Objective

An inclusive health insurance plan that covers small illnesses under OPD treatment and can also incur inpatient hospitalisation expenses. This policy aims at complete protection including maternity cover and an optional cover against eight chronic diseases.

Suited for

This policy is suitable for those seeking an all-in-one insurance cover. It is available on individual and family floater basis. A family floater policy may include proposer, spouse, up to two dependent children.

What does it do?

A comprehensive insurance policy which covers inpatient hospitalisation, out patient department treatment, maternity expenses, domiciliary treatment i.e., treatment taken at home, day care procedures which do not require hospitalisation due to technological advancement and other incidental expenses. Under OPD treatment, the insured member(s) are entitled to a limited consultations with doctor. Other OPD benefits like diagnostic tests, pharmacy, dental treatment and spectacles are capped. Critical illness cover and cover for newborn are two optional covers worth buying. Add-on critical illness cover provides for eight chronic illnesses and pays a lump sum on confirmed diagnosis of any of the illnesses. Coverage for other incidental expenses such as pre and post hospitalisation, treatment of organ donor, a specific daily cash allowance for one adult accompanying an insured child under inpatient hospitalisation, are available in the policy.

Pros

There is no exclusion or waiting period under OPD treatment cover.
This policy covers diagnostic tests, dental treatment, spectacles, contact lenses under OPD benefits.
Policyholder enjoys a 10 per cent increase in annual inpatient sum insured for every claim-free year up to maximum of 50 per cent of sum insured.
Policyholder is allowed to carry forward 50 per cent of unutilized Entitlement Certificates to the next policy year except for Annual Health Check up.
Premium paid towards this policy is eligible for tax benefit under section 80D of Income Tax Act.

Cons

There are no choices to make for inpatient sum insured. This policy is available with sum insured worth Rs 3 lakh only.
There is a capping on most of the benefits both under inpatient hospitalisation and OPD cover.
Cumulative bonus reduces by 20 per cent in the following year when claim has been made.

Our View

The policy features a comprehensive protection for an individual and family. It is recommended to take critical illness cover as an add-on to boost the scope of coverage. Maternity cover is another advantageous benefit provided childbirth is planned well before time as it involves a 4-year waiting period. There is no exclusion under OPD cover. Even pre-existing illnesses under out-patient treatment are covered with zero waiting period. Moreover, the policy provides for lifelong renewal. Since most of inpatient and OPD benefits are capped, avoid unnecessary expenses at hospital to avoid risk of slugging your cover

Eligibility

Maximum Policy Renewal Age (years)

No Limit

Coverage Type

Individual / Family Floater

Policy Term (years)

1

Sum Insured (Rs)

Maximum

3 lakh

Minimum

3 lakh

Tax Benefit

Premium paid is eligible for tax benefit under section 80D of the Income Tax Act

No Claim Bonus

10% increase in your annual inpatient benefit sum insured for every claim free year, till it reaches 50% of the Sum Assured and 50% carry forward bonus for unutilized OPD benefits(except Annual Health Check-up). In case a claim is made during a policy year, the cumulative bonus would reduce by 20% in the following year

Policy Termination

Insurance company may terminate the policy by giving a written notice of 30 days. Policyholder is allowed to terminate the policy at anytime by giving a written notice. In case no claim has been made under the policy, prorata percentage of premium will be refunded

Customer Service

Address

Apollo Munich Health Insurance Company Limited
Corporate Office: 10th floor, Tower B, Building No. 10, DLF Cyber City, Phase -II, Gurgaon, Haryana-122002
Registered Office: Apollo Hospital Complex, Jubilee Hills, Hyderabad - 500033

Mail to

customerservice@apollomunichinsurance.com

Call to

1800-102-0333 or 1800-103-0555

SMS

Health' to 56767333

Network Hospitals

Http://www.apollomunichinsurance.com/our-hospital-network.aspx

Scope of Cover

Cashless facility

Available at empanelled hospitals in India.

Re-imbursement

Available

Pre-post hospitalisation

Relevant medical expenses covered from 30 days prior and 60 days post hospitalisation

In-patient Treatment

Covers boarding, lodging, ICU, Operation theatre, Anesthesia, Blood, Oxygen, Surgical appliances, medicines, drugs and consumable, nursing and medical practitioner charges

Day-Care Procedures

140 in number are covered

Domiciliary Treatment

Covered

Daily cash for choosing shared accommodation

Rs 500 per day, Maximum Rs 3,000

Expenses for organ donor of transplant

Covered

Emergency Ambulance

Up to Rs 2,000 per hospitalisation

Daily Cash for 1 adult accompanying an insured child

Rs 300 per day, maximum Rs 9000

Newborn baby

Optional

Maternity Expenses with waiting period of 4 years

Normal Delivery- Rs 15,000;Caesarean Delivery- Rs 25, 000 (Including Pre/Post Natal limit of Rs 1,500 and infant baby limit of Rs 2,000)

Optional Cover for Critical Illness

Rs 3 lakh covered on an individual basis. It covers against 8 critical diseases namely: cancer, coronary artery (bypass) surgery, first heart attack (myocardial infarction), kidney failure (end stage renal disease), major organ transplantation, multiple sclerosis, paralysis and stroke after a survival period of 30 days after confirm diagnosis of any covered illness. Maximum cover ceasing age is 70 years.

Out-patient Treatment

Covered; It pays for doctor consultation, pharmacy expenses, spectacles, contact lenses, health check-up and diagnostic tests.

Pre-existing illnesses under OPD Benefits

covered without any waiting period

Out-patient Consultations

4 consultations for 1 member cover/ 6 for 2 members cover/ 8 for 2 members + upto 2 children

Diagnostic tests/ Pharmacy/ Dental treatment/ Spectacles, Contact lenses(Rs)

5000 for 1 member cover/ 5500 for 2 member cover/ 7000 for 2 adults + upto 2 children

Health Check-up within specified network and not available on reimbursement basis

1 Entitlement Certificate for 1 member cover, 2 Entitlement Certificates for 2 member and 2 adults + upto 2 children cover option. Allowed to member aged between 18 and 45 years from second year.

Exclusions and Waiting Period

under OPD treatment

No exclusions

under Inpatient treatment

Pre existing Diseases

Pre-existing Diseases will be covered after a waiting period of 3 years

No claim period

Any disease contracted during the first 30 days of commencement of the policy except for accidental emrgency

Waiting Period

24 hours for certain diseases and illnesses specified under policy document.Maternity expenses will be covered after a waiting period of 4 years.

General Exclusions

Non allopathic treatment.Any psychiatric or mental disorders.AIDS or any other related conditions.