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Apollo Munich Mediclaim Insurance

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.

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

Apollo Munich Mediclaim Insurance

  • Individual Plans
  • Family Plan Options
  • Senior Citizens
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
4)Health Checkup 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)
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
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
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
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*
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.
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.
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.
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.
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
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.
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
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
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)
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)
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.
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

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.

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.

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    710, 6th B Cross, 16th Main Road, Koramangala 3rd Block,
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