Apollo Munich Energy Health Insurance Plan
Apollo Munich Energy Health Insurance plan Introduction
Apollo Munich Energy Health Insurance plan is India’s first health insurance plan that truly understands diabetes. Apollo Munich Energy Health Insurance plan covers individuals who are currently diagnosed with Type II Diabetes or Pre-Diabetes (Impaired Fasting Glucose or Impaired Glucose Tolerance) or Hypertension. Apollo Munich Energy Health Insurance plan can be taken by an individual only.
Apollo Munich Energy Health Insurance plan is available in 2 variants they are, Silver plan and Gold plan. In Silver plan cost for wellness test is excluded. Where as, cost for wellness test is included in Gold plan. Both Silver plan and Gold plan are available with a co-payment (paid by an insured person each time a medical service is accessed) option. Policyholder will have to bear 20% of the claim amount payable.
Key Features and Benefits of Apollo Munich Energy Health Insurance plan
Wellness Program:
Apollo Munich Energy Health Insurance plan provides Wellness program. It is designed to manage your health. Under this wellness program two wellness tests or medical checks are conducted during the policy year.
- Wellness Test 1 or Half yearly check-up.
- Wellness Test 2 or Annual check-up.
| Period | Diagnostic Tests |
| Half yearly check-up | HbA1c, Blood pressure Monitoring, BMI. |
| Annual check-up | HbA1c, FBS, Total Cholesterol, Creatinine, HighDensity Lipoprotein (HDL), Low-Density Lipoprotein (LDL), Triglycerides (TG), Total Protein, Serum Albumin, Gamma-Glutamyltransferase (GGT), Serum Glutamic Oxaloacetic Transaminase (SGOT), Serum Glutamic Pyruvic Transaminase (SGPT), Bilirubin, Total Cholesterol: HDL Cholesterol, ECG, Blood Pressure Monitoring, BMI, Doctor Consultation. |
If policyholder opt for a Gold Plan, Apollo Munich will reimburse 100% of the cost incurred towards wellness tests if undergone at their network centers.
However, if you choose to undergo tests at a non network (but approved) center, at the end of policy year company will reimburse up to Rs. 2000/- only.
If you go for non-approved center, company will not be able to reimburse the amount.
Wellness Support:
- Access to a personalized wellness Web Portal that tracks your medical values from various tests, helps you monitor your condition, stores all your medical records and provides you special offers for health products that you may need.
- A Personalized Health Coach to guide your personal diet and fitness plans.
- Monthly Newspapers to provide you with information on health care and management.
- Access to a Centralized helpline to answer any queries that you may have.
Rewards points:
Based on the results of your medical tests, Apollo Munich will offer you incentives for staying healthy.
- Renewal premium discounts of up to 25% for management of health conditions.
- Reimbursement up to 25% of renewal premium towards your medical expenses.
There are other Key features of the Apollo Munich Energy Health Insurance plan they are,
- This plan provides Lifelong renewal i.e.,. you can renew your cover lifelong and stay covered forever.
- Under Cashless Hospitalization facility the patient does not settle the hospitalization expenses at the time of discharge from hospital. The settlement is done directly by the company.
- Sum Assured Enhancement: Sum assured can be enhanced only at the time of renewal, subject to no claim having been paid under the policy.
- Portability: If you are insured under another Insurer’s health insurance policy you can transfer to Apollo Munich with all your accrued benefits after due allowances for waiting periods.
- Tax benefits: Under Apollo Munich Energy Health Insurance plan, you can avail tax benefits under Section 80D. For more information regarding Income Tax Benefits, visit www.taxqueries.in.
Terms and Eligibility conditions of Apollo Munich Energy Health Insurance plan
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Inclusions in Apollo Munich Energy Health Insurance Plan
Inclusions in Apollo Munich Energy Health Insurance Plan are,
- Day one coverage for all hospitalisation arising out of Diabetes and Hypertension (No waiting period for complications arising out of diabetes)
- In-patient treatment: Medical expenses for Room rent, boarding expenses, Nursing, Intensive care unit, Medicines, drugs etc., will be covered
- Pre-hospitalization: Medical Expenses incurred in the 60 days before the Insured Person was Hospitalised will be covered.
- Post-hospitalization: Medical Expenses incurred in the 180 days after the Insured Person was discharged will be covered.
- Day care procedures: Medical Expenses for a day care procedure in this Policy where the procedure or surgery is taken by the Insured Person for less than 24 hours in a Hospital will be covered for listed day care procedures.
- Organ Donor: Medical Expenses will be covered for an organ donor’s treatment for the harvesting of the organ donated.
- Emergency Ambulance: Company will reimburse the expenses upto Rs. 2000/- incurred on an ambulance offered by a healthcare or ambulance service provider.
Exclusions in Apollo Munich Energy Health Insurance Plan
There are some exclusions under Apollo Munich Energy Health Insurance Plan, they are
- Any treatment within first 30 days of policy cover is excluded except any accidental injury.
- Any Pre-existing diseases will be covered after a waiting period or continuous renewal of 3 years.
- Pregnancy, dental treatment, expenses arising from HIV or AIDS and related diseases, external aids and appliances is not covered under this plan.
