Apollo Munich Mediclaim Insurance

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  • Apollo Munich Health Insurance is a joint venture between The Apollo Hospitals Group and Munich Health, world leaders in health insurance, a company which is part of the Munich Re Group, one of the largest Property & Casualty Reinsurers in the world. The company, headquartered in Gurgaon, is one of the largest standalone health insurers in India and offers a comprehensive range of Health, Personal Accident and Travel insurance solutions across its 40 branches across major metros in the country. They also have a strong distribution network of 25,000 individual agents and Bancassurance relationships with some of the leading Private and Public sector banks in the country. Apollo Munich is also extremely active in the Corporate Health insurance space.

    Apollo Hospitals group is a pioneer and leader in corporate healthcare in India and currently owns and manages 53 Hospitals, 1068 Pharmacies, 8000 Doctors and has the trust of 19 million patients. Munich Re Group (Health) has presence across 26 locations worldwide with over 5000 Experts in Health/Health insurance

    Why Apollo Health Insurance?

    Apollo Health is one of the leading Health insurers and currently enjoys a 20% market share among the Stand Alone Health insurers in the Indian market. Their advantages include:
    • More than 5.2 million customers from inception till date
    • Cashless Access to over 4650+ hospitals across the country and access to the best 10,000+ doctors in India.
    • Given the illustrious parents’ experience in the health space, they have the expertise required in the health insurance industry.
    • One of the fastest claims settlement in the industry with over
      • 95% of the claims settled within 30 days with average claim settlement duration of 15 days for clear cases
      • Cashless Authorisation is less than 2 hours of claims intimation
    • 100% Lifelong Renewal
    • Superior Customer Service with
      • More than 80% renewal rate with existing customers
      • High Level of 85% satisfied customers with claims and policy servicing
    • Wide Range of Sum Insured Options / Products
      • Sum insured from ₹ 1lac to ₹ 50 lacs
      • 16 products with 80 variants across all categories
    • More than just insurance – Apollo Health insurance provides Health & Wellness Portal + Stay Active Benefit

    Aa. Optima Restore – Individual

    Optima Restore is one of the best selling plans of Apollo Munich Health Insurance (AMHI) and it comes with 7 sum insured variants as depicted in the table below. The eligibility is as follows:
    • Entry age is 5 years onwards with maximum entry age of 65 years. A dependent child can be covered from the 91st day (if either parents are covered under this policy).
    • Any individual along with his spouse, dependent children, dependent parents / parents in law are eligible for buying this cover on individual sum insured basis. There is a family discount of 10% if 2 or more family members are covered under the same policy
    • In an individual policy, a maximum of 4 adults and a maximum of 5 children can be included in a single policy.
    • The policy period options include period of 1 or 2 years(s). (We offer 7.5% discount if you opt for a 2 year policy)
    The plan coves Pre & Post Hospitalisation, Day Care procedures, Organ Donor, Emergency Ambulance and Daily Cash benefit. There is also a Restore facility of 100% of the Sum insured, a Multiplier benefit for every claim free year apart from a Critical Illness Rider and Health Check up as part of the plan offering.
    Optima Restore – Individual
    Basic Sum insured per insured person per policy year (in ₹ INR) 3,00,000 5,00,000 10,00,000 15,00,000 20,00,000 / 25,00,000 / 50,00,000
    In-patient Treatment Covered
    Pre-Hospitalization Covered, upto 60 Days
    Post-Hospitalization Covered, upto 180 Days
    Day Care Treatment Covered
    Domiciliary Treatment/Home Treatment Covered
    Treatment for Organ Donor Covered
    Daily cash for Choosing shared accommodation 800 per day, Maximum 4,800 1,000 per day, Maximum 4,800
    Emergency Ambulance Upto Rs.2,000 per Hospitalisation
    E-opinion in respect of critical illnesses Covered
    Emergency Air Ambulance Cover Not Covered Covered upto 2,50,000 Lacs per hospitalization and maximum upto sum insured in an year
    2) Restore Benefit Equal to 100% of basic sum insured
    3) Multiplier Benefit Bonus 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
    Not covered Upto 1,500 Upto 2,000 Upto 4,000 Upto 5,000
    5) Critical Advantage (Illness) Rider Offered (where base Sum Insured is 10 lacs & above)

    Ab. Easy Health – with options of Standard, Exclusive and Premium

    AMHI’s Easy Health Individual Plan protects the individual insured from any unplanned emergency medical expenses and also offers a coverage for treatment of inpatient hospitalisation following illnesses and accidents. The Plan offers more than 10 variants of individual sum insured basis & also offers an add-on optional cover for listed Critical Illnesses.

