Apollo Munich Optima Senior Health Insurance Plan
Apollo Munich Optima Senior Health Insurance Plan Introduction
Apollo Munich Optima Senior Health Insurance Plan is exclusively for Senior citizens. Apollo Munich Optima Senior offers comprehensive cover for medical treatment of illnesses and accidents requiring in-patient hospitalisation. In Apollo Munich Optima Senior plan there are additional benefits like Cumulative Bonus, E-opinion (in case of critical illnesses) etc.
Under Apollo Munich Optima Senior Health Insurance plan, policyholder and/or his/her spouse can be covered on individual sum insured basis. Also it offer a family discount of 5% if both you and your spouse are covered under Apollo Munich Optima Senior policy.
Terms and Eligibility Conditions of Apollo Munich Optima Senior Health Insurance Plan
| Entry age: |
|
| Policy term: |
|
| Sum assured: |
|
| Coverage type: |
|
| Renewable till age: |
|
| Maximum Cover Ceasing Age: |
|
| Grace period: |
|
| Waiting period for pre-existing illness: |
|
| Pre-Policy Medical Check Up: |
|
| Co-Payment options: |
|
| Documents Required for fresh policy: |
|
| Documents Required during Renewal: |
|
Key Features and Benefits of Apollo Munich Optima Senior Health Insurance Plan
- Apollo Munich Optima Senior policy offers lifelong renewability i.e there is no maximum cover ceasing age in this policy.
- Copayment applicable on room rent type and specific illness and surgeries.
- In Apollo Munich Optima Senior policy there is a facility of E-opinion in case of Critical Illnesses.
- You can avail Tax benefit under Apollo Munich Optima Senior plan.
- Once you are insured under Apollo Munich Optima Senior policy you are covered for life.
- It covers up to 5 lakhs.
Other Benefits:
- 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.
- Sum Assured Enhancement: Sum assured can be enhanced only at the time of renewal, subject to no claim having been paid under the policy.
- Tax benefits: Under Apollo Munich Optima Senior plan, you can avail tax benefits for the premium amount under Section 80D of the Income Tax Act. For more information regarding Income Tax Benefits, visit www.taxqueries.in.
- Cumulative Bonus or No-claim discount: You get a Cumulative Bonus (CB) of 5% for every claim-free policy year provided policy is renewed without a break.
- Cashless transactions: Enables you to get treated on a cashless basis across 4000 hospitals in more than 800 cities.
- No claim based loading: Company will never load on renewal premiums.
- Discounts: 5% on renewal for each claim free year, 5% if spouse also buys this policy and 7.5% on selecting a 2 year policy term.
Inclusions in Apollo Munich Optima Senior Health Insurance Plan
Inclusions in Apollo Munich Optima Senior Plan are,
| In-patient Treatment: | Covered |
| Pre-Hospitalisation: | Covered, up to 30 Days |
| Post-Hospitalisation: | Covered, up to 60 Days |
| Day Care Procedures: | Covered, enlisted 140 Day Care Procedures |
| Domiciliary Treatment: | Covered |
| Organ Donor: | Covered |
| Emergency Ambulance: | Up to Rs.2,000 per Hospitalisation |
| E-opinion: | One opinion per Policy Year |
Exclusions in Apollo Munich Optima Senior Health Insurance Plan
There are some exclusions under Apollo Munich Optima Senior 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 Apollo Munich Optima Senior 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.
- Items of personal comfort and convenience.
- Experimental, investigative and unproven treatment devices and pharmacological regimens.
(For detailed information refer the Policy wordings and Apollo Munich Optima Senior Brochure attached below)
Buying procedure of Apollo Munich Optima Senior Health Insurance Plan
To buy Apollo Munich Optima Senior Health Insurance policy there is an easy guide,
Step 1: Discuss the policy benefits, Inclusions, exclusions and premium details with your advisor.
Step 2: Fill the application form with complete and accurate personal information and health profile.
Step 3: Submit the application form and the premium amount along with necessary documents to the company representative.
Step 4: Pre-policy check-up is required, depending on age, health declaration and sum assured. Your medical check-up will include
- A medical examination by a doctor.
- Blood tests to measure your cardiac status, cholesterol levels, blood sugar levels among other things
- Urine analysis andcardiac tests to assess the status of your heart and kidneys.
Step 5: On acceptance of your proposal, company would reimburse up to 50% of expenses incurred by you to conduct these tests. No reimbursement will be provided, in case your policy is declined.
Step 6: Final policy document and kit will be sent to you, in case of acceptance. If your proposal is not accepted, company will inform you with a proper reason.
Claim procedure under Apollo Munich Optima Senior 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 48 years 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 Apollo Munich Optima Senior documents 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 or log on to their website www.apollomunichinsurance.com or email at customerservice@apollomunichinsurance.com for any information or for clarifying your doubts.
- 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 Optima Senior 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.
Apollo Munich Optima Senior Health Insurance Plan premium calculator
You can calculate the premium using Apollo Munich Optima Senior premium calculator. Policy period, Number of members, Age and Sum assured are required to calculate the premium.
Apollo Munich Optima Vital Health Insurance Plan premium rates
Premium rates as per Age and Sum assured is given below in Apollo Munich Optima Senior premium table,
| Age Group / Sum Insured(Rs.) | 2,00,000 | 3,00,000 | 5,00,000 |
| 61-65 Years | 11,932 | 14,615 | 22,553 |
| 66-70 Years | 15,137 | 19,201 | 30,719 |
| 71-75 Years | 18,367 | 23,986 | 39,428 |
| 76-80 Years | 24,219 | 31,629 | 52,125 |
| 81- 85 Years | 32,051 | 42,433 | 70,849 |
| > 85 Years | 42,497 | 57,032 | 96,402 |
- The Apollo Munich Optima Senior premium will remain the same for the policy period as mentioned in the policy schedule.
- Your renewal premium may change due to change in your age or applicable Tax rate.
Frequently asked questions (FAQ’s) of Apollo Munich Optima Senior Health Insurance Plan
Do I have to undergo a medical checkup every year?
No, medical checkup is not required every year, if the insured renews the policy continuously without a break and there is no change in the policy terms and conditions.
Is cashless facility available across all hospitals?
The cashless facilities are available only at the hospitals which are in Apollo Munich’s network.
What is Co-Payment?
Co-payment means a cost-sharing requirement under a health insurance policy that provides that the insured will bear a specified percentage of the admissible costs. A co-payment does not reduce the sum insured.