
The cover-compounder - cover that grows every year, claim or no claim, up to five times your base, with refills that can even pay the same bill that drained it.
Two hospital bills in year one, on ₹10 Lakh of cover.
| Bill | Activ One |
|---|---|
| 1st bill₹7,00,000 | CoveredPaid from Sum Insured ₹7,00,000 |
| 2nd bill₹12,00,000 | CoveredPaid from |
Tell us about your family and health - this list reorders around what matters to you.
Start the 90-second checkYour hospital room is paid at its actual cost, up to the Sum Insured - no daily rupee cap and no room category limit on any plan. Most plans also let you cut your premium by opting into a room ceiling of a Single Private Room or a shared room; VIP and VIP+ do not offer that choice.
If you opt into a Room Rent Type Option to save premium, you accept a room ceiling for the whole policy year. The policy does not state what it pays if you then take a room above that category, so get that answer in writing before you opt in.
Claim Protect pays the hospital's non-medical items - gloves, syringes, bandages, sanitisers and the rest of Annexure I's four lists - up to the Sum Insured, so they are not deducted at discharge. It is built into six of the seven plans; on NXT you buy it as an optional cover.
Follow-up visits, medicines and tests for 180 days after discharge are paid up to the Sum Insured, with no separate rupee cap, as long as they are for the same condition that put you in hospital.
You have only 15 days after the post-hospitalisation treatment finishes to send the bills in, which is a tighter window than the 30 days allowed for the hospital claim itself. These are reimbursement claims, so you pay first and claim back.
Super Reload refills your full base cover whenever a claim exhausts it or falls short, with no limit on how many times in a year. Because it also triggers on a shortfall, it can pay the same bill that ran out of cover. On most plans the first claim in the life of the policy gets no reload; NXT is the exception and reloads from day one.
On every plan except NXT, the very first claim in the life of the policy gets no reload. If that first claim is a large one, you pay everything above your base sum insured and accumulated Super Credit from your own pocket.
There is no separate pool above your sum insured. The extra room comes from Super Reload: it triggers when your cover is insufficient for a claim, not only when it is used up, so it can top up the very bill that ran out and add one more base sum insured to it. On every plan except NXT, the first claim in the life of the policy gets none of this.
Unlike a pool that is funded from day one, this extra room is not there for the first claim in the life of the policy on any plan except NXT. A single large first claim is paid only up to your base cover plus accumulated Super Credit.
Twelve modern procedures - robotic surgery, oral chemotherapy, deep brain stimulation, stem cell therapy for bone marrow transplant and others - are paid at actual cost up to the Sum Insured, with no separate sub-limit. Most policies cap this group at a share of the cover; this one does not.
The twelve are the standard IRDAI set, and the policy says the list can be changed as medicine advances. A newer technique that is not yet on it can be refused until the insurer adds it.
Critical Illness is an optional cover you buy on top of the base plan, on any variant. It pays a lump sum of 10, 15, 20 or 25 lakhs on first diagnosis of one of 20 listed illnesses, and that money comes to you rather than to the hospital. It pays once: after a claim is admitted, the cover is not renewed for that person.
The cover ends for that person once a claim is admitted, so a second critical illness later gets nothing from this benefit. The lump sum is capped at the 25 lakhs option even if your health cover is far larger.
Anything you were diagnosed with, or advised treatment for, in the 36 months before the policy starts waits 3 years before it is covered. You can buy that wait down to 2 years or 1 year, but only when you take your first policy with this insurer. Unbroken cover ported from another insurer counts towards the wait.
Cover after the 3 years applies only to a condition you declared at the time of application and the insurer accepted. A condition you did not declare can stay excluded even after the wait, so a claim for it can be turned down.
A named list of common conditions - cataract, hernia, piles, kidney stones, joint replacement and more - waits 24 months before it is covered. Accident claims are exempt. If a listed condition is also pre-existing for you, the longer 3-year pre-existing wait applies instead. You can buy the 24-month wait down to 1 year at your first policy.
If a listed condition is also a pre-existing disease for you, you wait the full 3 years, not 2. A cataract you were already diagnosed with before buying the policy follows the longer wait.
Childbirth is excluded on most plans. Only the two international plans, VIP and VIP+, cover it, and only from ₹50 lakh sum insured upward: ₹1 lakh a year at ₹50-75 lakh cover, ₹2 lakh at ₹1 crore and above. A hospital delivery in a metro costs more than that, so you pay the rest from your own pocket.
Neither document states a waiting period for this benefit, so check what your Policy Schedule says before you count on it. At ₹1 crore and above the maternity cover works worldwide but leaves out the USA and Canada unless you buy the geographic extension.