    The Exclusive plan includes Maternity Expenses while the Premium Plan covers Maternity expenses, Outpatient dental cover, Recovery benefit and Cost of Spectacles & Hearing aids etc apart from letting the insured avail health check-up benefit every three years irrespective of claims. The eligibility is as follows:
    • Entry age is 5 years onwards with maximum entry age of 65 years. A dependent child can be covered from the 91st day (if either parents are covered under this policy).
    • In an individual policy, a maximum of 4 adults and a maximum of 5 children can be included in a single policy.
    • The policy period options include period of 1 or 2 years(s). (We offer 7.5% discount if you opt for a 2 year policy)
    Benefits Easy Health Standard Easy Health Exclusive Easy Health Exclusive
    Sum Insured per Insured Person per Policy Year (in lakhs) 1,00,000 / 1,50,000 / 2,00,000 / 2,50,000 /3,00,000 / 4,00,000 / 5,00,000 / 7,50,000 / 10,00,000 / 15,00,000 3,00,000 / 4,00,000 / 5,00,000 7,50,000 / 10,00,000 15,00,000 / 20,00,000 / 25,00,000 / 50,00,000 4,00,000 / 5,00,000 7,50,000 / 10,00,000 15,00,000 / 20,00,000 / 25,00,000 / 50,00,000
    In-patient Treatment Covered
    Pre-hospitalisation Covered
    Post-hospitalisation Covered
    Day Care Procedures Covered
    Domiciliary Treatment Covered
    Organ Donor Covered
    Emergency Ambulance Upto Rs. 2,000 per hospitalization
    Ayush Benefit Upto Rs. 20,000 Upto Rs. 25,000 Upto Rs. 50,000 Upto Rs. 25,000 Upto Rs. 50,000
    Daily Cash for choosing Shared Accommodation Rs. 500 per day, Maximum Rs. 3,000 Rs. 500 per day, Maximum Rs. 3,000 Rs. 800 per day, Maximum Rs. 4,800 Rs. 1000 per day, Maximum Rs. 6,000 Rs. 500 per day, Maximum Rs. 3,000 Rs. 800 per day, Maximum Rs. 4,800 Rs. 1000 per day, Maximum Rs. 6,000
    Daily Cash for accompanying an insured child Not Covered Rs. 300 per day, Maximum Rs. 9,000 Rs. 500 per day, Maximum Rs. 15,000 Rs. 800 per day, Maximum Rs. 24,000 Rs. 300 per day, Maximum Rs. 9,000 Rs. 500 per day, Maximum Rs. 15,000 Rs. 800 per day, Maximum Rs. 24,000
    Newborn baby Not Covered Addtional benefit on payment of additional premium
    Recovery Benefit Not Covered Rs. 10,000(>10 days of hospitalisation) Not Covered Rs. 10,000(>10 days of hospitalisation)
    Maternity Expenses Not Covered Normal Delivery Rs. 15,000*
    Caesarean Delivery Rs. 25,000* (* Including Pre/Post Natal limit of Rs.1,500 and New Born limit of Rs. 2,000) [waiting period 4 years]
    Normal Delivery Rs. 25,000*
    Caesarean Delivery Rs. 40,000* (* Including Pre/Post Natal limit of Rs.2,500 and New Born limit of Rs. 3,500) [waiting period 4 years]
    Normal Delivery Rs. 30,000*
    Caesarean Delivery Rs. 50,000* (* Including Pre/Post Natal limit of Rs.5,000 and New Born limit of Rs. 5,000) [waiting period 3 years]
    Normal Delivery Rs. 15,000*
    Caesarean Delivery Rs. 25,000* (* Including Pre/Post Natal limit of Rs.1,500 and New Born limit of Rs. 2,000) [waiting period 4 years]
    Normal Delivery Rs. 25,000*
    Caesarean Delivery Rs. 40,000* (* Including Pre/Post Natal limit of Rs.2,500 and New Born limit of Rs. 3,500) [waiting period 4 years]
    Normal Delivery Rs. 30,000*
    Caesarean Delivery Rs. 50,000* (* Including Pre/Post Natal limit of Rs.5,000 and New Born limit of Rs. 5,000) [waiting period 3 years]
    Outpatient Dental Treatment with Waiting Period of 3 years Not Covered Upto 1 % of Sum insured subject to a Maximum of Rs.5,000 Upto 1 % of Sum insured subject to a Maximum of Rs.10,000
    Spectacles, Contact Lenses, Hearing Aid Every Third Year Not Covered Upto Rs.5,000 Upto Rs.10,000
    E-Opinion in respect of a Critical Illness Not Covered Covered
    Critical Illness Rider Optional, if opted then the critical illness Sum insured 50% or 100% of in-patient Sum insured subject to minimum of Rs. 100,000 Optional, if opted then the critical illness Sum insured 50% or 100% of in-patient Sum insured Optional, if opted then the critical illness Sum insured 50% or 100% of in-patient Sum insured upto a Maximum of Rs 10 lakhs Optional, if opted then the critical illness Sum insured 50% or 100% of in-patient Sum insured Optional, if opted then the critical illness Sum insured 50% or 100% of in-patient Sum insured upto a Maximum of Rs 10 lakhs
    Health Checkup Upto 1% of Sum Insured per Policy, only once at the end of a block of every continuous four claim free years. Upto 1% of Sum Insured per Policy subject to a Maximum of Rs.5,000 per Insured Person, only once at the end of a block of every continuous three policy years. Upto 1% of Sum Insured per Policy subject to a Maximum of Rs.5,000 per Insured Person, only once at the end of a block of every continuous two policy years.
    Benefits under 3b), 3c), 3d) and 5) are subject to pre-authorisation by Apollo Munich

    Ac. Health Wallet - Individual

    This is a unique product in the market launched by which comes with seven sum insured variants from Rs.3 lacs to Rs.50 lacs and this plan coves Pre & Post Hospitalisation, Day Care procedures, Organ Donor, Emergency Ambulance and Ayush Treatment benefit. There is also a Restore facility of 100% of the Sum insured, a Multiplier benefit for every claim free year apart from a Critical Illness Rider and Health Check up as part of the plan offering.

    The unique feature of this plan is the Reserve Benefit which can be used for OPD expenses, any non-payable items under the chosen health insurance plan or to pay upto 50% of your renewal premium. The Reserve Benefit will keep on increasing every year and any unutilized balance under this benefit will be carried forward to next year with 6% bonus.

    The eligibility under the plan is as follows:
    • Policy is available for an individual between 91 days and 65 years. The maximum entry age is restricted to 65 years.
    • The Minimum entry age for Adult Dependent is 18 years and Maximum entry age is 65 years.
    • Children between 91 days and 5 years can be insured provided either parent is getting insured under this Policy.
    • The policy will be issued for a period of 1 year period and the sum insured & benefits will applicable on Policy Year basis.
    Health Wallet – Individual
    Basic Sum Insured per Insured Person per Policy Year (figs in ₹ INR) 3,00,000 / 5,00,000 / 10,00,000 / 15,00,000 / 20,00,000 / 25,00,000 / 50,00,000
    1a) Inpatient treatment Covered
    1b)Pre-hospitalisation Covered, upto 60 days
    1c) Post-Hospitalization Covered, upto 90 Days
    1d) Day Care Procedures Covered
    1e) Domiciliary Treatment Covered
    1f) Organ Donor Covered
    1g) Ambulance Upto 2,000 per Hospitalisation
    1h) Ayush Treatment Covered
    This benefit is not applicable if optional Deductible is chosen
    1i) Recovery Benefit 10,000 for hospitalisation exceeding consecutive 10 days
    This benefit is not applicable if optional Deductible is chosen
    1j) Worldwide Emergency Care 50% of Sum Insured upto a maximum of 20 lacs
    2) Restore Benefit Equal to 100% of Basic Sum Insured
    3) Preventive Health Check-up As per grid mentioned in the benefit
    4) Multiplier Benefit Bonus 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 at the time of renewal
    5) Reserve Benefit per Insured Person per Policy Year ( Rs) 5,000, 10,000, 15,000, 20,000 & 25,000
    6) Deductible (Optional) per Insured Person per Policy Year ( figs in ₹ INR) 2,00,000 / 3,00,000 / 5,00,000 & 10,00,000
    *10 deductible available for SI of 20 lacs and above
    7) Optional Rider - Critical Advantage Cover per Insured Person per Policy Year ( USD) USD 250,000, USD 500,000 & USD 10,00,000
    Offered with base policy Sum Insured of Rs. 10 lacs & above Offered if base policy Sum Insured is 10 lacs & above Illness covered under the rider are as following - Cancer Treatment / Coronary Artery By-pass surgery / Heart Valve Replacement or Repair, Neurosurgery / Live-donor Organ Transplant / Bone Marrow Transplant / Aorta Graft Surgery /Pulmonary Artery Graft Surgery

