Apollo Munich Health Insurance - Organisation Faqs
Who is Apollo Munich Health Insurance Company Limited?
It is a Health Insurance Company promoted by Apollo Hospitals in collaboration with Munich Health Insurance Company, a leading Health Insurance Company in Europe
Who is Munich Health?
Munich Health is a part of the Munich Re Group, which is the largest Reinsurance Company in the world. Munich Health is one of the leading health insurance companies in Europe.
Who owns Apollo Munich Health?
It is a 74:26 partnership between Apollo Hospitals and Munich Health.
Where is the Head Office of Apollo Munich Health?
Apollo Munich Health Insurance Company Limited is situated in Gurgaon, Haryana.
How long is the policy valid for?
The policy is valid for one year.
Is the premium exempted from Income Tax?
Premium up to Rs.15,000/- qualifies for tax benefit under Section 80D of the Income Tax Act.
How can I indemnify or claim benefits under the policy?
The expenses or benefits can be claimed or indemnified by reimbursement or by availing cashless services at the network hospitals.
Who is our Health TPA?
Family Health Plan (FHPL) is our designated TPA
How can I contact Apollo Munich for health insurnce?
To get in touch with Apollo Munich for health insurance just call us at +91-80-41101026. Alternatively leave your phone number on the callback form which is available at email / callback. One of our executive will get in touch with you shortly.
Would I have to fill the proposal form again at the time of renewal?
No, you would not have to do so.
Do I have to undergo any medical examination?
Medical examination may be required in some cases, based on the sum assured and the age of the person.
Do I have to undergo a medical checkup every year?
Medical check-up is valid for 3 years, if the insured renews it without a break and the sum assured remains the same.
Who pays for the medical examination?
"The proposed insured(s) has to pay for the cost of Pre-Policy Check-up (PPC) medical examination & investigations to the doctor/diagnostic centre. We will co-ordinate the appointment with our empanelled doctor/diagnostic centre through our appointed TPA.
On acceptance of your application and subsequent issuance of the policy, the actual expenses incurred towards the Pre-Policy Check-up (PPC) shall be *reimbursed to you subject to a maximum of Rs 300.
**Re-imbursement to be claimed from Apollo Munich Health Insurance Company Ltd. along with the original bill.
What is a Family Floater plan?
A Family Floater is a single policy that takes care of the hospitalization expenses of your entire family. Family Floater Health Plan takes care of all the medical expenses during sudden illness, surgeries and accidents.
Apollo Munich Health Insurance - General Faqs
What is a ‘cashless’ claim?
In a Cashless claim the insured do not have to pay any deposit or any fees for the covered services at the network provider. The charges for the covered services are paid directly by the insurer to the service provider through the process of ‘Authorization’
What is a reimbursement claim?
In a reimbursement claim the insured has to pay upfront for the services of the provider and seek reimbursement from the Insurer for the covered services
What is Authorization?
In an authorization process, the insured or the service provider seeks an approval and guarantee of payment from the insurer or it’s TPA for the covered services before the Hospitalization / service for planned treatment and during the course of Hospitalization / service for emergency treatment
What do I do in case of a cashless claim?
In case of a planned treatment, use your membership ID card at any of our network provider. The Network provider will send the authorization request note to us or our TPA. If the treatment is covered, the TPA or the Insurer will send an authority letter to the provider for cashless treatment. If the treatment is not covered, the TPA or the insurer will deny the cashless treatment. However, the insured can still continue with the treatment and submit the claim for reimbursement which will be processed by the TPA on its merit.
How to make intimation?
You can make claim intimation by informing us on our / TPA’s toll-free number or in writing to us / TPA at any of our offices. You will be entitled for the benefit of Pre 60 days and Post 90 days of hospitalization, if you intimate us 5 days in advance of the treatment.
Are there any charges by the hospital, which are not reimbursable and hence have to be paid by me even after “Cashless Service” has been authorized for treatment in the network hospitals?
Yes. There are quite a few charges, which are not reimbursable and have to be paid by you even though you have been authorized for ‘Cashless Service’ at the Network Hospitals. Some of those charges are enumerated below:
Registration/Admission charges.