This plan does not cover a newborn from birth. On a family floater a child can be added only after completing 90 days, and on an individual policy only from age 5. Any hospital care the baby needs before then, including a premature birth or an NICU stay, is paid from your own pocket.
A baby cannot join the policy until it completes 90 days, so every hospital bill in those first three months is paid by you.
There is no general OPD cover here - an ordinary doctor visit, test or medicine bill outside hospital is not paid. The only OPD benefit is the Chronic Management Program: a fixed number of teleconsultations and diagnostic tests for chronic conditions you have declared, such as diabetes or asthma, cashless at network providers. Most plans sell it as a paid option, VYTL includes it, and VIP and VIP+ do not offer it at all.
Hospital treatment for a mental illness - a condition caused by or linked to stress, anxiety or depression - is paid at actuals up to your full sum insured, on the same footing as a physical illness, on every plan. There is no separate lower cap. Therapy or a psychiatrist's visit outside hospital is not covered.
Cover begins at admission. Counselling sessions and any standalone psychiatric or psychological examination or test are excluded, so you pay for day-to-day mental health care from your own pocket.
Super Credit adds a fixed share of your base cover to your sum insured at every renewal, and it is added even in a year you claimed. On MAX that is 100% of base per year, growing to 500% of base, with a ceiling of 3 crores. VIP has no Super Credit at all, and on NXT you have to buy it as an optional cover.
Super Credit is added only if you renew or pay the premium within the grace period. If you reduce your base sum insured at renewal, the accumulated Super Credit is cut in the same proportion.
This product does not offer an aggregate deductible. The only deductible on sale is a per-claim deductible of INR 15,000 or INR 25,000, which you pay on each admissible claim instead of once a year, so a year with three claims costs you the deductible three times.
The per-claim deductible can only be chosen when your first policy with the insurer starts, and it cannot be dropped at renewal. It is not offered on VIP or VIP+.
45 named illnesses wait 24 months accidents from day 1 read by 9 body regions about 4 min
How long you wait, for what
Covered from the first day, with no waiting at all.
After the first month, ordinary illness is covered.
Each one is then covered, like any other illness.
Conditions you declared when you bought the plan.
After this, only proven fraud can be held against a claim.
Already diagnosed with one of these? A different rule applies - conditions you already have follow the pre-existing waiting period.
Tonsil and throat swelling
Head & Face
Swollen throat glands that cause pain and trouble swallowing.
“Tonsillitis & Adenitis — Medical & Surgical Treatment”
“Adenoiditis — Medical & Surgical Treatment”
Section D.1.2 · pages 10–11
High eye pressure (Glaucoma)
Head & Face
Increased pressure inside the eye that can harm vision.
“Glaucoma — Glaucoma Surgery”
Section D.1.2 · pages 10–11
Eyesight power issue
Head & Face
Common vision problems requiring glasses or contact lenses.
“Refractive Error Correction — Correction Surgery”
Section D.1.2 · pages 10–11
Eye lens clouding (Cataract)
Head & Face
A clouding of the eye lens that makes vision blurry.
“Cataract — Cataract Surgery”
Section D.1.2 · pages 10–11
Ear skin cyst
Head & Face
A harmful, growing cyst inside the ear that needs to be removed.
“Cholesteatoma — Medical & Surgical Treatment”
Section D.1.2 · pages 10–11
10 never paid 11 paid only if a condition is met 17 in every policy read from all 38 under a minute
No waiting period reaches these - the plan does not cover them at all.
If the treatment could reasonably have been given without admitting you, the claim is refused - even though you were admitted. This is one of the most common reasons a hospital bill goes unpaid.
Conditions for which treatment could have been done on an outpatient basis without any Hospitalization
PW p.13 D.2.3(c)
Any procedure using a radio-frequency probe - for example cardiac ablation for an arrhythmia, varicose vein treatment, tumour ablation or nerve ablation for chronic pain - is excluded. This plan's clause names no exception, so there is no advance approval you can ask for.
RFQMR, ECP, 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
PW p.14 D.2.6
Eleven procedures are excluded by name, including Cyber Knife and bioabsorbable stents, valves and implants. If your hospital quotes an advanced procedure, check its exact name against this list, because anything on the list is not paid at all.
RFQMR, ECP, 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
PW p.14 D.2.6
Insurance may not pay for general caretaking. Staying at a facility just to rest is not covered. Hiring helpers for daily tasks like walking or dressing may also be paid from your own pocket.
a) Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. This also includes:
i. 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.
ii. Any services for people who are terminally ill to address physical, social, emotional and spiritual needs.
PW p.11 D.1.5
Hormone replacement therapy is excluded by name - the treatment used to replace hormones the body no longer makes, most often around menopause or after surgery that removes the ovaries or testes. You pay for it yourself.