    Ad. iCan Cancer Insurance

    Another unique plan from AMHI is their Health plan specifically for Cancer called iCan. There are two variants called iCan Essential and iCan Enhanced with sum insured options of Rs.5, Rs.10, Rs.15, Rs.20, Rs.25 and Rs.50 lacs. The features of this plan are as follows:
    • The entry age under the plan is 5 and maximum entry age is 65 years.
    • Covers all types of Cancer and at all stages
    • Lumpsum payouts as well covering all Actual Treatment costs through Cashless/Reimbursement possible which can amount of 160% of the sum insured.
    • Lifelong Renewal, Even After Claims are paid
    • No Pre-policy Medical Check-up required
    • Advanced Treatments like proton beam therapy, immunotherapy, personalized & targeted therapy, stem cell transplantation, bone marrow transplantation also covered.
    • Waiting Period under the plan is 4 months (120 days)
    The plan also has the regular coverages of Pre & Post Hospitalisation, Day Care procedures, Emergency Ambulance apart from Second Opinion benefit and Follow-up Care cover.
    Product Variant iCan Essential iCan Enhance
    Sum Insured options 5, 10, 15, 20, 25, 50 (in lakhs)
    Second Opinion Covered
    MyCare Benefit
    Covers in-patient, outpatient & daycare costs for:
    Conventional Treatments, such as chemotherapy, radiotherapy, onco-surgery
    Advanced Treatments, such as targeted therapy, proton therapy, immunotherapy
    Up to sum insured
    CritiCare Benefit: On diagnosis of cancer, of specified severity Not available 60% of sum insured as lump sum payment, over and above the base sum insured
    FamilyCare Benefit: On diagnosis of stage IV cancer/recurrence of cancer Not available 100% of sum insured as lump sum payment, over and above the base sum insured
    Pre-Hospitalisation 30 Days
    Post Hospitalisation 60 Days
    Emergency Ambulance INR 2000 per hospitalisation
    Follow-up care post treatment Up to INR 3000, twice a year
    Waiting period 120 days
    Payout basis Cashless & reimbursement Cashless, reimbursement & 2 lump sum payouts*
    New iCan Cancer Insurance - Women iCan Essential
    Sum Insured options (figs in ₹INR) 5,00,000 / 10,00,000 / 15,00,000 / 20,00,000
    Second Opinion Covered
    MyCare Benefit :
    a) Conventional Treatments, such as chemotherapy, radiotherapy, onco-surgery
    b) Advanced Treatments, such as targeted therapy, proton therapy, immunotherapy
    Up to sum insured
    Pre-Hospitalisation 30 Days
    Post Hospitalisation 60 Days
    Emergency Ambulance INR 2000 per hospitalisation
    Follow-up care post treatment Up to INR 3000, twice a year
    Waiting period 120 days from policy commencement date, for all claims
    Payout basis Cashless and reimbursement of the covered expenses, up till specified limits

    FAQ’s on iCan

    Can an individual buy iCan policy if they are a cancer patient or have previously had cancer?
    No, they cannot buy the iCan policy in either of the two cases – if they have cancer or had cancer in the past.

    Does this plan cover all kinds of cancer? Does it cover cancer patients at all stages of development?
    Yes, all types of cancer are covered under this plan as well as the patient at all stages of cancer.

    Is there a waiting period under this plan?
    Yes, there is a waiting period of 4 months (120 days) under this plan.

    How will the insured get paid for their cancer treatment expenses?
    The insured can get paid for their cancer expenses through Cashless Hospitalisation (either Emergency or Planned) or Reimbursement post submission of all claim documents.

    Ae. Dengue Insurance

    Another unique plan from AMHI is a coverage specific for Dengue.The plan offers coverage for any medical expenses incurred on inpatient or outpatient treatment for dengue. Other eligibility criteria include:
    • This policy can cover individuals in the age group 91 days to 65 years. The maximum entry age is restricted upto 65 years.
    • The Minimum entry age for Adult is 18 years and maximum is 65 years. The minimum entry age for child is 91 days and the maximum is 25 years
    • The individual is not required to undergo any medicals before taking the policy.
    Dengue Care Plan
    Benefits (figs in ₹ INR) 50,000 / 100,000
    In-patient Treatment Upto Sum Insured
    Room Rent Single Private A/c Room
    Shared Accommodation Benefit Covered
    Pre-hospitalization 15 Days
    Post-hospitalization 15 Days
    Outpatient Treatment : Pharmacy, Diagnostics, Outpatient Consultation, Home Nursing 10,000
    Wellness Offers From time to time, we will provide insured the opportunity to purchase items or services curated by Us and related to prevention of Dengue on AMHI website or through other means. These items or services, which may be offered by Us or selected partners, may be offered with a discount or as part of a special scheme.

    Af. Optima Plus – Daily Hospital Cash

    Optima Cash is a top up plan that provides coverage to the insured under a daily cash benefit in case of hospitalisation due to illness or accidents. In addition to the hospital cash benefit, the plan also offers covers such as Parent’s hospitalization, Day care procedures, Child Birth, Convalescence benefit, etc. The eligibility criteria for this plan includes:
    • Coverage available between the ages of 5 years and 65 years. A dependent child can be covered from the 91st day (if either parent is covered under this policy).
    • The policy period options include period of 1 or 2 years(s).
    Optima Plus Daily Hospital Cash
    BENEFIT COVERAGE DURATION
    Sum Insured Options (in ₹ INR) 2,000 / 3,000
    Tenure Options (in years) 2 / 3 years
    Sickness Hospital Cash Daily cash amount for each continuous and completed period of 24 hours if the insured is hospitalised due to any sickness. Maximum up to 90 days per policy year.
    Sickness ICU Cash* Twice the Daily cash amount for each continuous and completed period of 24 hours if the insured is admitted in ICU due to any sickness. Maximum up to 15 days per policy year.
    Accident Hospital Cash Daily cash amount for each continuous and completed period of 24 hours if the insured is hospitalised due to any accident. Maximum up to 90 days per policy year.
    Accident ICU Cash# Twice the Daily cash amount for each continuous and completed period of 24 hours if the insured is admitted in ICU due to any accident. Maximum up to 15 days per policy year.
    Day Care Procedure Cash 50% of the Daily cash amount if the insured undergoes any of the 10 identified day care procedures which does not require 24 hours hospitalisation due to technological advancement. Maximum up to 6 day care procedures per policy year.
    Joint Hospitalisation due to an Accident^ Twice the Daily cash amount for each continuous and completed period of 24 hours where two or more Insured person(s) are concurrently hospitalised due to an accident. Maximum up to 10 days per policy year.
    Convalescence Cash^^ Lumpsum amount paid if insured person is hospitalised beyond 7 continuous days. Payable once per policy year
    Child Birth+ Lumpsum amount equivalent to twice the Daily Cash amount for maternity to female Insured in event of child birth. Payable twice during the life time of the insured.
    Parent Accommodation^^ Daily Cash amount for parent’s accommodation if the Insured child is aged 12 years or less and is hospitalised for more than 72 hours. Maximum up to 30 days per policy year.
    * Benefit 1a ii) sublimit under 1a i)
    # Benefit 1b ii) sublimit under 1b i)
    ^ In addition to benefits 1b i) and 1b ii)
    ^^ In addition to benefits 1a i), 1a ii), 1b i) and 1b ii)
    + waiting period of 2 years for availing this benefit.

