Apollo Munich Health Insurance

Features of Apollo Munich Health Insurance

• No. of members- The plan covers maximum 6 members of your family with up to 4 children and 2 adults.
• Lifelong Renewal – The plans offered are lifelong renewable hence it saves you from the financial burden and stress caused by a medical emergency and keeps you well prepared to handle any situation.
• No Sub-Limits on Room Rent - As sub-limits on room rent practically eat into your sum insured, Apollo Munich scores brownie points for their plans without any sub-limits on the room rent.
• Wide Sum Insured Options – offers varied choice of Sum Insured beginning at Rs. 1 lakh up to Rs. 15 lakhs at affordable premium.
• Pre & Post hospitalization cover- The plan covers medical expenses for 60 days prior to hospitalization and 90 days post hospitalization only for related medical expenses.
• Health Check-ups – The policy offers up to 1% of the sum insured under individual plan per insured person and also up to 1% of the sum insured per policy under family plans.
• Pre-existing diseases- Pre-existing diseases are covered after 3 years of waiting period.
• Co-payment- The plan has no co-payment policy.
• Restore Benefit - In Optima Restore health plan, Restore benefit is offered if the sum insured is exhausted during the year. This amount can be used for any new illnesses without any paperwork or any extra charge.

Benefits of Buying Health Insurance from Apollo Munich

• Competitively priced products
• Great customer service post sales
• Dedicated claim handler to make the claim settlement process smooth & easy.

Optima Restore

This is a health insurance plan with restore benefit offered by Apollo Munich. It offers coverage on individual or family floater basis given below are the details of each plan.

Individual Coverage :

• This plan offers coverage in range of Rs.3 lakh and Rs.50 lakh for individuals between age 5 years and 65 years.
• Pre and post hospitalization expense cover, coverage for expenses on day care treatments, no-claim bonus equal to 10 % of sum insured up to a maximum of 50%, etc. are the benefits offered in this plan.
• This health insurance policy specifically offers restore benefits up to 100 % of sum insured after the entire sum insured is exhausted. E-opinion (in case of critical illnesses) is of the additional benefits offered.

Family Coverage :

• This family floater plan offers coverage to entire family in range of Rs.3 lakh and Rs.50 lakh for adults up to age 65 years and dependent children between ages 3 months to 25 years.
• A maximum of 2 adults and 5 children can be covered.
• Pre and post hospitalization expense cover, coverage for expenses on day care treatments, no-claim bonus equal to 10 % of sum insured up to a maximum of 50%, etc. are the benefits offered in this plan.
• This policy specifically offers restore benefits up to 100 % of sum insured after the entire sum insured is exhausted. E-opinion and multiplier benefit are some of the additional benefits offered.

Energy :

This plan is designed especially for people with type 2 diabetes and hypertension. It provides coverage for these illnesses right from day 1 of the policy period. The details of the coverage offered are:

• The coverage amount is in range of Rs.2 lakh to Rs.10 lakh for individuals between age 18 years and 65 years.
• The plan has two variants gold and silver. Silver plan excludes wellness test whereas Gold plan includes wellness test. To know more about this plan, contact Coverfox.

Maxima :

This health insurance policy covers expense for treatment of regular illnesses along with hospitalization expenses and outpatient expenses. The details of coverage offered are

• The plan is available for individuals between age 91 days and 65 years for life.

Optima Vital

This is a critical illness benefit plan offered by Apollo, which offers a lump sum amount equal to sum insured upon diagnosis of critical illness listed in the policy wording.

• This plan specially offers coverage for critical illness in range of Rs.1 lakh and Rs.50 lakh for individuals between age 18 years and 65 years.
• The plan provides a lump-sum amount in case of critical illnesses. Other benefits include e-opinion and sum insured enhancement. If you are looking out for a benefit plan just like this one, contact Coverfox to know all about the terms and condition under this policy.