Stem cell therapy except Hematopoietic stem cells for bone marrow transplant for haematological conditions) or Surgery, or growth hormone therapy or Hormone Replacement Therapy
PW p.13 D.2.3(g)
Physical, psychiatric and psychological examinations and testing are excluded. Treatment itself is not excluded, but you pay for the assessment that leads to it from your own pocket.
Preventive care, vaccinations and immunizations (except in case of post-bite treatment); any physical, psychiatric or psychological examinations or testing
PW p.13 D.2.3(d)
Birth defects visible on the outside of the body are not paid. Internal ones are covered, subject only to the usual waiting periods.
Any conditions or abnormalities that are present at birth and are visible on the outside of the body, as well as any related diseases or defects
PW p.13 D.2.3(f)
Growth hormone therapy is excluded by name, and the clause gives no exception for a diagnosed deficiency. If a child needs it, you pay for it yourself - often lakhs of rupees a year, for several years.
Stem cell therapy except Hematopoietic stem cells for bone marrow transplant for haematological conditions) or Surgery, or growth hormone therapy or Hormone Replacement Therapy
PW p.13 D.2.3(g)
Medical costs for family planning are not covered. This means the policy may not pay for treatments to prevent pregnancy. It also may not pay for treatments to get pregnant.
contraception, sterilization, assisted reproduction including artificial insemination and IVF, ZIFT, GIFT, ICSI, gestational surrogacy, reversal of sterilization
PW p.12 D.1.17
Standard health policies may not cover the costs of pregnancy or childbirth. Normal deliveries and C-sections are excluded. The usual exception is an ectopic pregnancy; where a policy pays maternity as a benefit, its own wording says so.
childbirth expenses including complicated deliveries and caesarean sections, except ectopic pregnancy; miscarriage (unless due to an accident); lawful medical termination of pregnancy
PW p.13 D.1.18; Maternity Cover on VIP/VIP+ only, PR p.28
Written as exclusions, but the policy states a way in. The condition is the whole point.
In a life-threatening situation or after an accident, expenses up to the stage of stabilisation are payable. Disapplied entirely where the inbuilt Claim Protect benefit is in force.
Insurance companies have a list of banned hospitals and doctors. If you go to them, your claim may be rejected. The exceptions are a life-threatening emergency or an accident - and even then the policy pays only up to the point you are stabilised.
Expenses incurred towards treatment in any hospital or by any Medical Practitioner or any other provider specifically excluded by the Insurer 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.
PW p.12 D.1.11
Brought back into cover on MAX by the inbuilt Claim Protect benefit.
Items in Lists I, II, III and IV are cut from the hospital bill. On this plan the inbuilt Claim Protect benefit pays these items back, so you do not pay for them from your own pocket.
As mentioned under Annexure (I), items in List I, II, III & IV will be excluded unless forms a part of In-patient hospitalization.
PW p.14 D.2.5; restored by inbuilt Claim Protect C.4
Diagnostics related or incidental to the treatment you were admitted for stay covered.
Health insurance pays for actual medical treatments. If you stay in a hospital purely for diagnostic tests or scans, the bill may not be covered. There must be an active treatment going on.
a) Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded.
b) Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment are excluded.
PW p.11 D.1.4
Paid when prescribed by a doctor as part of a hospitalisation claim or day-care procedure, or when the treating doctor certifies that an admission for supplements is necessary because of a covered claim.
General vitamins and supplements are not covered. You may have to pay for them yourself. Insurance may only pay if a doctor strictly prescribes them during a hospital stay.
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
Admission for nutritional and electrolyte supplements unless certified by the attending medical practitioner that they are necessary as a direct result of a covered claim
PW p.12 D.1.14; PW p.13 D.2.3(e) · cl. D.1.14, D.2.3(e)
Paid for reconstruction following an accident, burns or cancer, or to remove a direct and immediate health risk certified by the treating doctor. Plastic surgery needed because of an injury is separately granted as a base benefit.
Surgeries done just to look better are excluded. However, plastic surgery needed after a bad accident may be covered. Surgeries for burns or cancer reconstruction are also covered.
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.
PW p.12 D.1.8; grant at C.1.1.1(c)
In-patient dental treatment made necessary by an illness or injury is covered as a base benefit.
There is no dental cover for ordinary visits. Dental work serious enough to need admission is paid under the hospitalisation benefit.
Dental / Oral Treatment: Treatment, procedures and preventive, diagnostic, restorative, cosmetic services related to disease, disorder and conditions related to natural teeth and gingiva except if required by an Insured Person while Hospitalized due to an Accident
PW p.13 D.2.3(h); in-patient grant at C.1.1.1(b)
The optional Durable Medical Equipment Cover buys eight of these items back.
