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Apollo Munich Maxima Health Insurance Plan

Apollo Munich Maxima Health Plan Introduction

Apollo Munich Maxima plan is a health insurance plan with unique Out-patient features to take care of small and regular illnesses like dental treatment, Spectacles or contact lens, Health check up etc.,. We all visit hospitals more often for small illnesses than the big ones, but most health policies work only when you undergo major treatment. So, Apollo Munich introduced Maxima health plan which don’t just care for the big illnesses but also cares for little illnesses.

Apollo Munich Maxima Health Insurance plan not only covers Out-patient cover but also provides In-patient cover. This Maxima Health policy can be issued to an individual and/or family.

Two members and two adults + up to 2 children can be covered, under Family floater option.
The family includes spouse, dependent parents and dependent children.
The premium under family floater coverage will be charged on the age of the eldest insured member.

Key Features and Benefits of Apollo Munich Maxima Plan

In-patient Benefits:

	1 Member	2 Members	2 Adults + Up to 2 Children
Sum Insured per Policy year	300,000	300,000	300,000
a) In-patient Hospitalisation	Covered
b) Pre-Hospitalisation	30 days
c) Post-Hospitalisation 60 days	60 days
d) Day Care Procedures	140 procedures covered
e) Domiciliary Treatment	Covered
f) Daily Cash for choosing shared accommodation	500 per day; maximum 3,000
g) Organ Donor	Covered
h) Emergency Ambulance	Up to 2,000 per hospitalisation
i) Daily Cash for accompanying an insured child	300 per day; maximum 9,000
j) Maternity Expenses** (Waiting Period 4 years)	Normal delivery- 15,000; Caesarean delivery- 25, 000 (Including Pre/Post Natal limit of 1,500 and infant baby limit of 2,000)
k) Newborn baby cover	Optional
Optional Benefit Critical Illness Rider** (Offered on Individual basis)	300,000

** Benefits do not dip into in-patient Sum Insured.

Out-patient Benefits:

Benefits per Policy year	1 Member	2 Members	2 Adults + Up to 2 Children
a) Doctor consultations*	4 consultations	6 consultations	8 consultations
b) Diagnostic tests#c) Pharmacy#d) Dental treatment#e) Spectacles, Contact lenses#	5,000	5,500	7,000
f) Annual Health Checkup within specified Network**	1 entitlement certificate	2 entitlement certificate	2 entitlement certificate

*The reimbursement against non-network out-patient consultation is restricted up to Rs. 400/-

#The reimbursement against Diagnostic tests, OPD (Out Patient Department) Dental treatment, Spectacles, Contact lenses outside Apollo Munich network is restricted upto the Sum Insured mentioned in the table.

**Annual Health check-up is not available on reimbursement basis and is available only within the specified network.

Terms and Eligibility conditions of Apollo Munich Maxima Health Insurance plan

Entry age:	Minimum: 91 days Maximum: 60 years
Policy term:	1 year
Renewable till age:	Lifelong
Maximum cover ceasing age:	Nil (For Optional Benefit of Critical Illness, cover ceasing age in Apollo Munich Maxima policy is 70 years)
Coverage type:	Individual / Family.
Sum insured:	Minimum: Rs. 3,00,000 Maximum: Rs. 3,00,000
Grace period for renewal:	30 days
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.
Waiting period for pre-existing illness under In-patient module:	After continuous renewal of 3 years. (Waiting period will get reduced by 1 year on every continuous renewal of your Apollo Munich Maxima Health Insurance Policy) [Note: This is applicable only to In-patient Module and Critical Illness benefit. Not applicable to OPD benefits.]
Documents Required for fresh policy:	Policyholder need to fill up an ‘Application form’ with accurate medical history along with ‘address proof’. Medical examination may be required in some cases, based on the sum assured and the age of the person.
Documents Required during Renewal:	Policyholder do not have to fill the Proposal Form or ‘Application form’ again at the time of renewal in case he/she renew the policy before renewal date or within the grace period of 30 days post the renewal date. Policyholder will require to apply for a fresh policy if he/she renew the policy beyond the renewal date.

Inclusions in Apollo Munich Maxima Health Insurance Plan

Inclusions in Apollo Munich Maxima Health plan under Out-patient cover,

Doctor Consultations: 4 or 6 or 8 consultations anywhere, as per plan opted for you and your family.
Pharmacy Expenses: Pharmacy bills are also covered.
Diagnostics: Cost of diagnostic tests taken by policyholder or anyone covered under family floater option will also be paid.
Specialist Services: Take cares of Dental treatment, Spectacles and Contact lenses up to a certain limit.
Health Check-ups: Annual health check-up is provided to any person above 18 years of age. Person above 45 years can avail this benefit from second year.
Pre-existing illnesses: If you need medicines or a Doctor’s consultation for any pre-existing illness, it will be covered without any waiting period under OPD benefits.
Flexibility: You can use the OPD vouchers as per your requirements without worrying about any sub-limits.
Tax benefits: You can avail tax benefits under Section 80D of Income Tax Act. For more information regarding Tax Benefits, visit www.taxqueries.in.