Attendant/Visitor pass charges.
Special nursing charges not authorized by the attending doctor.
Service charges not forming a part of the room rent.
Charges for extra bed for attendant etc.
Bed retaining charges.
Charges for TV, Laundry etc.
Telephone/Fax charges.
Food and Beverages for attendants and visitors, toiletries etc.
Purchase of Medicines not related to the treatment.
Stationery, xerox or certifying charges.
The above list is only indicative and not exhaustive.
Are cosmetic treatments or medical attention for cosmetic purposes covered?
No. Cosmetic treatments (including any complications arising out of or howsoever attributable to any cosmetic treatments), aesthetic treatments, experimental, investigational or unproven procedures or treatments, devices and pharmacological regimens of any description are not covered. The treatment of obesity (including morbid obesity) and any other weight control programs, services, or supplies is not covered.
Does Easy Health policy cover benefits if one suffers illness/disease or contract injury through accident either in India or outside India?
Yes, Easy Health protection is available for illness/disease contracted anywhere in the World provided the treatment is availed in India.
How will the payment of claim be made?
All claims will be payable in Indian currency by cheque or through bank transfer.
What is TPA?
TPA stands for Third Party Administrator. The TPA referred to in your policy documents is your contact to us. TPA is working on our behalf and is providing you with all of the services which are promised in your policy. In case of an insured event, you are supposed to contact the TPA for intimation, request for authorization and claiming of benefits.
How does one get reimbursement for pre- and post-hospitalization expenses under this scheme?
Your policy allows reimbursement of medical expenses incurred towards the ailment/ disease for which hospitalization was medically necessary prior to hospitalization and after discharge. Send all invoices in original with supporting documents along with a copy of the discharge summary to the respective TPA. TPA will scrutinize the claim and settle the invoices subject to the overall limit of the policy. The invoices must be sent to TPA within 10 days from the date of completion of treatment. If you inform us of your hospitalization at least 5 days before admission, we will extend the timeframe for pre- and post-hospitalization expenses reimbursement from 30 days to 60 days (pre-hospitalization) and from 60 days to 90 days (post-hospitalization).
How does one get reimbursements in case of treatment in non-network hospitals?
Cashless hospitalization is available only in network hospitals. You are at liberty to choose a non-network hospital also. In case you avail treatment in a non-network hospital (see the definition of a hospital), we will reimburse you the amount of bills subject to the policy taken by the policyholder. Note: Only expenses relating to hospitalization will be reimbursed as per the policy taken. All non-medical expenses will not be reimbursed.
What are the benefits of your health card?
A health card mentions the contact details and the contact numbers of the TPA along with your policy details. In case of a medical emergency, you can call on these numbers for queries, clarifications and for seeking any kind of assistance. Moreover, you need to display your health card at the time of admission into the hospital.
What if I also have or intend to buy a medical policy of any other insurance company?
It’s your choice, but you would have to intimate us of the same and the concerned insurance company.
How do I find out which Hospitals are part of a given insurance network?
You can also get this information by calling the toll-free number provided in the insurance policy or log on to our website for details.
Should the claim be submitted with the insurance company or with TPA?
Preferably with the TPA.
Is Health check up covered under this policy?
The insured person is entitled every two years for reimbursement of the cost of a medical check-up (subject to 1% of the SI) conducted in a registered diagnostic center if the preceding two completed policy years have been claim-free.
A Medical Practitioner is one who is engaged in the medical profession, who holds a degree/diploma of a recognized institution and is registered by the Medical Council of the respective state in India. It includes a physician, specialist or surgeon.
What do you mean by Pre and Post hospitalization?
Pre- and Post-hospitalization expenses cover all relevant medical expenses incurred 30 days prior to hospitalization and expenses incurred during 60 days after hospitalization. By RELEVANT EXPENSES, we mean all expenses pertaining to the disease for which he/she is hospitalized, prior to hospitalization.
For Example: A person maybe required to undergo certain tests to confirm the disease for which he is eventually hospitalized. The Doctor's consultation fees for this, the expenses for tests and medicines 30 days prior to hospitalization for that particular disease are covered. RELEVANT EXPENSES for post-hospitalization 60 days after being discharged from the hospital, e.g. the subsequent follow-up consultations with specialists, medicines and test expenses are covered.
