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Apollo Munich Optima Restore

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) 
Minimum5; 3 months for children
Maximum65
Maximum Policy Renewal Age (years)No Limit
Coverage TypeIndividual/ Family
Sum Insured (Rs) 
Maximum15 lakh
Minimum3 lakh
Policy Term (years)1 or 2
Tax BenefitPremium paid is eligible for tax benefit under section 80D of the Income Tax Act
DiscountPremium 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 BonusBonus 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 UpRequired at discretion of insurance company; 50% of the expenses incurred will be reimbursed on acceptance of proposal.
Free look Period15 days from date of receipt of policy
Grace Period for Policy Renewal30 days grace period is allowed to policyholder for payment of premium at the insurers discretion.
Policy TerminationInsurance 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 
AddressApollo 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[email protected]
Call to1800-102-0333/ 1800-103-0555
SMSRestore' to 56767 333
Network HospitalsHttp://www.apollomunichinsurance.com/our-hospital-network.aspx
Additions to the Plan
Scope of Cover
Cashless facilityAvailable at empanelled hospitals in India.
Re-imbursementIn case policyholder opts for non empaneled hosiptal.
Pre-post hospitalisationRelevant medical expenses covered from 60 days prior and 180 days post hospitalisation
In-patient TreatmentCovered
Day-Care Procedures140 in number are covered
Domiciliary TreatmentCovered
Expenses for organ donor of transplantCovered
Emergency AmbulanceUp to Rs 2,000 per hospitalisation
Restore BenefitEqual 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 diseasePre-existing Diseases will be covered after a waiting period of 36 months
No claim periodAny disease contracted during the first 30 days of commencement of the policy except for aciidental emergency
Waiting Period24 months for specific illnesses and treatments
General exclusionsNon allopathic treatment.AIDS or any related illness will not be coveredTreatment of any mental or related disease is also excluded.
Annual Premium Option for Individual
Age (in Years)Sum insured (in Rs)
3 Lac5 Lac10 Lac15 Lac
0-174095474163997679
18-354487560980049809
36-4547786395825110056
46-50780098131340716327
51-5511556144451990424251
56-6014725177192546231050
61-6528088328094072742467
66-70*35903420774766049710
71-75*39870468445303255167
76-80*51776609496918872233
> 80*62691739718402387672
Premiums are exclusive of service tax
*Premium rates only for renewal
Annual Premium Option for Family Floater Plan (1 Adult + 1 Child)
Age (in Years)Sum insured (in Rs)
3 Lac5 Lac10 Lac15 Lac
18-3553547296929111334
36-45614380491058912902
46-509828122851707320830
51-5511963149532054525020
56-6015047188082593531609
61-6529134338874197243770
66-70*36950431554879450897
71-75*40916479225416656353
76-80*52822620277032273420
> 80*63738750498515888859
Premiums are exclusive of service tax
*Premium rates only for renewal
Annual Premium Option for Family Floater Plan (1 Adult + 2 Children)
Age (in Years)Sum insured (in Rs)
3 Lac5 Lac10 Lac15 Lac
18-35676491851159014110
36-45742696951266415404
46-5010784153801848222499
51-5514321179012459629953
56-6016274203422785033903
61-6532112371824595347933
66-70*39928464505242154690
71-75*43894512165779360146
76-80*55800653217394977213
> 80*66716783448878592652
Premiums are exclusive of service tax
*Premium rates only for renewal
Annual Premium Option for Family Floater Plan (1 Adult + 3 Children)
Age (in Years)Sum insured (in Rs)
3 Lac5 Lac10 Lac15 Lac
18-358410120221435117459
36-459233131571572719127
46-5013409180912306928102
51-5516762207442881435095
56-6018601232513185338778
61-6535015403894982551981
66-70*42830496575595058378
71-75*46797544246132163835
76-80*58703685287747780902
> 80*69618815519231396341
Premiums are exclusive of service tax
*Premium rates only for renewal
Annual Premium Option for Family Floater Plan (2 Adults + 1 Child)
Age (in Years)Sum insured (in Rs)
3 Lac5 Lac10 Lac15 Lac
18-35750899231231314982
36-458736109201425817333
46-5015561194522592731626
51-5519530244133215939154
56-6023274290923813646401
61-6543095500116190764588
66-70*56907663937504978289
71-75*67315788138912192791
76-80*86485101501115109120263
> 80*104059122449138973145114
Premiums are exclusive of service tax
*Premium rates only for renewal
Annual Premium Option for Family Floater Plan (2 Adults + 2 Children)
Age (in Years)Sum insured (in Rs)
3 Lac5 Lac10 Lac15 Lac
18-359555125221567119068
36-4510920136501785921718
46-5017063213292825034425
51-5521809272613588843689
56-6025715321444214451278
61-6546175534256603668907
66-70*59987698077881182224
71-75*70395822279288396726
76-80*89565104915118871124198
> 80*107139125863142734149049
Premiums are exclusive of service tax
*Premium rates only for renewal
Annual Premium Option for Family Floater Plan (2 Adults)
Age (in Years)Sum insured (in Rs)
3 Lac5 Lac10 Lac15 Lac
18-35609476871010312314
36-45752293171239215087
46-5013649172182287027923
51-5517172214652829734456
56-6021158264473471942254
61-6539974465495771960207
66-70*53786629317123374297
71-75*64194753518530588799
76-80*8336498039111293116271
> 80*100938118987135157141122
Premiums are exclusive of service tax
*Premium rates only for renewal