ABHICL: How to Register an Insurance Complaint to Aditya Birla Health Insurance Co. Limited?

Aditya Birla Health Insurance Co. Limited (ABHICL) is a joint venture between Aditya Birla Group, and MMI Holdings, a South African financial services group. Also, ABHICL is a part of Aditya Birla Capital Ltd (ABCL). The company offers health insurance policies, financial products, and services.

Have complaints about health insurance policy? You can raise your concerns to the customer care representatives or officers through the helpline number, email, or WhatsApp, or register an online complaint to Aditya Birla Health Insurance (ABHI).

You can complain to Aditya Biral Health Insurance (ABHI) about policy claims, premiums, payment refunds, hospitalization, purchase and renewal, or settlement of claims.

Resolve issues related to these health insurance plans:

• Activ One NXT
• Activ Health Platinum
• Arogya Sanjeevani
• Activ Fit
• Super Health Topup
• Activ Assure Diamond
• Activ Care Classic
• Ekam Suraksha

Has your complaint not been resolved to your expectations? Escalate the grievance to the Head of Customer Care. Further, you can complain to the appointed Grievance Redressal Officer (GRO) of Aditya Birla Health Insurance Co. Ltd. with case ID.

Note: Have complaints related to the violation of consumer rights by ABHICL? File a consumer complaint to the National Consumer Helpline (NCH) of the Department of Consumer Affairs.

Level 1: Customer Care, Aditya Birla Health Insurance

At this level 1, your issues are initially handled by the customer care representatives or the local branch officers of Aditya Birla Health Insurance.

If you have any complaints regarding services and insurance policy, call the toll-free customer care number, email your concerns, or lodge your complaint online through the mobile app or online form.

Official details to complain with ABHICL:

Note: To contact the officials of the local branch of Aditya Birla Health Insurance, click here (locate branch).

Required details to register a complaint:

• ABHI Policy Number
• Nature of issue
• Description with relevant facts such as claims delayed, payment settlement, premium, application, etc.
• Attach supporting documents, if any

After successful registration, note down the reference/case ID to track status or escalate to higher authority (If not resolved).

Insurance Claim Help

If you want to submit a cashless or reimbursement claim for your ABHI policy, you can submit the claim form online or visit the nearest local branch with all supporting documents.

Want to track claim status? Click Here (adityabirlacapital.com)

1. Cashless Claim:

• Visit “Make a Cashless Claim (adityabirlacapital.com)“
• Find a listed cashless hospital
• Verify patient identity (share policy number and ID Proof)
• Submit the request form online or at the hospital
• Track claim settlement

2. Reimbursement Claim:

• Click “File a reimbursement claim“
• Inform Hospitalization within 48 hours after admission or 3 days before
• Submit your documents and form within 15 days at the local branch
• Track claim status

If your claim is not settled even after providing all original documents and other details per the policy, you can complain to the ABHI officials. Not resolved? Escalate to the Head of Customer Service and GRO at Head Office.

Level 2: Head – Customer Care, ABHICL

If your submitted complaints related to insurance claims, payments, or any other matters (corruption/denial of service) are not resolved at the local branch or customer care of level 1, escalate the grievance to the Head of Customer Care at Aditya Birla Health Insurance.

While escalation, provide the following details:

• Case ID (reference number of the previous complaint)
• Policy Number
• Subject
• Description of the issue with expected resolution.
• Supporting documents (if any)

Send a written complaint letter, email, or contact to Head CS at:

Level 3: Grievance Redressal Officer (GRO), ABHICL

As per the grievance policy of Aditya Birla Health Insurance, if your escalated complaint to the Head of Customer Care is not resolved within 2 weeks, lodge a grievance to the appointed Grievance Redressal Officer at Aditya Birla Health Insurance Co. Ltd.

With a previous case ID, you may email or submit a written grievance letter to the local branch GRO.

Still, not resolved within 30 days? Approach the Insurance Ombudsman, IRDAI.

Level 4: Insurance Ombudsman, IRDAI

As per the Insurance Ombudsman Rules of 2023, if complaints related to insurance, claims, health plans, or policy fees/premiums are not resolved to your satisfaction by Aditya Birla Health Insurance Co. Limited within 30 days, kindly file a complaint to Insurance Ombudsman, IRDAI.

The details for filing an insurance complaint are as follows:

• Click: File an online complaint with the Insurance Ombudsman
• Email (for assistance): inscoun@cioins.co.in

Regulatory Authority

If you are dissatisfied with the final resolution provided by Aditya Birla Health Insurance Co. Ltd or the Insurance Ombudsman, you have these alternative options to address specific disputes:

• Internal Arbitration: Attempt to resolve disputes directly with ABHICL through mutual agreement.
• Regulatory Compliance: Lodge online complaints related to insurance standards and violations of laws with the Insurance Regulatory and Development Authority of India (IRDAI).
• Consumer Commission: For disputes involving compensation amounts exceeding ₹30 lakh, submit your complaint against ABHICL to the National Consumer Disputes Redressal Commission (NCDRC) through the E-DAAKHIL.

Legal Action: If you are not satisfied with the final decisions and regulatory orders from Aditya Birla Health Insurance Company Limited, you may take legal action.

• Click “File a case online by e-filing to District/High Courts” to submit a case.
• It is advisable to seek advice from legal professionals or lawyers before proceeding with legal action.

Reference

• Aditya Birla Health Insurance (adityabirlacapital.com)
• GrievanceRedressalPolicy_New.pdf (adityabirlahealth.com)