NPS Swasthya: Aditya Birla Health Insurance Introduces Top-Up Cover With Premiums Starting at ₹1,732

Mumbai, October 8: Aditya Birla Health Insurance (ABHI) has introduced a Group Activ Health Top-Up policy for NPS Swasthya account holders, with annual premiums starting at ₹1,732. The policy allows subscribers to extend health insurance coverage to their legally married spouse and up to two financially dependent children.

The launch comes as NPS Swasthya, a healthcare-focused initiative under the National Pension System (NPS), progresses with its operational framework. The Pension Fund Regulatory and Development Authority (PFRDA) has issued guidelines covering eligibility, contributions, withdrawals and insurance provisions under the initiative.

Who Is Eligible for the Health Top-Up Policy?

The policy is available to eligible NPS Swasthya account holders and their family members, subject to the prescribed age limits.

• • Subscriber and spouse: 18 to 70 years

• • Dependent children: 91 days to 25 years

The policy offers six family coverage combinations:

• • 1 Adult (1A)

• • 2 Adults (2A)

• • 1 Adult + 1 Child (1A+1C)

• • 1 Adult + 2 Children (1A+2C)

• • 2 Adults + 1 Child (2A+1C)

• • 2 Adults + 2 Children (2A+2C)

Sum Insured and Deductible Options

Subscribers can choose from four sum insured options. Each option comes with an aggregate deductible, which is the amount that must be borne before the top-up cover becomes payable, subject to the policy terms.

The annual premium varies depending on the age band of the adult member, the family composition and the selected sum insured.

Annual Premium for 1 Adult

For individual coverage, the annual premium starts at ₹1,732 for the ₹30 lakh sum insured option in the 18–40 age band. The following table lists the premiums across all four coverage options.

Annual Premium for 2 Adults

For coverage covering two adults, the annual premium for the ₹30 lakh option starts at ₹3,049 for the 18–40 age band.

Annual Premium for 1 Adult and 1 Child

For a family comprising one adult and one child, the annual premium for the ₹30 lakh cover begins at ₹2,772 for the 18–40 age band.

Annual Premium for 1 Adult and 2 Children

For one adult and two children, the ₹30 lakh coverage option carries an annual premium starting at ₹3,525 for the 18–40 age band.

Annual Premium for 2 Adults and 1 Child

For a family comprising two adults and one child, the annual premiums are listed below for the four available sum insured options.

Annual Premium for 2 Adults and 2 Children

The premium figures provided for the two-adult, two-child combination are the same as those listed for two adults and one child. These figures should be verified with the insurer before publication.

Waiting Periods and Pre-Existing Disease Coverage

The policy covers pre-existing diseases after a waiting period of 12 months, subject to the submission of a Good Health Declaration.

Other applicable waiting periods include:

• • Initial waiting period: 30 days

• • Specified diseases and procedures: One year

• • Pre-existing diseases: 12 months

Policyholders should review the detailed policy wording for applicable exclusions, conditions and other limitations.

Key Features and Benefits

The Group Activ Health Top-Up policy includes several hospitalisation and treatment benefits, subject to the policy’s terms and conditions.

• • Hospital room: Coverage for a single private room during regular hospitalisation.

• • Intensive Care Unit (ICU): Expenses covered as per actuals.

• • AYUSH treatment: Coverage for eligible treatments under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy.

• • Mental illness: Coverage included, subject to policy terms.

• • Modern treatments: Coverage for specified modern medical treatments.

• • HIV-related treatment: Coverage included, subject to applicable conditions.

• • Day-care procedures: Eligible procedures that do not require 24-hour hospitalisation are covered.

• • Domiciliary hospitalisation: Coverage for eligible treatment received at home under prescribed conditions.

• • Road ambulance: Up to ₹2,500 per emergency incident.

• • Pre- and post-hospitalisation: Medical expenses covered for 30 days before and 60 days after hospitalisation, respectively.

Other Policy Conditions

A Good Health Declaration is mandatory for every member covered under the policy. The policy also provides a 30-day free-look period, during which policyholders can review the terms and conditions and exercise cancellation rights in accordance with the applicable rules.

The policy offers renewal up to lifetime, subject to the insurer’s terms and conditions.

Eligibility is stated to extend to Indian citizens and individuals associated with NPS Swasthya account holders, subject to the applicable policy requirements.

What Should Subscribers Keep in Mind?

The Group Activ Health Top-Up policy offers multiple coverage options for individuals and families enrolled through NPS Swasthya. However, subscribers should compare the sum insured, deductible, premium and waiting periods before choosing a plan.

Since this is a top-up policy, it is particularly important to understand how the aggregate deductible works and what expenses must be paid before the insurer’s top-up benefits become applicable. Prospective policyholders should also verify the applicable premium for their family combination and age band with ABHI.

For more personal finance updates, stay informed about developments in insurance, retirement planning and the National Pension System.

Disclaimer: This article is for informational purposes only and should not be considered investment advice from Aarogyam Times. Securities mentioned, if any, are illustrative and do not constitute recommendations. Readers should conduct their own research or consult a registered financial adviser before making investment decisions.