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Apollo Munich Optima Cash Health Insurance plan

Apollo Munich Optima Cash Health Insurance plan Introduction

Apollo Munich Optima Cash Health Insurance plan is a daily hospital cash benefit plan. At the time of hospitalization, apart from treatment coverage, people also want to have coverage for additional expenses. Thus brought, Apollo Munich Optima Cash plan which gives you the daily cash amount, depending upon the number of days an assured is hospitalized.

Apollo Munich Optima Cash policy can be issued to an individual and/or family. The family includes self, spouse and dependent children. Apollo Munich Optima Cash policy is available in 2 variants they are, Gold plan and Platinum plan. In Gold plan Childbirth and Parents Accommodation benefits are excluded. Where as, Childbirth and Parents Accommodation benefits are included in Platinum plan.

Key Features of Apollo Munich Optima Cash Plan

Some key features of Apollo Munich Optima Cash plan are,

Less paper work.
Medical bills are not required for claims.
Pre-policy checkup is not required in case of a clean proposal form.
Optima Cash plan offers coverage on individual sum assured basis only.
Tax benefits: You can avail tax benefits under Section 80D of Income Tax Act. For more information regarding Tax Benefits, visit www.taxqueries.in.
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.
Discounts: Family Discount of 10% if two or more family members are covered under the same policy.

Eligibility conditions of Apollo Munich Optima Cash Plan

Entry age:	Minimum: 5 years; 91 days (for Dependent Child). Maximum: 60 years
Policy term:	Minimum: 1 year Maximum: 2 years
Daily cash amount for 90 days / 180 days:	Minimum: Rs. 1,000/- Maximum: Rs. 3,000/-
Renewable till age:	Lifelong
Waiting period:	30 days
Waiting period for pre-existing illness:	After continuous renewal of 3 years.
Grace period:	30 days from the expiry date to renew the policy.
Maximum cover ceasing age:	Nil
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.

Other points to Remember:

Apollo Munich Optima Cash Premium at renewal may change due to changes in the applicable Tax rate or a change in your age.
Sum Assured Enhancement: Sum assured can be enhanced only at the time of renewal, subject to no claim having been paid under the policy.

Inclusions in Apollo Munich Optima Cash Plan

Apollo Munich Optima Cash plan covers Daily Cash Amount for a continuous and completed period of 24 hours of Hospitalisation for the following benefits,

Sickness Hospital Cash.
Accident Hospital Cash.
Day-Care Procedure Cash.
Joint Hospitalisation due to an Accident.
Convalescence.

Others two benefits included in Apollo Munich Optima Cash Platinum plan are,

Childbirth.
Parent Accommodation.

S.no	Benefit	Coverage	Duration
1 i)	Sickness Hospital Cash	Daily cash amount for each continuous and completed period of 24 hours if the insured is hospitalised due to any sickness.	Maximum up to 90 days/ 180 days per policy year.
1 ii)	Sickness ICU Cash*	Twice the Daily cash amount for each continuous and completed period of 24 hours if the insured is admitted in ICU due to any sickness.	Maximum up to 15 days per policy year.
2 i)	Accident Hospital Cash	Daily cash amount for each continuous and completed period of 24 hours if the insured is hospitalised due to any accident.	Maximum up to 90 days/ 180 days per policy year.
2 ii)	Accident ICU Cash	Twice the Daily cash amount for each continuous and completed period of 24 hours if the insured is admitted in ICU due to any accident.	Maximum up to 15 days per policy year.
3.	Day Care Procedure Cash	50% of the Daily cash amount if the insured undergoes any of the 10 identified day care procedures which does not require 24 hours hospitalisation due to technological advancement.	Maximum up to 6 day care procedures per policy year.
4.	Joint Hospitalisation due to an Accident^	Twice the Daily cash amount for each continuous and completed period of 24 hours where two or more Insured person(s) are concurrently hospitalised due to an accident.	Maximum up to 10 days per policy year.
5.	Convalescence Cash^^	Lump sum amount paid if insured person is hospitalised beyond 7 continuous days,	Payable once per policy year.
Others two benefits included in Apollo Munich Optima Cash Platinum plan are, Childbirth and Parent Accommodation
6.	Child Birth	Lumpsum amount equivalent to twice the Sickness Daily Cash amount for maternity to female Insured in event of childbirth. There is a waiting period of 2 years for availing this benefit	Maximum twice during the lifetime of the Insured Person
7.	Parent Accommodation	Daily Cash amount for parent’s accommodation if the Insured child is aged 12 years or less and is hospitalised for more than 72 hours; in addition to Sickness/Accident Hospital Cash benefits above	Maximum upto 30 Days per policy year

^In addition to benefit 2 i) and 2 ii). ^^In addition to benefit 1 i), 1 ii), 2 i) and 2 ii) *Benefit 1 ii) sublimit under 1 i), #Benefit 2 ii) sublimit under 2 i)

Exclusions in Apollo Munich Optima Cash Plan

There are some exclusions under Apollo Munich Optima Cash 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 4 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 Optima Cash Brochure attached below.

Claim procedure under Apollo Munich Optima Cash 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:

In case the treatment requires Hospitalisation, you must inform the company immediately. Intimate any event of hospitalization not later than 7 days from the admission date.
If the above condition is not fulfilled on the grounds that the claim was intimated to any other insurer covering the hospitalization expenses, then the company would accept a written confirmation of such intimation from the insurer.
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.
In case of any deficiency, company would request you for the relevant documents which you need to submit within 15 days of our request.

Frequently asked questions (FAQ) of Apollo Munich Optima Cash Plan

How can I renew my Optima Cash insurance policy after one year?

The Company would send you a renewal notice informing you of the expiry of your health policy. You do not have to fill the Application form again at the time of renewal in case you renew the policy before renewal date.

How will the claim payment be made in case of a reimbursement claim?

All claim payments will be transferred directly to the bank account of customer. In case he/she has requested for NEFT (National Electronic Funds Transfer) transfer, the following details must be provided in the NEFT form for company to transfer the amount,

Account Holder’s Name
IFSC Code
Account Number
Branch address

In case the above details are not provided, Company would settle the claim by cheque in the name of policyholder.

What happens when the limit of insurance is exhausted under an Optima Cash Health Insurance Policy?

If the sum assured is exhausted in a particular year due to large medical expenses, the insurer is not liable to bear or reimburse the insured for any further expenses.