    Ag. Optima Super – Aggregate Top Up

    The Optima Super plan is an aggregate plan that offers the insured varied sum insured & deductible combinations to choose so they can opt for the optimum coverage as per their requirements. There are three sum insured options to choose from which are 5 lacs, ₹7 lacs and ₹10 lacs with deductible options ranging from ₹1 lac to ₹10 lacs. The plan also coves Pre & Post Hospitalisation, 144 Day Care procedures, Organ Donor and Emergency Ambulance cover. The plan also gives the insured an option to convert to a Fully Nil Deductible plan near your retirement. Eligibility criteria is:
    • The insured age is from 5 years upto the age of 65 years. A dependent child can be covered from the 91st day (if either parent is covered under this policy).
    • The policy covers on individual sum insured basis & maximum of 6 members can be added in a single policy
    • The policy period options include period of 1 or 2 years(s).
    Optima Super - Aggregate Top Up
    BENEFIT COVERAGE
    Sum Insured per Insured Person per Policy Year (figs in ₹ INR) 500,000 / 7,00,000 / 10,00,000
    Deductible (Rs. In Lacs) The customer can choose either of the option 1,00,000 / 2,00,000 / 3,00,000 / 4,00,000 / 5,00,000 / 6,00,000 / 7,00,000 / 10,00,000
    In-patient Treatment Covered; Hospitalization for minimum 24 hours required.
    Pre-hospitalization Medical expenses incurred in 60 days immediately before hospitalisation.
    Post-hospitalization Medical expenses incurred in 90 days immediately after discharge from hospital.
    Day Care Procedures Coverage for enlisted 144 day care procedures which do not require 24 hours hospitalization.
    Organ Donor Medical expenses for harvesting of the organ donated to the Insured person.
    Ambulance Services Expenses up to 2,000 per hospitalization.

    Ah. Optima Vital – Critical Illness Plan

    Optima Vital from AMHI is an insurance plan which covers Critical Illness and will pay the insured a lump sum amount for the identified critical illness, medical events or surgical procedures incurred by the insured. This amount is payable on a confirmed diagnosis with defined severity of the illness or the date of undergoing specified surgery in respect of that Critical Illness and the insured surviving the defined survival period. The survival period under this particular plan is 30 days, which means the insured will need to survive for 30 days after diagnosis to be eligible for coverage under the policy. The plan also covers an E-opinion which is actually a second opinion with the insurer’s panel of medical specialists. The eligibility for this plan include:
    • Coverage is available to an individual from the age of 18 years onwards with maximum entry age of 65 years.
    • A dependent child can be covered from 18 years upto 25 years provided both parents are covered in a critical illness plan of any Indian Insurer.
    • Policy Period can be 1 or 2 years(s) depending on the insured’s choice and requirement
    • The list of Critical Illnesses are named and in the table below for an immediate perusal.
    Optima Vital - Critical Illness Plan
    BENEFIT COVERAGE
    Critical illness Sum Insured Options (figs in ₹ INR) on individual basis 1,00,000 / 2,00,000 / 3,00,000 / 4,00,000 / 5,00,000 / 10,00,000 / 15,00,000 / 20,00,000 / 25,00,000 / 30,00,000 / 35,00,000 / 40,00,000 / 45,00,000 / 50,00,000
    Coverage for 37 Critical Illnesses 1. Cancer of Specified Severity
    2. Kidney Failure requiring Regular Dialysis
    3. Multiple Sclerosis with Persisting Symptoms
    4. End Stage Liver Disease of Specified Severity
    5. First Heart Attack of Specified Severity
    6. COMA of Specified Severity
    7. Major Burns
    8. Goodpasture’s Syndrome
    9. Apallic Syndrome
    10. Aplastic Anaemia
    11. Systemic Lupus Erythematosis
    12. Bacterial Meningitis
    13. Multiple System Atrophy
    14. Progressive Scleroderma
    15. Open Chest CABG
    16. Major Organ/Bone Marrow Transplant
    17. Aorta Graft Surgery
    18. Open Heart Replacement or Repair of Heart Valve
    19. Pneumonectomy
    20. Pulmonary Artery Graft Surgery
    21. Primary Parkinson’s Disease
    22. Alzheimer’s Disease
    23. Motor Neuron Disease with Permanent Symptoms
    24. Stroke resulting in Permanent Symptoms
    25. Permanent Paralysis of Limbs
    26. Primary Pulmonary Arterial Hypertension
    27. Benign Brain Tumour [resulting in permanent neurological symptoms]
    28. Cardiomyopathy
    29. End stage Lung Disease
    30. Brain Surgery
    31. Progressive Supranuclear Palsy
    32. Creutzfeldt-Jakob Disease (CJD)
    33. Major Head Trauma
    34. Encephalitis
    35. Blindness
    36. Deafness
    37. Total Loss of Speech
    E-opinion in respect of a Critical Illness Second opinion from a medical practitioner selected by the insured person from AMHI panel.
    The maximum sum insured available above 55 years of age is restricted up to 20,00,000.

    Ai. Energy- Diabetes Plan

    Energy is another unique product from the AMHI stable and is a plan tailormade for Diabetes patients. It is essentially a wellness management program for individuals with Type 1 Diabetes, Type 2 Diabetes Mellitus, Impaired Fasting Glucose (IFG), Impaired Glucose Tolerance (IGT) and/or Hypertension. It offers Day 1 coverage for all hospitalisation arising out of Diabetes and Hypertension (with no waiting period). The plan is also a combined package providing coverage for Inpatient hospitalisation expenses along with an availability of wellness solutions & health rewards for monitoring your health and earning rewards accordingly. The plan covers:
    • Individuals from the age of 18 years to 65 years for individuals with Type 1 Diabetes, Type 2 Diabetes Mellitus, Impaired Fasting Glucose (IFG), Impaired Glucose Tolerance (IGT) and/or Hypertension.
    • There are 8 sum insured options from ₹2 lacs upto ₹50 lacs
    • The plan has 2 variants – Gold (cost of wellness test included) & Silver (cost of wellness test excluded), both available with/ without the co-payment option of 20%.
    • The policy will be issued for 1 year.
    The plan coves Pre & Post Hospitalisation, 182 Day Care procedures, Organ Donor, Emergency Ambulance and Shared Accommodation benefit. There is also a Restore facility of 100% of the Sum insured, a Cumulative Bonus benefit for every claim free year
    Energy - Diabetes Plan
    BENEFIT COVERAGE
    Basic Sum Insured Per Person Per Policy Year (figs in ₹ INR) 2,00,000 / 3,00,000 / 5,00,000 / 10,00,000 / 15,00,000 / 20,00,000 / 25,00,000 / 50,00,000
    In Patient Hospitalization Covered
    Pre-Hospitalization Covered, 30 Days
    Post-Hospitalization Covered, 60 Days
    Day Care Procedures 182 daycare procedures
    Organ Donor Covered
    Emergency Ambulance Upto 2,000 per Hospitalisation
    Shared Accommodation Benefit Covered
    Restore Benefit Covered
    Cumulative Bonus 10% upto a maximum of 100%
    HbA1c Checkup Benefit Covered
    Wellness discount Upto 25% of Renewal Premium

