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 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 |
Additions to the Plan
| 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) | |||
| 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. | ||||
