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Apollo Munich Optima Super Health Insurance Plan

Apollo Munich Optima Super image

Apollo Munich Optima Super Health Insurance Plan Introduction

Apollo Munich Optima Super Policy is a Super top up health insurance plan, which is meant to enhance your sum insured as per your need at a lower cost. Under Apollo Munich Optima Super Policy, unlike other top-up plans, you do not have to cross the deductible limits at every claims incidence instead you can aggregate them during a policy period over multiple hospitalizations.

In Apollo Munich Optima Super Plan, you can choose to convert top up plan into a regular (nil deductible) health insurance plan. This is beneficial for individuals with group cover and low sum insured policies. It can be taken as an individual plan or as a family floater.

Key features and Benefits of Apollo Munich Optima Super policy

Features:

Apollo Munich Optima Super offers a lifelong Renewal Benefit and comes with the added option of availing a single cover for your entire family (family floater).
In a family floater policy, a maximum of 2 adults and a maximum of 2 children can be included in a single policy. The 2 adults can be a combination of Self, Spouse, Father or Mother.
In an individual policy, a maximum of 6 members can be added in a single policy, a maximum of 4 adults and a maximum of 5 children can be included in a single policy. The 4 adults can be a combination of Self, Spouse, Father or Mother.
In a family floater the age of the eldest member will be considered while computing premium for the family.
Cashless claim facility available across 4000+ hospitals in India.

Benefits:

Switch Option (Waiver of Deductible): Optima Super gives you an option of converting into a full-fledged nil deductible plan by using the Waiver of Deductible benefit. This option can be exercised by you only when you retire (or even at the 6th policy anniversary). Advantages under Waiver of Deductible benefit are,

It is hassle free with no underwriting or medical tests.
Reduction in Waiting Period.
Your deductible is waived off and you are covered from the first rupee.

Discount: Family Discount- 10%(if 2 or more family members are covered). Additional discount- 7.5% offered on premium(if 2 year policy and pay 2 years premium in advance as single premium).

Tax Benefits: You can avail Tax benefit under Section 80D of the Income Tax Act. For more information regarding Income 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.

Free look Cancellation: Company offer a period of 15 days from the date of receipt of the Policy document to review the terms and conditions of Apollo Munich Energy Health insurance plan.

Terms and Eligibility conditions of Apollo Munich Optima Super Policy

Entry age of an Individual:	Minimum age: 91 days Maximum age: 65 years
Dependent children(If Parent covered under same Policy):	Minimum age: 91 days Maximum age: 5 years
Policy Period:	Lifelong validity (but after 1 year/2 years period it needs renewal)
Sum assured:	Minimum: 5 lakhs Maximum: 10 lakhs
Deductible Options:	Minimum: 1 lakh Maximum: 10 lakhs
Maximum cover ceasing age:	Nil
Grace Period:	30 days from expiry date of renew the policy
Coverage type:	Individual plan Family floater plan
Waiting period for pre-existing illness:	Within 30 days from policy except the claims arising due to an accident. 2 years for specific diseases.
Documents required at the time of renewal:	No need to fill fresh application at the time of renewal within the grace period and before the renewal date.

Inclusions in Apollo Munich Optima Super Policy

In Apollo Munich Optima Super Policy, Hospitalisation expenses are included for accidents or illness
Pre-Hospitalisation: Medical expenses are incurred in 60 days before hospitalisation.
Post-Hospitalisation: Immediately after discharge from hospital within 90 days medical expenses are incurred.
In Apollo Munich Optima Super Policy day care procedures are covered.
Medical treatment of the organ donor for harvesting the organ i.e. including surgery to remove organs from a donor in the case of transplant surgery
Ambulance services are also available upto Rs.2000 per hospitalisation.
Pre-Acceptance Medical Test:Pre-Policy Check-up based upon sum insured & deductible at our network may be required.
The cost of such medicals would be borne by the Insured and upon acceptance, we shall refund 100% of the expenses incurred on medical tests.
The medical reports are valid for a period of 30 days from the date of Pre-Policy Checkup.

Exclusions in Apollo Munich Optima Super Policy

They are some exclusions in Apollo Munich Optima Super policy.

All treatments are excluded within 30 days in Apollo Munich Optima Super Policy except any accidental injury.
In Apollo Munich Optima Super Policy any pre existing diseases will be covered after waiting a period of 4 years.
In Apollo Munich Optima Super Policy the critical diseases like HIV or AIDS expenses are excluded
Abuse of intoxicant or hallucinogenic substances like alcohol and drugs are excluded in Apollo Munich Optima Super Policy.
Experimental, investigative and unproven treatment devices and pharmacological regimens are excluded.
2 years waiting period for specific diseases like cataract, hernia, joint replacement surgeries, surgery of hydrocele etc are excluded.
In Apollo Munich Optima Super Policy Pregnancy, dental treatment, external aids and appliances are excluded.