    Aj. Optima Plus – Top Up

    Optima Plus Top Up plan from AMHI offers to cover the insured for higher hospitalization expenditures at nominal premium. This is where the insured typically has another base health policy which has limited sum insured provided by another individual policy or a corporate plan provided by the employer. It is the only plan in India that provides the insured an option to convert to a fully fledged nil deductible health insurance plan on retirement. It is a plan which offers additional sum insured at a reasonable premium and also remains active if the insured is shifting jobs etc. While the primary sum insured is fixed at ₹5 lacs, the insured has an opportunity of choosing for the deductible options available from ₹1lac to ₹5 lac. The eligibility criteria are:
    • Coverage for individuals from the age of 5 years onwards with maximum entry age of 65 years. A dependent child can be covered from the 91st day (if either parent is covered under this policy).
    • The policy period options include period of 1 or 2 years(s)
    The plan coves Pre & Post Hospitalisation, 140 Day Care procedures, Organ Donor, Emergency Ambulance and Domiciliary Treatment benefit.
    Optima Plus Top Up
    BENEFIT COVERAGE
    Sum Insured per Insured Person per Policy Year 500, 000
    Deductible (figs in ₹ INR) (As mentioned in Policy Schedule) The customer can choose either of the option : 100,000; 200,000; 300,000; 400,000; 500,000
    In-patient Treatment Covered; Hospitalization for minimum 24 hours required.
    Pre-hospitalization Medical expenses incurred in 60 days immediately before hospitalisation.
    Post-hospitalization Medical expenses incurred in 90 days immediately after discharge from hospital.
    Day Care Procedures Coverage for enlisted 140 day care procedures which do not require 24 hours hospitalization.
    Organ Donor Medical expenses for harvesting of the organ donated to the Insured person.
    Emergency Ambulance Expenses up to 2,000 per hospitalization.
    Domiciliary Treatment Medical expenses incurred by an Insured person for availing medical treatment at his home which would otherwise have required hospitalization.

    Ak. Maxima – Comprehensive Plan for Individuals

    Maxima, as the name suggests is the plan offering Maximum coverage under the Apollo Munich banner. The basic difference between Maxima and most other plans in the market include the fact that this plan covers Outpatient expenses incurred by the insured and these expenses could be for something as simple as a fever, stomach pain, back ache, head ache etc. Maxima plan offers unique out-patient benefits to take care of your regular illnesses incurred by the insured individual. Other features include:
    • Under the plan depending on the number of members covered, there are 4/6/8 consultations for the insured and their family
    • Out patient treatments costs include Doctor Consultations, Pharmacy Expenses, Diagnostic Test Costs, Coverage for Spectacles, Contact Lenses, Dental Treatments etc are all covered.
    • Annual Health Check up is included (for members above 18 years of age) with the insurer’s hospital network for the insured / or family member based on the option chosen
    • Apart from the OPD treatments, the insured can also opt for inclusion of Part B, which is for Inpatient treatment and has coverages like Pre and Post Hospitalisation, Organ Donor, Day Care Procedures, Domiciliary Treatment, Ambulance Expenses etc.
    • There is also a Maternity cover and Critical Illness available to be chosen by the insured on an optional basis.
    Maxima - Comprehensive Plan
    Sum Insured per Policy (all figs in ₹ INR) 1 Member 2 Members 2 Adults + Upto 2 Children
    a) Out-patient Consultations* 4 Consultations 6 Consultations 8 Consultations
    b) Diagnostic Tests# 5,000 5,000 7,000
    c) Pharmacy#
    e) Spectacles, Contact Lenses#
    e) Spectacles, Contact Lenses#
    f) Annual Health Check-up within specified Network^ 1 Entitlement Certificate 2 Entitlement Certificates 2 Entitlement Certificates
    * The reimbursement against non-network Outpatient Consultations is restricted up to lower of actual expenses or 400. # The reimbursement against non-network Diagnostic Tests, Pharmacy, Outpatient Dental Treatment, Spectacles, Contact Lenses is restricted up to lower of actual expenses or the Sum Insured mentioned above. ^ One Entitlement Certificate of Annual Health Check-up includes following tests: Hb, PCV, RBC, MCHC, MCV, MCH, Total WBC, Differential Count, ESR, PLT, Peripheral Smear, Complete Urine Analysis, GTT, Serum Calcium, Serum Creatinine, Lipid Profile (Total Cholesterol, HDL Cholesterol, LDL Cholesterol, Triglycerides, Cardiac Risk Ratio), Liver Function Test (Total Protein, Albumin, Globulin, Total bilirubin, ALT, AST, GGTP), Blood group, ECG (Resting), X-ray (chest), Ultrasound (Upper abdomen screening), Consultation by General Physician, Consultation by Gynaecologist.
    1 Member 2 Members 2 Adults + Upto 2 Children
    Part B- Inpatient Module
    Sum Insured per Policy (all figs in ₹ INR) 3,00,000 3,00,000 3,00,000
    a) In-patient Treatment Covered
    b) Pre-Hospitalization 30 days; can be increased to 60 days
    c) Post-Hospitalization 60 days; can be increased to 90 days
    d) Day Care Procedures Covered
    e) Domiciliary Treatment Covered
    f) Daily Cash for choosing Shared Accommodation 500 per day, Maximum 3,000
    g) Organ Donor Covered
    h) Emergency Ambulance Upto 2000 per hospitalisation
    i) Daily Cash for Accompanying an Insured child 300 per day; Maximum 9,000
    j) Maternity Expenses ** Waiting Period 4 years Normal Delivery-15,000; Caesarean Delivery- 25,000 (Including Pre/Post Natal limit of 1,500 and Infant baby limit of 2,000)
    k) New born baby Optional
    Optional Benefit
    Critical Illness ** [Offered on Individual Sum Insured basis] 3,00,000
    * *These benefits do not dip into inpatient Sum Insured

    Ba. Health Wallet – Family Option

    This is a unique product launched for both individuals and families which has a Reserve Benefit which can be used for OPD expenses, any non-payable items under the chosen health insurance plan or to pay upto 50% of your renewal premium. The Reserve Benefit will keep on increasing every year and any unutilized balance under this benefit will be carried forward to next year with 6% bonus. It also has the option of conversion to a full fledged Indemnity Health insurance plan if the Insured Person has been insured with AMHI for first time under this Policy before the age of 50 years and the policy has been renewed for a continuous period of 5 years.

