and rate chart for more details.

Aditya Birla Health Insurance Co. Limited. IRDAI Reg.153. CIN No. U66000MH2015PLC263677.
Product Name: Super Health Plus Top Up, Product UIN: ADIHLIP21061V022021.
Address: 9th Floor, Tower 1, One World Centre, Jupiter Mills Compound, 841, Senapati Bapat Marg, Elphinstone Road,
Mumbai 400013. Email: care.healthinsurance@adityabirlacapital.com, Website: adityabirlahealthinsurance.com,
Telephone: 1800 270 7000. For more details on risk factors, terms and conditions please read terms and conditions
carefully before concluding a sale. Trademark/Logo Aditya Birla Capital is owned by Aditya Birla Management Contact us:
Corporation Private Limited and Trademark/logo HealthReturns, Healthy Heart Score and Active Dayz are owned by 1800 270 7000
Momentum Metropolitan Life Limited (Formerly known as MMI Group Limited). These trademark/ Logos are being used
by Aditya Birla Health Insurance Co. Limited under licensed user agreement(s).