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Apollo Munich Optima Senior

Objective

This is a special health insurance policy designed to provide lifelong coverage to senior citizens.


Suited for

Anyone who fulfills the eligibility criteria can buy this policy.


What does it do?

Anyone proposing to buy this policy will be required to go through a medical check up. In certain cases mentioned, co-payment clause applies which means that total claim amount will be shared among policyholder and insurance company in a pre-specified ratio. Apart from hospitalization benefit, it also covers pre and post hospitalization expenses, domiciliary treatment, day care procedures, and hospitalization expenses of organ donor in case of transplant.


Pros

It offers lifelong renewal.
It offers a 5 per cent discount on premium on including spouse.
It allows 7.5 per cent discount for opting a 2-year policy.
The policy assures of no claim based premium loading.
There are no sub-limits on inpatient hospitalisation cover.
Premium paid under this policy enjoys a tax benefit under Section 80D.


Cons

Co-payment in certain cases acts as a limitation.


Our View

There is no escape from co-payment clause when looking a policy for a senior citizen. USP of the policy is that it assures of no claim based loading and it covers inpatient hospitalisation expenses without any sub-limits. This policy is a perfect balance between the benefits and cost. If you can afford the premiums, this is a recommended plan. But if you are looking for a cheaper policy, you would be required to compromise on the scope of cover as well.

Eligibility
Maximum Policy Renewal Age (years)Lifelong renewal
Coverage TypeIndividual
Sum Insured (Rs) 
Maximum5 lakh
Minimum2 lakh
Policy Term (years)1/2
Discount5% on renewal for each claim free year.
5% if spouse also buys this policy.
7.5% on selecting a 2 year policy term
Pre Policy Medical Check UpRequired (insurer would reimburse 50% of cost on acceptance of insurance proposal)
Grace Period for Policy Renewal30 days
Co Payment Clause15% on accomodation in a twin sharin room or lower room type.
30% on accomodation in a single room or higher room type (15% in case of an emergency).
30% on specific illnesses such as cataract(each eye), hysterectomy, joint replacement etc.
15% to all day care procedures
Policy TerminationPolicyholder is allowed to cancel the policy at anytime by providing a notice. Insurer may also terminate the policy by giving a 30 days notice
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 to1800-103-0555
SMSHEALTH to 56767333
Network HospitalsHttp://www.apollomunichinsurance.com/our-hospital-network.aspx
Additions to the Plan
Scope of Cover
Cashless facilityavailable at network hospitals
Reimbursement facilityavailable if treatment taken in non-network hospitals
Pre and post hospitalisationcovered upto 30 days prior and 60 days post hospitalisation
Inpatient treatmentcovered
Day care procedurescovers 140 listed day care treatment
Domiciliary treatmentcovered only if treatment exceeds 3 days
Organ donorcovers medical treatment of organ donor
Emergency ambulancepays upto Rs 2000 for each hospitalisation in case of an emergency
Second Opinionallows to obtain an opinion from medical panel for listed critical illnesses once a policy year
Exclusions and Waiting period
Pre-existing diseasescovered after 3 years of continuous policy renewal
No claim period30 days from policy start date
Waiting period2 years for specified illnesses like hernia, sinusitis, cataract, joint knee replacement etc.
Other exclusionsNon allopathic treatmentsHIV/AIDS and related conditions
Annual Premium
Age (in years)Sum Insured (in Rs)
2 lakh3 lakh5 lakh
61-65119321461522553
66-70151371920130719
71-75183672398639428
76-80242193162952125
81-85320514243370849
>85424975703296402
Premiums are exclusive of service tax and cess.