    The plan also comes with seven sum insured variants from ₹3 lacs to ₹50 lacs and this plan coves Pre & Post Hospitalisation, Day Care procedures, Organ Donor, Emergency Ambulance and Ayush Treatment benefit. There is also a Restore facility of 100% of the Sum insured, a Multiplier benefit for every claim free year apart from a Critical Illness Rider and Health Check up as part of the plan offering. The eligibility of the plan is as follows:
    • This policy can be issued to an individual and/or family. This policy covers persons in the age group 91 days to 65 years. The maximum entry age is restricted to 65 years.
    • The Minimum entry age for Adult Dependent is 18 years and Maximum entry age is 65 years.
    • Children between 91 days and 5 years can be insured provided either parent is getting insured under this Policy. There is no maximum cover ceasing age on renewals.
    • The family includes following relationships - spouse, dependent children and dependent parents and dependent in laws. The policy offers option of covering on individual sum insured basis and on family floater basis. A maximum of 6 members can be added in a single policy, whether on an Individual or Family floater basis.
    • In a family floater the age of the eldest member will be considered while computing premium for the family. In an individual policy Sum Insured of the Dependent insured members should be equal to or less than the Sum Insured of the primary insured member. In case where two or more children are covered, the Sum Insured for all the children must be same. Sum insured of Dependent Parents must be the same.
    Health Wallet - Family Option
    Basic Sum Insured per Insured Person per Policy Year (figs in ₹ INR)) 3,00,000 / 5,00,000 / 10,00,000 / 15,00,000 / 20,00,000 / 25,00,000 / 50,00,000
    1a) Inpatient treatment Covered
    1b)Pre-hospitalisation Covered, upto 60 days
    1c) Post-Hospitalization Covered, upto 90 Days
    1d) Day Care Procedures Covered
    1e) Domiciliary Treatment Covered
    1f) Organ Donor Covered
    1g) Ambulance Upto 2,000 per Hospitalisation
    1h) Ayush Treatment (This benefit is not applicable if optional Deductible is chosen) Covered
    1i) Recovery Benefit (This benefit is not applicable if optional Deductible is chosen) Rs 10,000 for hospitalisation exceeding consecutive 10 days
    1j) Worldwide Emergency Care 50% of Sum Insured upto a maximum of 20 lacs
    2) Restore Benefit Equal to 100% of Basic Sum Insured
    3) Preventive Health Check-up As per grid mentioned in the benefit
    4) Multiplier Benefit Bonus 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 at the time of renewal
    5) Reserve Benefit per Insured Person per Policy Year ( ₹ INR) 5,000, 10,000, 15,000, 20,000 & 25,000
    6) Deductible (Optional) per Insured Person per Policy Year ( Rs in Lakh) 2,00,000 / 3,00,000 / 5,00,000 / 10,00,000 (*10 deductible available for SI of 20 lacs and above)
    7) Optional Rider - Critical Advantage Cover per Insured Person per Policy Year ( USD) USD 250,000, USD 500,000 & USD 10,00,000
    Offered with base policy Sum Insured of 10 lacs & above Offered if base policy Sum Insured is 10 lacs & above Illness covered under the rider are as following - Cancer Treatment / Coronary Artery By-pass surgery / Heart Valve Replacement or Repair, Neurosurgery / Live-donor Organ Transplant / Bone Marrow Transplant / Aorta Graft Surgery /Pulmonary Artery Graft Surgery

    Bb. Optima Restore – Family Floater

    Optima Restore Family Floater plan is designed specially to cover a family which can include your spouse, dependent children, parents and parents-in-law. The primary insured can choose from seven sum insured variants from ₹3 lacs, ₹5 lacs, ₹10 lacs, ₹15 lacs, ₹20 lacs, ₹25 lacs and ₹50 lacs. The plan also includes unique benefits such as Restore, Multiplier and Stay Active.

    With Restore benefit even if any family member uses the sum insured partially or fully, instantly an additional 100% of the sum insured will be added to the insured’s policy, and the restored sum insured would be available to everyone covered under the plan. It is applicable once during a policy year. Similarly the Multiplier benefit rewards the insured with a 100% increase in sum insured for every two claim free years. The Stay Active benefit rewards customers who lead an active lifestyle, the benefit allows a customer to enjoy premium discounts simply by exercising.

    The plan also covers Pre & Post Hospitalisation, Domiciliary Expenses, Day Care Treatments, Organ Donor, Daily Cash, E-Opinion (which is a second opinion), Emergency Ambulance Expenses (including Air Ambulance), Health Check-up and Critical Advantage Rider. Other criteria include:
    • Coverage is offered from the age of 5 years till maximum entry age of 65 years. A dependent child can be covered from the 91st day (if either parents are covered under this policy).
    • The Primary Insured you’re their family members namely spouse, dependent children, dependent parents / parents in law are eligible for buying this cover on floater sum insured basis.
    • The policy period options include period of 1 or 2 years(s).
    Optima Restore Family Floater
    Basic Sum insured per insured person per policy year( figs in ₹ INR)) 3,00,000 5,00,000 10,00,000 15,00,000 20,00,000 / 25,00,000 / 50,00,000
    1) Inpatient treatment Covered
    Pre-hospitalisation Covered, upto 60 days
    Post hospitalisation Covered upto 180 days
    Day Care procedures All Day Care Treatment Covered
    Domiciliary treatment Covered
    Organ donor Covered
    Daily cash for Choosing shared accommodation 800 per day, Maximum 4,800 1,000 per day, Maximum 4,800
    Emergency Ambulance upto 2,000 per hospitalisation
    E-opinion in respect of critical illnesses Covered
    Emergency Air Ambulance Cover Not Covered Covered upto 2.5 Lacs per hospitalization and maximum upto sum insured in an year
    2) Restore Benefit Equal to 100% of basic sum insured
    3) Multiplier Benefit Bonus 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
    4) Health Checkup Not covered Upto 2,500 Upto 5,000 Upto 8,000 Upto 10,000
    5) Critical Advantage Rider Offered (where base Sum Insured is 10 lacs & above)

    Bc. Easy Health (Standard Plan) – Family Option

    Easy Health Family Floater Plan protects the insured’s family from unforeseen emergency expenses following an illness or accident and also offers a comprehensive cover for medical treatment for in-patient hospitalisation. The Plan offers coverage on floater sum insured basis & offers an add-on optional cover for listed Critical Illnesses. The plan has seven sum insured options ranging from ₹2 lacs to ₹15 lacs. Eligibility criteria include:
    • Insured age from 5 years till the maximum entry age of 65 years. A dependent child can be covered from the 91st day (if either parent is covered under this policy).
    • Insured’s family members can include spouse, dependent children, dependent parents, parent-in-law, grandparents and grandchildren. Family discount between 5% and 10% is offered depending on the number of members of the family covered under the policy.
    • The policy period can be for 1 or 2 year(s).
    The plan also covers Pre & Post Hospitalisation, Domiciliary Expenses, Day Care Treatments, Organ Donor, Daily Cash, E-Opinion (which is a second opinion), Emergency Ambulance Expenses, Ayush Benefit, Health Check-up and Critical Illness Rider.
    Easy Health Standard Plan - Family Option
    Sum Insured per Policy per Policy Year (figs in ₹ INR)) 2,00,000 / 3,00,000 / 4,00,000 / 5,00,000 / 7,50,000 / 10,00,000 / 15,00,000
    1 a) In-patient Treatment Covered
    1 b) Pre-hospitalization Covered
    1 c) Post-hospitalization Covered
    1 d) Day Care Procedures Covered
    1 e) Domiciliary Treatment Covered
    1 f) Organ Donor Covered
    1 g)) Emergency Ambulance Upto 2,000 per hospitalisation
    1 h) Ayush Benefit Upto 20,000
    1 i) Daily Cash for choosing Shared Accommodation 500 per day, Maximum 3,000
    2 a) Daily Cash for accompanying an insured child Not Covered
    2 b) Newborn baby Not Covered
    2 c) Recovery Benefit Not Covered
    2 d) Emergency Air ambulance Not Covered
    3 a) Maternity Expenses Not Covered
    3 b) Outpatient Dental Treatment (Waiting Period 3 years) Not Covered
    3 c) Spectacles, Contact Lenses, Hearing Aid (Every Third Year) Not Covered
    3 d) E-Opinion in respect of a Critical Illness Not Covered
    4 Critical Illness Rider Optional, if opted then the Critical Illness Sum Insured 50% or 100% of In-patient Sum Insured subject to minimum of 1,00,000
    5 Health Check up Upto 1% of Sum Insured per Policy, only once at the end of a block of every continuous four claim free years
    6 Critical Advantage Rider Offered (where base Sum Insured is 10 lacs & above)

    Bd. Optima Super Aggregate Top Up – Family Option

    The Optima Super Aggregate Top Up plan offers the insured varied sum insured & deductible combinations to choose so they can opt for the optimum coverage as per their requirements. There are three sum insured options to choose from which are 5 lacs, ₹7 lacs and ₹10 lacs with deductible options ranging from ₹1 lac to ₹10 lacs.

