Apollo Munich Optima Senior

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.

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.

Maximum Policy Renewal Age (years)

Lifelong renewal

Coverage Type

Individual

Sum Insured (Rs)

Maximum

5 lakh

Minimum

2 lakh

Policy Term (years)

1/2

Discount

5% 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 Up

Required (insurer would reimburse 50% of cost on acceptance of insurance proposal)

Grace Period for Policy Renewal

30 days

Co Payment Clause

15% 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 Termination

Policyholder 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

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

[email protected]

Call to

1800-103-0555

SMS

HEALTH to 56767333

Network Hospitals

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

Scope of Cover
Cashless facility	available at network hospitals
Reimbursement facility	available if treatment taken in non-network hospitals
Pre and post hospitalisation	covered upto 30 days prior and 60 days post hospitalisation
Inpatient treatment	covered
Day care procedures	covers 140 listed day care treatment
Domiciliary treatment	covered only if treatment exceeds 3 days
Organ donor	covers medical treatment of organ donor
Emergency ambulance	pays upto Rs 2000 for each hospitalisation in case of an emergency
Second Opinion	allows to obtain an opinion from medical panel for listed critical illnesses once a policy year

Exclusions and Waiting period
Pre-existing diseases	covered after 3 years of continuous policy renewal
No claim period	30 days from policy start date
Waiting period	2 years for specified illnesses like hernia, sinusitis, cataract, joint knee replacement etc.
Other exclusions	Non allopathic treatmentsHIV/AIDS and related conditions

Annual Premium
Age (in years)	Sum Insured (in Rs)
Age (in years)	2 lakh	3 lakh	5 lakh
61-65	11932	14615	22553
66-70	15137	19201	30719
71-75	18367	23986	39428
76-80	24219	31629	52125
81-85	32051	42433	70849
>85	42497	57032	96402
Premiums are exclusive of service tax and cess.