Objective

This policy aims at providing uninterrupted and ample insurance coverage. It can be bought online through company's website. It is unique in two ways. One, it restores the sum insured if the cover gets depleted during a policy year. Another is that it doubles the basic sum insured if no claims were made during two consecutive policy years.

Suited for

Though it is available as an individual and family floater policy, it is a felicitous family floater policy because it restores sum insured for other family members in case a member depletes the entire cover.

What does it do?

Optima Restore offers two unique benefits. First, it restores basic sum insured if insured person exhausts his limit during the policy year. The restored sum insured can be utilized against some other illness not claimed earlier during the policy period. In case of family floater policy, the restored sum can be used by some other person insured under the floater policy. For instance, if a person extinguishes sum insured of Rs 5 lakh during first policy year, the policy reinstates entire sum insured. The individual may claim the reinstated sum insured for some other illness not related to the earlier illness. In case of family floater policy, the reinstated sum insured can be used by some other family member covered under the policy.

Second, this policy provides a no claim bonus at 50 per cent of basic sum insured for each claim-free year. Thus, the sum insured doubles itself in case no claims arise during two consecutive years. Sample this, for a Rs 5 lakh policy, the sum insured becomes Rs 7.5 lakhs in case of a claim-free year and Rs 10 lakhs after second claim-free year. However, in case of a claim, the bonus would be reduced by 50 per cent of sum insured in subsequent year.

This policy covers inpatient hospitalisation expenses. It covers pre and post hospitalisation expenses. Day care procedures which do not require a 24-hour stay in hospital due to technological upgradation and domiciliary treatment wherein, treatment is taken at home on advice of doctor which would otherwise require hospitalisation also falls under its coverage. It also provides emergency ambulance.

Pros

Unique benefit is that it restores the sum insured even if it's completely utilized during a policy year.
There is no cover ceasing age. It offers a life long insurance.
The policy provides a discount of 7.5 per cent on advance payment of 2-year premium.
Family discount of 10 per cent is applicable on including three or more family members under the same policy.
It covers pre and post hospitalisation expenses.
This policy can be purchased online.
Premium paid under this policy qualifies for deduction under section 80D of Income Tax Act.

Cons

Sum Insured gets restored only once the full basic sum insured is depleted.
Restored sum insured if not used during the policy period, cannot be carried forward to next policy year.
In case, cumulative bonus has been passed and a claim arises during that year, cumulative bonus would be reduced by 50 per cent in the following year.

Our View

The sui generis concept eliminates the usual drawback of inadequate sum insured, to cover other members after one of the member claims insurance, in the policy. No claim bonus of 50 per cent per year, hence doubling the basic sum insured after two such years makes this policy exceptional. Life long renewals adorn this policy further. This product is undoubtedly worthwhile in case of floater policies that include all family members under single policy. However, one must know that it does not cover maternity expenses. As far as premiums are concerned, Policy benefits outweigh the cost.

Eligibility

Entry Age (years)

Minimum

5; 3 months for children

Maximum

65

Maximum Policy Renewal Age (years)

No Limit

Coverage Type

Individual/ Family

Policy Term (years)

1 or 2

Sum Insured (Rs)

Maximum

15 lakh

Minimum

3 lakh

Tax Benefit

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

Discount

Premium discount of 7.5% on advance premium payment for 2 year policy term.
Family discount of 10% is applicable if 3 or more family members included.

No Claim Bonus

Bonus of 50% of the Basic Sum Insured for every claim free year, maximum upto 100%. In case of claim, bonus will be reduced by 50% of the basic sum insured However this reduction will not reduce the Sum Insured below the basic Sum Insured of the policy.

Pre Policy Medical Check Up

Required at discretion of insurance company; 50% of the expenses incurred will be reimbursed on acceptance of proposal.

Free look Period

15 days from date of receipt of policy

Grace Period for Policy Renewal

30 days grace period is allowed to policyholder for payment of premium at the insurers discretion.

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, 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/ 1800-103-0555

SMS

Restore' to 56767 333

Network Hospitals

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

Scope of Cover

Cashless facility

Available at empanelled hospitals in India.

Re-imbursement

In case policyholder opts for non empaneled hosiptal.

Pre-post hospitalisation

Relevant medical expenses covered from 60 days prior and 180 days post hospitalisation

In-patient Treatment

Covered

Day-Care Procedures

140 in number are covered

Domiciliary Treatment

Covered

Expenses for organ donor of transplant

Covered

Emergency Ambulance

Up to Rs 2,000 per hospitalisation

Restore Benefit

Equal to 100% of Basic Sum Insured, Restore benefit automatically reinstates the basic sum insured in case you exhaust it in a policy year

Exclusions and waiting period

Pre-existing disease

Pre-existing Diseases will be covered after a waiting period of 36 months

No claim period

Any disease contracted during the first 30 days of commencement of the policy except for aciidental emergency

Waiting Period

24 months for specific illnesses and treatments

General exclusions

Non allopathic treatment.AIDS or any related illness will not be coveredTreatment of any mental or related disease is also excluded.