Objective

This is an online insurance policy that aims to relieve insured person from huge mediclaims. It is based on concept of deductible, which involves cost-sharing among the policyholder and insurance company. It also allows to convert this top-up policy into a basic health insurance policy without any deductible where insurance company will be liable to pay for all admissible expenses.

Suited for

This policy can be taken for self, spouse, dependent children and dependent parents below 65 years of entry age on an individual sum insured basis. It is suitable only if the probability of chronic ailments resulting into huge medical bills in single hospitalisation is high.

What does it do?

Optima Plus is a top-up health insurance policy also known as Deductible policy wherein, insurance company becomes active only once single hospitalisation medical bills breach the threshold limit. Expenses up to threshold limit have to be paid by insured person. Sample this, for a policy with deductible limit of Rs 3 lakh, if admissible medical expenses during a single hospitalisation stood at Rs 2 lakh, insurance company is not bound to pay anything. Here, policyholder has to bear the claim himself. In another case, if total medical bills pertaining to a single hospitalisation amount to Rs 4 lakh, insurance company will pay Rs 1 lakh (Rs 4 lakh-3 lakh).
Insurance company has tinkered this policy in order to set it apart from other top-up policies available in the market. It offers 'Waiver of Deductible' option which means it allows to convert this top-up policy into a full fledged health insurance policy without any deductible limit. Insured person can then enjoy a full health cover worth Rs 5 lakh. Conversion is allowed only when insured person reaches 58 years of age till 60 years provided the person entered the policy for the first time when he was 50 or younger.
This policy covers inpatient hospitalisation expenses including diagnostic procedures, accommodation, blood, anesthesia, oxygen, ICU and operation theatre expenses, medicines, nursing and cost of implant instruments used during surgeries. 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 have otherwise required hospitalisation also fall under its coverage. It also provides for emergency ambulance and hospitalisation expenses of organ donor during organ transplant.

Pros

There is no cover ceasing age. It offers lifelong insurance.
It provides a flat 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 as well.
This policy can be purchased online.
Premium paid under this policy qualifies for deduction under section 80D of Income Tax Act.

Cons

Deductible limit is applicable to each hospitalisation except in case of any one illness.

Our View

Optima Plus is an additional cover to protect against huge medical bills that a basic health policy abstains from. It is meant to be taken along with a basic health policy as an add-on cover. A major drawback is that threshold limit applies to each and every hospitalisation or to each illness. It is generally assumed that chances of contracting major illnesses at later age are high which in turn would lead to heavy medical bills. Thus, the optional waiver of deductible and conversion of top up policy to an ordinary policy is not a good option too. By converting it into an ordinary plan, the insurance company actually shrugs off its liability to indemnify large admissible claims. Thus, we do not recommend this policy.

Eligibility

Entry Age (years)

Minimum

18; 3 months

Maximum

65

Maximum Policy Renewal Age (years)

No Limit

Policy Term (years)

1 or 2

Sum Insured (Rs)

Maximum

5 lakh

Minimum

5 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

Not Applicable

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

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 60 days prior and 90 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

Waiver of Deductible

Allowed; Insured person can enjoy a full fledged insurance cover by taking the policy conversion option between 58 to 60 years of age.

Exclusions and Waiting Period

Deductible

Insurance company is liable to pay expense in excess of deductible amount. Deductible shall apply to each and every hospitalisation except claims made for any one illness.

Pre-existing disease

covered after a waiting period of 48 months

No claim period

Any disease contracted during the first 30 days of commencement of the policy unless the policy is presented for renewal or transfer from some other insurer and that the policy was in force with same or any other insurer without any break in the previous policy year.

Waiting Period

Certain treatments such as hernia etc. will be covered after 24 months starting from inception of the policy.

General Exclusions

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