- Specific diseases like cataract, hysterectomy, hernia, joint replacement etc., has 2 years exclusion.
- Hospitalization due to war or due to nuclear, biological or chemical weapon and radiation of any kind is excluded.
- Non-allopathic treatment, mental disorder, congenital diseases, cosmetic surgery or weight control treatments are excluded.
- Abuse of intoxicant substance like drugs and alcohol is excluded.
(For detailed information of exclusions refer the documents attached below.)
Claim procedure under Apollo Munich Energy Health Insurance Plan
Claim Procedure for Hospitalization related benefits,
Hospitalisation in Non Network Hospitals:
Emergency Hospitalisation:
- Get admitted into the hospital.
- Inform Apollo Munich about the hospitalisation.
- Settle the hospital bills in full and collect all the bills, reports and documents, at the time of discharge.
- Place your claim with the company for processing and reimbursement.
Planned Hospitalisation:
- Inform Apollo Munich about the planned hospitalisation 7 days prior to the admission.
- Get admitted into the hospital.
- Settle the hospital bills in full and collect all the bills, reports and documents, at the time of discharge.
- Place your claim with the company for processing and reimbursement.
Hospitalisation in Network Hospitals:
Emergency Hospitalisation:
- Get admitted into the hospital.
- Inform Apollo Munich within 24 hours of hospitalisation.
- Coordinate with the hospital to have the details sent to the company for authorization for cashless service.
Planned Hospitalisation:
- Please coordinate with your doctor and the hospital.
- Send in all the details of your planned hospitalisation including the plan of treatment, cost estimates etc. to Apollo Munich.
- Also, indicate the address or fax number to where the authorisation is to be sent along with the mobile number to receive updates on your claims and authorisations.
- This should be sent to the company at least 7 days prior to the admission.
For detailed information refer the documents and Apollo Munich Energy brochure attached below.
Intimation and Assistance:
- For intimation of claim, contact the company at least 48 hours prior to an event which might give rise to a claim. For any emergency situations, contact them 24 hours of the event.
- You can contact them through, Toll Free: 1800-102- 0333, Fax: 1800- 425- 4077 and get detailed information.
- Use the Claim Intimation Form for intimation of a claim.
Claim Procedure for Reimbursement of Medical Expenses:
- For Reimbursement of Medical Expenses, you should send the duly signed claim form and all the documents such as Hospital Main Bill, Pharmacy Bill, ECG, Hospital Bill Payment Receipt, Doctor’s Prescription, etc., to Apollo Munich within 15 days of the completion of the treatment.
- If there is any deficiency in the documents or information submitted by you, company will send the deficiency letter within 7 days of receipt of the claim documents.
- On receipt of the complete set of claim documents, company will make the payment for the admissible amount, along with a settlement statement within 30 days.
- Payment will be made in the name of the proposer, for items covered under your policy.
Claim Procedure to avail Cashless facility:
- For any emergency hospitalisation, Apollo Munich must be informed within 24 hours after the treatment or Hospitalisation, then it will provide cashless service by making payment to the extent of their liability directly to the Network Hospital.
- For any planned hospitalization, company must be given notice within at least 48 hours before the planned treatment or Hospitalisation, then it will provide cashless service by making payment to the extent of their liability directly to the Network Hospital.
- If in case there is any deficiency in the documents or information sent, the same shall be communicated to the hospital within 6 hours of receipt of documents.
- Insured person is entitled for cashless only in their network hospitals.
- In case the treatment is not covered under Apollo Munich Energy policy a rejection letter would be sent to the provider within 6 hours.
Claim Procedure for E-Opinion:
- Submit duly filled claim form along with the copy of all medical reports at any of Apollo Munich Branch Office.
- You need to select Company Panel Doctor from whom you would prefer to take the e-opinion.
- On receipt of the complete set of documents Apollo Munich will forward the same to the concerned doctor.
- The E-Opinion will be send to the member within 7 working days of the receipt of the complete set of documents.
Frequently asked questions (FAQ) of Apollo Munich Energy Health Insurance Plan
What is meant by Type 2 Diabetes and Hypertension?
Type 2 diabetes also called maturity onset diabetes indicates a condition which is characterized by either insulin resistance or relative deficiency of insulin secretion. Hypertension is defined as a repeatedly elevated Blood Pressure (BP) exceeding 140 over 90 mmHg.
What is meant by Co-Payment?
Under Energy health insurance policy, Co-Payment means a cost-sharing requirement provides that, the Policyholder will bear a specified percentage of the admissible claim amount. A Co-Payment does not reduce the Sum assured.
What are the documents needed for portability?
The documents required for Apollo Munich Energy Plan under portability are,
Proposal form, Portability form, Last 3 year’s copy of expiring health insurance policy and Copy of renewal notice.
What is the Buying Procedure of Energy Health plan?
- You should fill the application form stating your personal information and health profile.
- Give up the application form and the premium amount along with necessary documents to the company.
- 100% of the total cost incurred by you to conduct tests will be borne by the company, on acceptance of your policy.
- On acceptance of your policy, the final policy document and kit will be sent to the policyholder.