Individual Personal Accidental Plan :

This is a personal accident disability plan offered by Apollo, which provides compensation in case of death or disability due to accident. The details of coverage offered are as follows:

• This policy covers expenses in case of accidents for people between age 91 days and 69 years in the range of Rs.5 lakh and 5 crore.
• The sum insured after age of 70 years (for existing policy holders) is only Rs.5 lakh.
• This policy provides worldwide accidental coverage. Accidental death, complete or partial disability, emergency ambulance charges, etc. are covered in this policy.

Optima Plus

This is a top-up plan, a plan with an agreed upon deductible amount to be paid at the time of claim, here are the details of coverage offered

• The entry age for this plan is between 5 years and 65 years.
• It can also cover a dependent child over the age of 91 days.
• It has coverage of Rs.5 lakh with a deductible in range of Rs.1 lakh and Rs.5 lakh.

Optima Super

This is an aggregate top-up plan, which gives you flexibility to choose the deductible and coverage amount. The details are as follows

Individual Coverage

• This is a top up plan, which covers anybody between age 5 years and 65 years. This plan can also cover a dependent child from the age of 91 days.
• This plan offers coverage of Rs.5 lakh to Rs.10 lakh with deductible in range of Rs.1 lakh and Rs.10 lakh.
• In this plan, individuals have the flexibility of choosing the combination of coverage amount and deductible amount as per one's needs.
• Like Optima plus, this also offers the option to convert to zero deductible after retirement. Family Floater Coverage
• This is a family floater plan, which provides top-up cover for entire family for members between age 5 years and 65 years and dependent children from age 91 days on wards.
• A maximum of 2 adults and 2 children can be covered under this floater.
• This plan offers coverage of Rs.5 lakh to Rs.10 lakh. Along with benefit to opt for zero deductible after retirement this plan also offers flexibility to customers to choose their own combination of deductible and coverage.

Optima Cash- (Daily Hospital Cash Plan)

• This is another top up plan for anyone between age 5 years and 65 years. Is also available to dependent children after age 91 days.
• This plan offers the benefit of daily cash allowance in case of hospitalization and certain day procedures.
• This policy also comes with a convalescent cash benefit.

Senior Citizen

• This is an exclusive health insurance plan for senior citizens, which provide coverage for both individual and/or their spouse from age 61 onwards.
• Benefits like E-opinion, Cumulative Bonus, Domiciliary Treatment, etc. are available under this policy.

Dengue Care

• This is another top up plan for anyone between age 5 years and 65 years. Is also available to dependent children after age 91 days.
• This plan offers the benefit of daily cash allowance in case of hospitalization and certain day procedures.
• This policy also comes with a convalescent cash benefit.

• This is an exclusive plan that covers you for inpatient & outpatient treatment for Dengue.
• Offers benefits like one premium irrespective of age, no medicals, comprehensive in-patient hospitalization cover with no sub-limits/co-payment, cover for OPD expenses up to Rs.10000/- and only 15 days of waiting period.
• Lifelong renewable.

Claims Process at Apollo Munich Health Insurance

The Health Insurance Policy can be claimed through two ways: Cashless settlement at the network hospital and Re-imbursement after the treatment/hospitalization. However, in both scenarios, an early intimation to the insurance company is mandatory. A pre-approval needs to be in place for a planned hospitalization.

For Cashless Service:

• At the time of hospitalization, submit the completed Pre-Authorization form at the TPA desk
• The TPA representative will then forward the form to Apollo Munich for an approval along with necessary doctor's report
• The request is then reviewed by the Claim Experts at Apollo Munich and an approval is then issued. Please note that the insurance company can raise queries, if required
• In case of rejection of the authorization, initiate the required treatment and claim for reimbursement later

For Re-imbursement of Claim:

• Post hospitalization, complete the claim form and submit the same to the insurance company along with other documents like Discharge Summary issued by the hospital, Prescriptions, Bills and Invoices for medicines/treatments, etc.
• In case, insurance company needs any further clarification/information, it will be duly notified to you
• Similarly, if the claim is rejected, a detailed rejection letter will be shared with you along with the reasons for denial Apollo Munich takes pride in their claim settlement process. They claim to have settled 95% of the claims within 30 days.