    The plan also coves Pre & Post Hospitalisation, 144 Day Care procedures, Organ Donor and Emergency Ambulance cover. The plan also gives the insured an option to convert to a Fully Nil Deductible plan near your retirement. Eligibility criteria is:
    • The insured age is from 5 years upto the age of 65 years. A dependent child can be covered from the 91st day (if either parent is covered under this policy).
    • The policy covers on individual sum insured basis & maximum of 6 members can be added in a single policy
    • Insured and their family members namely spouse, dependent children, dependent parents are eligible for buying this cover on a floater sum insured basis.
    • Maximum 4 members can be added in a floater policy with a maximum of 2 adults and a maximum of 2 children. The 2 adults can be a combination of Self, Spouse, Father or Mother.
    • The policy period options include period of 1 or 2 years(s).
    Optima Super Aggregate Top Up – Family
    BENEFIT COVERAGE
    Sum Insured per Policy per Policy Year (in ₹ INR) 5,00,000 / 7,00,000 / 10,00, 000
    Deductible (in ₹ INR)) The customer can choose either of the option 1,00,000 / 2,00,000 / 3,00,000 / 4,00,000 / 5,00,000 / 6,00,000 / 7,00,000 / 10,00,000
    In-patient Treatment Covered; Hospitalization for minimum 24 hours required.
    Pre-hospitalization Medical expenses incurred in 60 days immediately before hospitalisation.
    Post-hospitalization Medical expenses incurred in 90 days immediately after discharge from hospital.
    Day Care Procedures Coverage for enlisted 144 day care procedures which do not require 24 hours hospitalization.
    Organ Donor Medical expenses for harvesting of the organ donated to the Insured person.
    Ambulance Services Expenses up to 2,000 per hospitalization.

    Ca. Optima Senior Plan

    Optima Senior is the plan exclusively for Senior citizens launched in the Indian market by Apollo Munich Health. The plan offers comprehensive cover for medical treatment of illnesses and accidents requiring in-patient hospitalisation. There are three sum insured variants to choose from for the insured - ₹2 lacs, ₹3 lacs and ₹5 lacs. The plan covers Pre & Post Hospitalisation, Domiciliary Expenses, 140 Day Care Treatments, Organ Donor, E-Opinion (which is a second opinion) and Emergency Ambulance Expenses.

    Eligibility criteria for the plan are
    • Insured age should be 61 years above.
    • Insured and their spouse can be covered under the policy on individual sum insured basis. (family discount of 5% is offered if both insured & spouse are covered)
    • The policy period options include period of 1 or 2 years(s).
    Optima Senior
    BENEFIT COVERAGE
    Sum Insured per Policy per Policy Year (in ₹ INR) 2,00,000 / 3,00,000 / 5,00, 000
    1a) Inpatient Treatment Covered
    1b) Pre Hospitalisation Covered, upto 30 days
    1c) Post Hospitalisation Covered, upto 60 days
    1d) Day Care Procedures Coverage for enlisted 144 day care procedures which do not require 24 hours hospitalization.
    1e) Domiciliary Expenses Covered
    1f) Organ Donor Medical expenses for harvesting of the organ donated to the Insured person covered
    1g) Ambulance Services Expenses up to 2,000 per hospitalization.
    2a) E-Opinion One opinion per policy year

    Benefit Descriptions under all the Apollo Munich Plans:

    In-Patient Hospitalisation
    The medical expenses for coverage of hospitalization following an illness or accident for more than 24 hrs with no room rent limits.

    Pre-Hospitalisation Expenses
    The medical expenses that are incurred by the insured due to illness upto 60 days immediately before the insured is hospitalized.

    Post-Hospitalisation Expenses
    The medical expenses incurred by the insured for upto 180 days immediately after the insured is discharged from hospital.

    Day-Care Procedures
    The medical expenses for all day-care procedures are covered under the respective plans upto the sum insured limits. Day Care procedures are those which do not require 24 hours hospitalization.

    Domiciliary Treatment Expenses
    The treatment expenses involved in getting a treatment for the insured done at home which otherwise would need hospitalization.

    Organ Donor Expenses
    Treatment expenses for the organ donor at the time of harvesting the organ and transplanting the same.

    Daily Cash for Choosing Shared Accommodation
    A lump sum amount given to the insured for selecting a shared room with another patient in a network hospital.

    Emergency Ambulance
    Expenses incurred by the insured if ambulance service is used on the way to hospital for hospitalization (up to Rs. 2000) in an emergency situation.

    Preventive Health Check-up
    Reimbursement for a preventive health check-up package taken for general assessment of health status, it does not include any diagnostic or investigative medical tests for evaluation of illness or a disease. This benefit is available at renewal at the end of a block of 2 years on base sum insured of 5 lacs and annually on base sum insured of 10 Lacs and above.

    Restore Benefit
    Automatic re-instatement of the basic sum insured, if the basic sum insured and multiplier benefit has been exhausted during the policy year. Basic sum insured will be re-instated only once in a policy year.

    E-opinion
    On request of the Insured person diagnosed with a critical illness, AMHI will arrange for a second opinion from a medical practitioner selected by the insured person from their medical panel. This benefit can be availed once in a policy year.

    Additional Cover for Critical Advantage Rider (optional)
    The insured can opt to cover themselves worldwide at AMHI network centres against treatment expenses for 8 major illnesses that include Cancer, Coronary Artery by-pass surgery, Heart Valve replacement / repair, Neurosurgery, Live Donor Organ Transplant, Bone Marrow Transplant, Pulmonary artery graft surgery and Aorta Graft Surgery. The rider offers the insured the freedom to not only avail best healthcare services world over but also covers all travel costs for the insured and accompanying relative, accommodation expenses, second opinion & post hospitalization expenses. This rider will be offered where base policy Sum Insured is Rs.10 lacs & above. This rider can be issued to an individual and/or family only on individual Sum Insured basis.

    Stay Active Benefit
    In order to reward the healthy lifestyle of the insured, AMHI will offer a discount at each renewal if the insured achieves an average step count target on the mobile application provided by AMHI in the specified time interval.

    Additional Cover for Critical Illness (optional)
    The insured can opt for an additional cover for Critical Illness which covers for cancer, coronary artery (bypass) surgery, first heart attack (myocardial infarction), kidney failure (end-stage renal disease), major organ transplantation, multiple sclerosis, paralysis and stroke. The sum insured for Critical Illness can be either 50% or 100% of your basic sum insured subject to minimum of Rs. ₹100,000 & maximum Rs. ₹10, 00,000.

    Maternity Expenses
    Medical Expenses for maternity including pre-natal and post-natal expenses after a waiting period of 4 years.

    New born baby Cover
    Optional coverage for new born infants from birth (Day 1 - 90) for In-patient Treatment benefit, subject to acceptance of proposal and premium payment in full.