For detailed information refer Apollo Munich Optima Super Brochure and Apollo Munich Optima Super Policy Wordings.

Buying Procedure For Apollo Munich Optima Super Health Insurance Policy

Fill the application form with accurate details.
Submit the application form and premium amount with necessary documents to company representatives.
Medical check up is applicable based on your age and sum assured.
If your policy is accepted then 100% reimbursement will be done to conduct tests.
If proposal is not accepted, then no reimbursement will be provided.

Claim Procedure For Apollo Munich Optima Super Health Insurance Policy

Assistance:

For any Informations or doubts or for clarifications, you can toll free number 1800-102-0333 or log on to our website www.apollomunichinsurance.com or e-mail us at customerservice@apollomunichinsurance.com

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 for cashless:

You can collect claim form available at all offices.
They offer cashless settlement at prefered hospitals.
Cashless settlements are applicable for emergency conditions and you should inform to Apollo Munich within 24 hours after hospitalisation.
For any Planned surgeries, you should inform to Apollo Munich before 48 hours.
For confirmation purpose Apollo Munich will check the details the details and send letter to the provider.
Please pay the non-medical and expenses not covered to the hospital prior to the discharge.

Note: Insured person is applicable for cashless coverage only in oue empanelled hospitals.

For detailed information refer Apollo Munich Optima Super Claim Procedure

Apollo Munich Optima Super Premium Rates

In Apollo Munich Optima Super Policy the premium rates under individual coverage will be charged on the completed age of the individual insured member.
For family floater policy will be considered on the completed age of the eldest insured member.
Premium rates are subject to change with prior approval from IRDA.
The Policy Period mentioned in the Apollo Munich Optima Super Policy schedule will remains same for premium rates.
At the time of renewal the premium rates may change due to change in your age or changes in applicable tax rates.
In Apollo Munich Optima Super Policy the Sum Insured of the dependent insured members should be equal to or less than the Sum Insured of the Primary Insured member.
Incase where two or more children are covered, the Sum Insured for all the children must be same. Sum insured of all Dependent Parents must be same.
Note: Premium rates and policy terms and conditions are for standard healthy individuals. These may change post underwriting of proposal based on medical tests (where applicable) and information provided on the proposal form.

Apollo Munich Optima Super Gross Premium Table (Exclusive of Taxes):

Individual sum assured:

Apollo Munich Optima Super Premium Table

For Detailed information refer Apollo Munich Optima Super Prospectus

Apollo Munich Optima Super Premium Calculator

You can calculate the premium using Apollo Munich Optima Super premium calculator. Policy period, Number of members, Age and Sum assured are required to calculate the premium.

Frequently Asked Questions (FAQ’s) of Apollo Munich Optima Super Policy

What is Top up Health insurance policy?

Basically top up health insurance plans are for reimbursement of medical expenses beyond a certain limit and meant for a single illness. Top up plans works like a cost sharing model, where insurance company has defined a particular amount which you have to bear in every claim from your own pocket and balance if any will be taken care by insurer up to maximum sum assured bought.

Both your regular health insurance plan and top up insurance can be claimed together for single hospitalization if the expenses are coming out to be more than the deductible amount.

What is Super Top up Health insurance policy?

In case of top up policy, the deductible applies per hospitalization or claim and in case of Apollo Munich Optima Super the Super top up deductible is per policy year. Super top up activation is not limited to single hospitalization but it takes into account the total of all claims made in a policy year. Once the total hospitalization expenses exceed the deductible in a single year, the rest of the expenses if any will be taken care by Apollo Munich Super top up health insurance plan.

What is a Deductible?

Deductible means a cost-sharing requirement among the policyholder and insurance company under a health insurance policy. It provides that the insurer will not be liable for a specified rupee amount in case of indemnity policies. And also for a specified number of days/hours in case of hospital cash policies which will apply before any benefits are payable by the insurer. A deductible does not reduce the Sum assured.

The company is not liable for any payment unless the Medical Expenditures exceed the Deductible. Deductible shall be applicable for each and every hospitalisation except claims made for any one Illness.

Example of Deductible:

Mr. Raju has policy (Policy Period-1Jan-2010 to 31-dec-2010) with Sum assured of Rs. 5,00,000 and with a deductible of Rs. 5,00,000.

In May 2010, he is hospitalised and a claim is filed for Rs. 4,00,000. Claim is not admissible in this scenario since his deductible is Rs. 5,00,000.

In June 2010, he is hospitalised and a claim is filed for Rs. 600,000. In this scenario claim payment will be made for Rs. 1,00,000 [6,00,000-5,00,000].