Policy explained · Aditya Birla
Aditya Birla Activ Health (Platinum Enhanced): what your policy covers
Aditya Birla Activ Health (Platinum Enhanced) sets a room rent limit that depends on your plan. It has a 24-month wait for knee & hip replacement and a 36-month wait for pre-existing conditions. Optional add-ons can add a co-pay. What you pay depends on your plan variant, so this page shows the limits in words and no rupee example.
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At a glance
- 🛏️Depends on your planRoom rentDepends on your plan; every limit in the documents is listed belowPolicy wordings, page 12, read 28 Sep 2026
- 🧾10%Co-payIf you chose the optional network discount add-on and are treated outside that networkNot in the worked examplePolicy wordings, page 50, read 28 Aug 2026
- ⏳24 monthsKnee & hip replacement waitOver by month 30Policy wordings, page 55, read 28 Aug 2026
- ⏳36 monthsPre-existing conditions waitNot over at month 30Customer information sheet (CIS), page 14, read 28 Aug 2026
- 🩹Not coveredConsumablesThese are yours to payPolicy wordings, page 60, read 28 Aug 2026
Waiting periods, month by month
- Pre-existing conditions36 monthsNot over at month 30
- Knee & hip replacement24 monthsOver by month 30
- Spine surgery24 monthsOver by month 30
- Prostate surgery24 monthsOver by month 30
- Hysterectomy24 monthsOver by month 30
Worked example: a knee & hip replacement bill
Depends on your plan variant. We do not show a rupee example for this policy, because:
- The room limit is set by your plan in the policy schedule (its Product Benefit Table), which is not in the documents we read.
The limits as the policy states them:
- Room rent limit: Set by your plan in the policy schedule (its Product Benefit Table), which is not in the documents we read (Policy wordings, page 12, read 28 Sep 2026)
- Co-pay: No general co-pay in the wording. With an add-on: 10% if you chose the optional network discount add-on and are treated outside that network (Policy wordings, page 50, read 28 Aug 2026)
Every room rent limit in the documents we read:
Reasonable and Customary Charges for Room Rent for accommodation in Hospital room and other boarding charges up to the limits as specified in the Policy Schedule / Product Benefit Table of this Policy
Policy wordings, page 12
Ask what you would pay for knee & hip replacement on your plan
The terms, with the policy text
10 terms read from the Aditya Birla Activ Health (Platinum Enhanced) documents (UIN ADIHLIP24102V052324). Open a source to read the policy text, its conditions and the page.
| Term | What it means | Policy text and source |
|---|---|---|
| Room rent limit | Set by your plan in the policy schedule (its Product Benefit Table), which is not in the documents we readLimit applies | Policy wordings, page 12Reasonable and Customary Charges for Room Rent for accommodation in Hospital room and other boarding charges up to the limits as specified in the Policy Schedule / Product Benefit Table of this Policy |
| Co-pay | No general co-pay in the wording. With an add-on: 10% if you chose the optional network discount add-on and are treated outside that networkOnly in some cases | Policy wordings, page 50(i) If the Insured Person takes In-patient Hospitalization Treatment as applicable under section C.I.(1) in a Hospital other than those listed as “Preferred Provider Network”, then the Policyholder / Insured Person shall bear a Co-Payment of 10% on each and every claim arising in such regard, which will be in addition to any other Co-Payment applicable under the Policy. |
| Proportionate deduction | Applies: if your room costs more than the limit, the insurer cuts the charges linked to the room in the same ratioCan cut your bill | Policy wordings, page 12Condition: Not applied to ICU charges. If the Insured Person is admitted in a room category / limit that is higher than the one that is specified in the Policy Schedule / Product Benefit Table of this Policy, then the Insured Person shall bear a rateable proportion of the Room Rent (and the total Associated Medical Expenses, including surcharge or taxes thereon) in the proportion of the difference between the Room Rent of the entitled room category to the Room Rent actually incurred. |
| Consumables (gloves, masks and other non-medical items) | Not covered: these are yours to payNot covered | Policy wordings, page 6053. Non-Medical Expenses including but not limited to RMO charges, surcharges, night charges, service charges levied by the Hospital under any head and as specified in the Annexure I for Non- Medical Expenses |
| Waiting period for pre-existing conditions | 36 months of continuous coverNot over at month 30 | Customer information sheet (CIS), page 14Pre-existing Diseases shall be covered a/fter a waiting period of 36 months as specified in Product Benefit Table / Policy Schedule |
| Waiting period for knee & hip replacement | 24 months of continuous coverOver by month 30 | Policy wordings, page 55Expenses related to the treatment of the listed Conditions, surgeries / treatments shall be excluded until the expiry of 24 months of continuous coverage after the date of inception of the first policy with Us. This exclusion shall not be applicable for claims arising due to an accident. |
| Waiting period for spine surgery | 24 months of continuous coverOver by month 30 | Policy wordings, page 56Prolapse of the intervertebral disc |
| Waiting period for prostate surgery | 24 months of continuous coverOver by month 30 | Policy wordings, page 57Benign Hypertrophy / Enlargement of Prostate (BHP / BEP) |
| Waiting period for hysterectomy | 24 months of continuous coverOver by month 30 | Policy wordings, page 56Dysfunctional Uterine Bleeding (DUB) Endometriosis Menorrhagia Pelvic Inflammatory Disease |
| Exclusion rule for bariatric surgery | Covered when the policy's conditions are metConditions apply | Policy wordings, page 576. Obesity / Weight Control (Code- Excl06) 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 |
Questions
Does Aditya Birla Activ Health (Platinum Enhanced) have a room rent limit?
At a ₹5 lakh sum insured: set by your plan in the policy schedule (its Product Benefit Table), which is not in the documents we read. Source: Policy wordings, page 12, read 28 Sep 2026.
How is proportionate deduction calculated on Aditya Birla Activ Health (Platinum Enhanced)?
If your room costs more than the room rent limit, the insurer divides the limit by your room's daily rent and pays that share of the charges linked to the room. Not applied to ICU charges. Source: Policy wordings, page 12, read 28 Aug 2026.
Check your own policy
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Sources
- Aditya Birla Activ Health (Platinum Enhanced): policy wordings (accessed 28 Aug 2026)
- Aditya Birla Activ Health (Platinum Enhanced): customer information sheet (cis) (accessed 28 Aug 2026)