    Daily Cash for accompanying an Insured Child
    Daily cash amount for 1 accompanying adult if insured child under 12 years is hospitalised and hospitalisation exceeds 72 hrs.

    Cumulative Bonus
    The insured will get a Cumulative Bonus (CB) of 10% for every claim-free year accumulating up to 100% (in the event of a claim, CB will be reduced by 10% of SI on the next renewal).

    Sum Insured Enhancement
    Sum Insured can be enhanced only at the time of renewal subject to no claim have been lodged/ paid under the policy. If the insured increases the sum insured one grid up, no fresh medicals shall be required. In cases where the sum insured increase is more than one grid up, the case shall be subject to medicals. In case of increase in the sum insured waiting period will apply afresh in relation to the amount by which the sum insured has been enhanced. However, the quantum of increase shall be at the discretion of the company.

    Portability
    If the individual is insured with some other company’s health insurance and wishes to shift to AMHI on renewal, they can. AMHI portability policy is customer friendly and aims to achieve the transfer of most of the accrued benefits and makes due allowances for waiting periods etc.

    Frequently Asked Questions (FAQ’s)

    Medical examinations may be required in some cases, based on the sum insured and the age of the individual.
    Yes, the insurer will pay the admissible amount for the medical expenses incurred subject to the terms and conditions (sum insured) of the policy. The insured might have to pay for the non-medical and expenses not covered under the policy, directly to the hospital prior to being discharged.
    Apollo Munich has a hospital network of more than 4650 hospitals pan India where the insured can be treated.
    AMHI offers policies for periods of 1 and 2 years. The policy will be in force for the duration opted for by the insured.
    No, the insured does not have to go for a medical check every year as long as the policy is renewed continuously.
    Medical expenses, means all medically necessary expenses that an Insured Person has incurred for medical treatment following an illness or accident during the policy period. These expenses should not be more than the expenses incurred had the Insured Person not been insured.
    When the insured is admitted to the network hospital, they need to inform the Insurance Help desk at the hospital about coverage under Apollo Munich Health, by submitting the health card to the hospital help desk. 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 will check the policy conditions and the sum insured and approve the estimate.
    In a Family Floater plan all insured members are covered on floater sum insured basis. The sum insured for a family floater is the maximum liability for any and all claims made by all the insured members.
    Pre- and Post-hospitalization expenses cover all medical expenses incurred by the insured within 30 days prior to hospitalization and expenses incurred within 60 days post hospitalization provided the expenses were incurred for the same condition for which the Insured Person’s hospitalisation was required.
    A waiting period is the length of time the insured needs to wait before being eligible for Health Policy benefits.
    Co-payment means a cost-sharing requirement under a health insurance policy that provides that the insured will bear a specified percentage of the admissible costs. A co-payment does not reduce the sum insured, however it reduces the premium payable by the insured to the insurer. Co-Payment option is available for the Energy Policy and Optima Senior Policy.
    Cashless facilities are available at all the 4650+ network hospitals of AMHI.
    Pre-existing Condition is any condition, ailment or injury for which the insured had signs or symptoms, and / or were diagnosed, and / or received medical advice/ treatment, within 48 months prior to the first policy issued by the insurer.
    The expenses or benefits can be claimed or indemnified by 1) seeking reimbursement by submitting claims bills or 2) availing cashless services at the any of the network hospitals of AMHI.
    Cashless settlements are made directly to the network hospital where treatment has been availed upto the payable amount under the policy.
    Yes, the premium paid for health insurance policies qualifies for deduction under Section 80D of the Income Tax Act.
    For all retail policies, the in-house claims settlement team (TPA) is Family Health Plan Limited (FHPL).
    The claim document should always be submitted to the TPA whose details are available on the policy document.
    The proposed member (insured) has to pay for the cost of Pre-Policy Check-up (PPC). AMHI will co-ordinate the appointment with AMHI empanelled doctor/diagnostic centre through the TPA. On acceptance of the insured’s application and subsequent issuance of the policy, 50% of the expenses incurred per insured person will be reimbursed.
    With rapidly changing demographics and lifestyles prevalence of critical illness is on the rise in India. Treatment of critical illness requires additional coverage due to high medical costs for treating such critical illnesses. AMHI policies covers 8 most common critical illnesses were an insured member is compensated by a lumpsum payment.
    The employer will cover medical expenses only as long as the insured is employed in the company. Tomorrow, the insured may change their job, retire, or even start something on their own. In all such cases the insured and their family will be financially impacted if a medical emergency arises and the individual does not have health insurance. Also the employers normally provide a nominal coverage (sum insured of ₹2-3 lacs) which may not be sufficient for all medical treatment. Having a complementary insurance policy will always be handy.

    How do you file a claim on a Apollo Munich Health policy?

    The insured can register a claim on any policy at the AMHI Customer Service Centre or any of the offices of Apollo Munich Health by letter/phone/email or in person. They will need to provide the following information while registering the claim:
    • Name of the Insured
    • Policy number
    • Date and time of problem
    • Nature of problem
    • Location of problem
    For any help or information regarding Claims on AMHI policy, please
    • Call on : 1800-102-0333
    • Email at customerservice@apollomunichinsurance.com
    • Courier your query directly to their CPC office
      Apollo Munich Health Insurance Co. Ltd.,
      iLABS Centre, 2nd & 3rd Floor,
      Plot No 404 - 405,
      Udyog Vihar, Phase – III,
      Gurgaon-122016, Haryana

    Health Insurance Products

    Optima Senior

    • For Individuals aged 61 years and above.
    • Lifelong renewal
    • No loading on premium during renewals irrespective of expenses incurred during the current year.
    • It has a TPA called Family Health Plan Ltd , which helps in faster claims settlement.
    • E-opinion
    • Maximum Coverage options: INR 2 lakhs, INR 3Lakhs or INR 5 lakhs

    Optima Restore

    • Restore Benefit: Equal to the Sum insured. Extra Sum insured will be reinstated only after the basic Sum insured amount has been exhausted. This does not involve additional cost.
    • Multiplier Benefit: 50% of the initial basic Sum insured for every year without claims and Maximum is 100%. If there are claims, only the bonus is reduced by 50%, not the initial Sum insured.

    Easy Health Standard

    • For Individual: Apollo Munich easy health standard for individuals provides coverage for medical expenses INR 2 lakhs to 5 lakhs
    • For Family: Apollo Munich easy health standard for family provides coverage for medical expenses INR 2 lakhs to 5 lakhs.

    Easy Health Exclusive

    • For Individual: Apollo Munich easy health exclusive for individuals provides coverage for medical expenses INR 3 lakhs to 50 lakhs.
    • For Family: Apollo Munich easy health exclusive for family provides coverage for medical expenses INR 3 lakhs to 50 lakhs.

    Easy Health Premium

    • For Individual: Apollo Munich easy health Premium for individuals provides coverage for medical expenses INR 4 lakhs to 50 lakhs.
    • For Family: Apollo Munich easy health Premium for family provides coverage for medical expenses INR 4 lakhs to 50 lakhs.
    -

    ONLINE CHAT

    • Address
    • InstantCover Insurance Web Aggregator Private limited
      710, 6th B Cross, 16th Main Road, Koramangala 3rd Block,
      Bangalore - 560 034.
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