Inclusions in Apollo Munich Maxima Health plan under In-patient cover,

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.
Domiciliary Treatment: Medical Expenses incurred by an Insured Person for medical treatment taken at his home will be reimbursed.
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.
Maternity Expenses: Medical Expenses for maternity including pre-natal and post-natal expenses will be covered after a waiting period of 4 years.
Newborn baby: There is an Optional Coverage for newborn baby from birth (day 1-90) for In-patient Treatment benefit.

Other benefits covered under Apollo Munich Maxima Plan are,

Additional Critical Illness cover:

Additional Critical illness cover is an optional cover which you can opt as per your needs.
This provides coverage against 8 specified critical illnesses.
It is always paid as a lump sum benefit in addition to any medical expenses you may incur for hospitalisation.

Renewal Benefits:

For In-patient treatment: Maxima plan offers a cumulative bonus of 10% for every claim free year, acquiring to a maximum of 50% of your in-patient sum assured. In the event of a claim, the cumulative bonus is reduced by 10% on the next renewal.
For Out-patient benefits: Maxima plan offers the advantage of carrying forward 50% of any unutilized entitlement certificates to the next policy year. This excludes the Annual Health Check-up.

Exclusions in Apollo Munich Maxima Health Insurance plan

There will be no exclusions for OPD benefits.

Below exclusions are applicable only to In-patient Module and Critical Illness benefit,

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 refer the Form and Apollo Munich Maxima Brochure attached below.

Claim procedure under Apollo Munich Maxima Health Insurance Plan

Claim procedure for In-patient benefits under Maxima plan,

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 the company 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, company 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 Maxima plan, a rejection letter would be sent to the provider within 6 hours.

Claim procedure for Out-patient benefits under Maxima plan,

Assistance:

You can contact the company through, Toll Free: 1800-102- 0333, Fax: 1800- 425- 4077 for any doubts and get detailed information.

Claim Procedure to avail Cashless facility:

Select a provider from the list provided to you for the required service. List of providers is available at www. apollomunichinsurance.com.
Visit the provider along with your, Entitlement Certificates and Membership card.
In case of non photo ID card please carry a valid photo ID proof like driving license/ PAN card etc.
Declare the type of Entitlement Certificates available with you to the administration.
Handover the required Entitlement Certificates to the concerned person at the administration.
Avail the service mentioned in the entitlement certificate. Also, sign at the back of the entitlement certificate before handing them over.
In case you avail of services more than the eligibility, kindly pay the difference directly to the provider.
In case any service is availed that is less than the denomination of the entitlement certificate, the difference cannot be reimbursed from the company or the provider.

(For example, if you buy medicines worth Rs. 70 and use a Rs. 100

entitlement certificate, the difference of Rs. 30 is not reimbursable.)

Claim Procedure for Reimbursement:

Reimbursement of Medical expenses for OPD consultation, Diagnostic Tests, Pharmacy, Out-patient Dental Treatment, and Spectacles/Contact Lenses would be done in cases where the member visits a non network provider.
Annual Health Check-Up benefit can be availed only at network provider.
Submit, the following documents to the company on completion of service. a) Duly signed Original Entitlement Certificate. b) Original payment receipt. c) Prescription and ID card.
Only original copies of the Entitlement Certificate shall be valid.
Entitlement Certificate may be used by the Insured Persons, whose name is mentioned on the entitlement certificate.
You will be reimbursed the fixed amount as mentioned in Entitlement Certificate or actual payment made, whichever is lower.

Frequently asked questions (FAQ) of Apollo Munich Maxima Health Insurance Plan

What is meant by In-patient treatment?

In-patient Treatment means treatment arising from Illness or accident where Insured Person has to stay in a Hospital for more than 24 hours and includes Hospital room rent or boarding expenses, Intensive Care Unit (ICU)charges, nursing, etc.,.

What is meant by OPD treatment?

OPD Treatment is one in which the Insured person visits a hospital or associated facility like a consultation room for diagnosis and treatment based on the advice of a medical practitioner. The Insured person is not admitted as a day care or inpatient.

Where do I submit a claim?

Submit all claims to the local office of the Apollo Munich. You can contact Apollo Munich through 24×7 toll free no. – 1800 – 102 – 0333 or email at: customerservice@ apollomunichinsurance. com or Fax at: 1800 – 425 – 4077.

Who can buy Maxima Health?

Maxima health policy can be bought by anyone aged below 45 years and can be renewed lifelong. Maxima Health policy is available for both individual and as family floater plan. The family floater will either cover two adults or two adults and children (maximum two).