Wheelchairs, crutches, sleep-apnoea machines, home dialysis kit, blood-pressure and sugar monitors, glucometers, nebulisers and oxygen concentrators are not paid. If you take the optional Durable Medical Equipment Cover, eight of these items are paid again.
b) Wigs, or toupees, and related expenses.
c) Expenses for prosthesis (artificial body parts), corrective devices, external durable medical equipment, wheelchairs, crutches, or instruments used in the diagnosis / 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 asthma / COPD conditions, cost of cochlear implant(s) unless necessitated by an Accident.
PW p.13 D.2.4(b)–(c); overridden by C.13.11
A cochlear implant IS paid when an accident made it necessary.
Glasses, contact lenses and hearing aids are not paid for. A cochlear implant is paid only when an accident made it necessary. If an illness caused the hearing loss, you pay for the implant yourself.
Hearing aids, spectacles or contact lenses including optometric therapy, multifocal lens
PW p.13 D.2.4(a), (c)
At 7.5 dioptres or worse the correction escapes this exclusion - but it then sits on the specified-disease list and waits 2 years.
Surgeries to remove your glasses are usually not covered. They are seen as a cosmetic choice. The policy pays only when your eyesight is very weak - 7.5 dioptres or worse.
Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres.
PW p.12 D.1.15
Paid when haematopoietic (blood-forming) stem cells are used for a bone marrow transplant for a blood condition.
Stem cell therapy - treatment that uses stem cells to repair damaged blood, tissue or organs - is excluded. This plan makes one exception: haematopoietic (blood-forming) stem cells used for a bone marrow transplant for a blood condition are paid.
Stem cell therapy except Hematopoietic stem cells for bone marrow transplant for haematological conditions) or Surgery, or growth hormone therapy or Hormone Replacement Therapy
PW p.13 D.2.3(g)
Paid on your doctor's advice, at 18 or older, with BMI 40 or more - or 35 or more with obesity-related cardiomyopathy, coronary heart disease, severe sleep apnoea or uncontrolled Type 2 diabetes, after less invasive methods have failed. This plan also carries an inbuilt Obesity Treatment grant.
The policy pays for weight-loss surgery only when your doctor advises it, you are 18 or older, and your BMI is 40 or more - or 35 or more together with a condition like heart disease, severe sleep apnoea or uncontrolled diabetes. Surgery to change how you look is not covered.
Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions:
a) Surgery to be conducted is upon the advice of the Doctor.
b) The surgery / Procedure conducted should be supported by clinical protocols.
c) The member has to be 18 years of age or older and
d) Body Mass Index (BMI); 1) greater than or equal to 40 or 2) greater than or equal to 35 in conjunction with any of the following severe co-morbidities following failure of less invasive methods of weight loss: i. Obesity-related cardiomyopathy ii. Coronary heart disease iii. Severe Sleep Apnea iv. Uncontrolled Type2 Diabetes
PW p.11–12 D.1.6; grant at C.1.1.1(h)
7 just for qualifying 3 cost you a co-pay, a deductible or a room cap capped at 27.1% about 2 min
From the 1st renewal only
Every claim at a hospital outside their preferred network carries a 10% co-payment from your pocket - no emergency exception is stated.
You pay the first ₹15,000 or ₹25,000 of every single claim yourself.
First purchase only - cannot be dropped at renewal
Your room cover narrows from any room to a single private room, or to shared accommodation.
95.53% claims settled 16,500 cashless hospitals 1.73 solvency under a minute

10 comparisons, every clause that differs under a minute
Sources
Everything on this page is read from the insurer’s own filings. It is an educational summary - not advice, not a recommendation to buy, and we sell nothing.
Plan facts last updated 9 Sept 2026.
IRDAI UIN: ADIHLIP24097V012324
3 documents we read this from under a minute
Sum Insured, bonus and extra pools only, computed for the MAX plan. Room rent, co-pay and other limits are separate rules, not in these figures.
Aditya Birla Health Insurance is a standalone health insurer (SAHI) that began operations in 2016 as a joint venture between Aditya Birla Capital and South Africa's Momentum (MMI) Group. Headquartered in Mumbai and registered with IRDAI under number 153, it is known for a wellness-linked model that ties premium rewards to healthy behaviour. It writes only health and allied cover, not the broader property and motor lines of a general insurer.
95.53%
of claims settled, counted by number of claims
68.16%
share of premium paid back out as claims
1.73
capital cushion held - IRDAI floor is 1.5
16,500+
where claims can be settled without you paying first
Every insurer sits inside the same regulated safety net. You are never left with only the insurer's answer.
Raise it with Aditya Birla
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