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Apollo Munich Optima Restore Health Insurance plan

Apollo Munich Optima Restore Health Insurance plan Introduction:

Apollo Munich Optima Restore is a unique health plan with Restore benefit. It is recently launched by Apollo Munich Health Insurance. Apollo Munich Optima Restore plan can be taken as an Individual or as a Family Floater i.e., for Spouse, Children and Parents. It is different from other health insurance policies due to its Restore Benefit and Multiplier Benefit.

Apollo Munich Optima Restore Plan provides cover for entire family. Maximum of four people can be covered, under Family floater option. You can choose for two adults and two children or for one adult and three children. Apollo Munich Optima Restore plan provides major benefits to the policyholders especially in Family floater plans.

Key Features and Benefits of Apollo Munich Optima Restore Plan

Apollo Munich Optima Restore plan provides two unique benefits they are,

Restore Benefit.
Multiplier Benefit.

Restore Benefit:

Restore Benefit is the unique benefit under Optima Restore plan where, the company restores the Basic sum assured automatically if it is exhausted during the policy year. Thus, if the Initial SA (sum assured) gets exhausted, the entire Basic sum assured is restored back during the policy year at no extra charge. This is mainly beneficial for Family floater plans as there is high probability of exhausting the insurance coverage.

For example:

If the policyholder has a Apollo Munich Optima Restore plan of 5 lakhs and is exhausted due to hospitalization during the policy year, then the company restores the amount of 5 lakhs which you can use for other illness or for any other member covered in this plan under Family floater option.

Limitations of Restore benefit under Optima Restore plan:

Restore benefit is applicable only once during a policy year.
Restore benefit is not Carried forward, if it is not utilized in a policy year.
Restore benefit begins only when the Basic SA (sum assured) along with bonus (if any) is utilized completely.
Restore benefit cannot be claimed on the disease or illness for which the claim has been made in the current policy year.

Multiplier Benefit:

Multiplier Benefit is the other unique benefit under Optima Restore Plan where, if the policyholder had a first claim free year, 50% of Basic Sum Assured will be increased as a NCB (no claim benefit) by the company. If you don’t claim even in the second year, then 100% of the Basic sum assured will be increased as a NCB by the company. Under Optima restore plan, if a claim is made after the bonus has applied then the multiplier bonus is decreased by 50% of basic Sum assured in the following policy year.

For Example:

If the policyholder has a Apollo Munich Optima Restore plan of 5 lakhs and don’t claim in the first year, then company will increase cover to 7.5 lakh for the second year and if you don’t claim even in the second year, it will be increased to 10 lakh in the third year, while you only pay a premium for a 5 lakh policy.

There are other Key features of the Apollo Munich Optima Restore plan they are,

This plan provides Lifelong renewal i.e., you can renew your cover lifelong and stay covered forever.
No sub-limit on room rent.
No claim based loading: Company will never load on renewal premiums.
Easy Upgrade: Policyholder can easily upgrade the cover to next level at renewals.
Cashless transactions: Enables you to get treated on a cashless basis across 4000 hospitals in more than 800 cities.
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: You can avail tax benefits under Section 80D. (For more information regarding Income Tax Benefits, visit www.taxqueries.in.)
Discounts: Family Discount of 10% if two or more family members are covered under Apollo Munich Optima Restore Individual Sum Insured Plan. An additional 7.5% discount is offered on the premium if you choose a 2 year policy.

Terms and Eligibility conditions of Apollo Munich Optima Restore Plan

Entry age:	Minimum: 91 days Maximum: 65 years
Policy term:	Minimum: 1 year Maximum: 2 years
Renewable till age:	Lifelong
Sum assured:	Minimum: 5,00,000 Maximum: 5,00,000
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.
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 Optima Restore Plan

Inclusions in Apollo Munich Optima Restore Plan are,

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.

Exclusions in Apollo Munich Optima Restore Plan

There are some exclusions under Apollo Munich Optima Restore 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 refer the Form and Apollo Munich Optima Restore Brochure attached below.

Claim procedure under Apollo Munich Optima Restore Plan

Claim Procedure for Hospitalization related benefits,

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 Optima restore policy a rejection letter would be sent to the provider within 6 hours.

Claim Procedure for Critical illness:

You must intimate the company within 14 days of diagnosis of first occurrence of Critical Illness.
You must submit a duly filled claim form along with specified documents within 45 days of completion of survival period for the Critical Illness against which the claim is made.
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.
Any additional information requested must be submitted to the company within 15 days of their request.
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.

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 company 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 Optima Restore Plan

Do I need to undertake a medical check-up while buying a health insurance policy?

If any member to be insured is above 45 age or for sum insured 7 Lakhs or above, you may be required to undergo a medical check-up after you buy.

What is beneficial for me, Family floater insurance or an individual insurance?

Generally, at younger ages Family floater cover is advisable. You should go for an individual insurance cover, as you grow older.

What are the documents needed for portability?

The documents required for Apollo Munich Optima Restore 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 difference between a family floater and critical illness insurance?

The individual or family floater health insurance policies will pay you only what you have spent for medical treatment during hospitalization. On the other hand, the critical illness or the hospital cash insurance pays you the amount insured, regardless of the amount spent for medical treatment.

What is meant by Cashless Hospitalization?

In the event of hospitalization, the patient or their family will have to pay a bill to the hospital. 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.