What do you mean by pre-existing disease or conditions?
By pre-existing disease we mean a disease or a condition existing in a person before the acceptance of the risk. The insured or a person buying the policy may or may not be aware of these conditions. These conditions may aggravate and lead to serious medical conditions in the future.
How can I indemnify or claim benefits under the policy?
The expenses or benefits can be claimed or indemnified by reimbursement or by availing cashless services at the hospitals
Is cashless facility available across all hospitals?
The cashless facilities are available only at the hospitals which are in the network.
Are all the major corporate hospitals on the network?
We have a network of over 4000 hospitals for you to choose from.
Will I get cashless at government institutions like AIIMS/TMH/ARMY Referral hospitals?
No, this facility does not extend to government hospitals.
What is the procedure for availing cashless benefit?
When you are admitted to the network hospital, you need to show the Apollo Munich Health Card to the treating doctor. The Network Hospital would contact the responsible TPA (Third Party Administrator, mentioned on the card) and fill up the pre-authorization form. Then it would send the same to TPA with estimation of expenses. The TPA checks the policy conditions and the sum insured and approves the estimate.
If I avail cashless facility, will you pay the entire amount or will I be required to bear part of the bill at the hospital?
Yes, a part will have to be borne by you, if it consists of the inadmissible amounts that are listed in the Terms and Conditions.
In case of cashless treatments, in whose favour are cheques settled or who gets the payments?
The cheques are sent to the hospital to whom approvals for cashless are given.
What is Co-Payment?
You have to submit all the original bills, discharge summary, documents, claim form and photocopy of the Apollo Munich Health ID card to the regional Third Party Administrator (TPA) office, mentioned on the ID card and the User Guide.
The claim will be reimbursed only after verification of the records if the ailment/disease falls under the terms and conditions of the policy. If the condition is covered, the claim will be reimbursed.
Should the claim be submitted to Apollo Munich Health or to the responsible Third Party Administrator (TPA)?
The claim documents should be submitted to the responsible TPA, mentioned on the ID card and the User Guide.
What is a waiting period?
A waiting period is the length of time the insured may have to wait before being eligible for Health Policy benefits.
Why should I take a Family Floater Health Plan if I already have health insurance from my employer, or if my family and I are already covered by my corporate?
Your employer will cover your medical expenses only as long as you are in his services. Tomorrow, you may change your job, retire, or even start something on your own. In all such cases you and your family will be stranded if a medical emergency arises and you have not arranged for an alternative health insurance policy. It is at this point of time that Family Floater Health Insurance policy will come to your rescue.
Family Floater Health Insurance policy can also act as a supplement to your existing medical cover in case the cost of medical treatment is higher than your existing cover level.
Do you sell individual policies and group policies?
We offer both, group and individual policies.
What is the basic difference between individual and group health insurance coverage?
An individual policy is purchased by you directly from us.
With a Group Health Insurance Policy, the group is the master insured and the insurance company contracts with the group. Insurance certificates, issued to a participating member, acts as your policy. In addition, group health insurance often contains special coverage's that are not available or are very expensive on an individual basis. The purchasing power of the group makes this economically feasible.
Why should I buy a critical illness cover?
Just for your information, a study conducted in Toronto's leading cardiac emergency hospital showed, that 91% of the patients who were admitted with a heart attack would have qualified for a Critical Illness pay out
Similarly, 75% of all stroke victims survive and 60% of stroke survivors are left with a disability
With the medical profession now saving more and more people are prolonging their life. It's almost as important to get Critical Illness Insurance as life insurance
Apollo Munich Health Insurance - Post-sales Faqs
How can I add my family members to my existing
At the time of renewing an Individual Policy or Floater Policy you can add dependants to your existing policy subject to necessary procedure and approval from us.
You cannot add dependants in the middle of a policy except in the case of a new born baby or a newly married spouse. For product specific conditions kindly refer to the product brochures.
I want to increase my sum insured. How do I go about it?
The sum insured can be increased only at the time of renewal of the insurance policy, subject to necessary approval from the under writers of the company.
