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Phone: 011-41324957, 41623784, Mob:+91-8447757651 & 53 Email: ria1@surekhae.com
OPD Coverage Health Insurance Plans
 
Last Updated On- 05, April 2012
(1) Who offers OPD Coverage as a part of Health Insurance Plan   (2) Policy Wording/ Proposal Form/ Brochure
(3) Product details of Various Companies for OPD Coverage Insurance Policy
 
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3- ApolloMunich Maxima Health Insurance Policy
Renewal Incentives:
Outpatient Module
Carry Forward Bonus- If any available Entitlement Certificates are not used by Insured Person in a Policy Year, then We will carry forward 50% of these Entitlement Certificates to the next Policy Year except for Annual Health Check-Up.

Process for obtaining Carry Forward Entitlement Certificates
You have to send us all unused entitlement certificates before renewal (grace period of 15 days from the due date of renewal can be provided). After verifying the entitlement certificates and checking the admissibility of Carry Forward Bonus as mentioned above, fresh entitlement certificates will be issued within 30 days of the receipt of the unused entitlement certificates provided that the policy is renewed with Us without a break.
In-patient Module:
Cumulative Bonus- We will offer Cumulative bonus of 10% of the Sum Insured for every claim free year accumulating up to 50%. In the event of a claim, the
Cumulative bonus will be reduced by 20% of sum insured on renewal.

Key Exclusions:
[Applicable to In-patient Module and Critical Illness benefit]
- Any treatment within first 30 days of cover except any accidental injury.
- 2 years exclusion for specific diseases.
- Coverage for Pre-existing diseases from 4th year onwards.
- Expenses arising from HIV or AIDs and related diseases.
- Abuse of intoxicant or hallucinogenic substance like drugs and alcohol.
- War or act of war, nuclear, chemical or biological weapon and radiation of any kind.
- Non-allopathic treatment.
Terms of Renewal
- We offer life-long renewal unless the Insured Person or any one acting on behalf of an Insured Person has acted in a dishonest or fraudulent manner or any misrepresentation under or in relation to this policy or the Policy poses a moral hazard.

- Maximum Age- There is no maximum cover ceasing age in this policy. For Optional Benefit of Critical Illness maximum cover ceasing age in this policy would be 70 years.

- Waiting Period- The waiting periods mentioned in the policy wording will get reduced by 1 year on every continuous renewal of your Maxima Insurance Policy.

- Renewal Premium– Renewal premium are subject to change with prior approval from IRDA.

Requirement
- Completed proposal form
- Pre Policy Check-up (PPC) depending on the age and sum insured. For accepted PPC cases, we will reimburse 100% of the expenses incurred subject to maximum of Rs. 2,000/- per insured person.
Premium Rates :
Annual Premium in INR [Excluding Service tax and applicable cess]
Base Product*
Age Group 1 Adult 2 Adults 2 Adults+Upto 2 Children
0-17 12,682 - -
18-45 13,795 19,135 25,810
46-60 16,910 23,585 30,705
> 60 24,831 35,778 42,720
Optional Benefit Critical Illness* [On individual Sum Insured basis]
Age Group Sum Insured = 3 Lac
0-17 92
18-45 785
46-60 3,741
61-70 10,983
Avail tax benefit for the premium amount under section 80D of Income Tax Act
*We may apply a risk loading on the premium payable (based upon the declarations made in the proposal form and the health status of the persons proposed for insurance). The maximum risk loading applicable for an individual shall not exceed above 100% per diagnosis / medical condition and an overall risk loading of over 150% per person. These loadings are applied from Commencement Date of the Policy including subsequent renewal(s) with Us or on the receipt of the request of increase in Sum Insured (for the increased Sum Insured). We will inform You about the applicable risk loading through a counter offer letter. You need to revert to Us with consent and additional premium (if any), within 15 days of the issuance of such counter offer letter. In case, you neither accept the counter offer nor revert to Us within 15 days, we shall cancel your application and refund the premium paid within next 7 days. Please note that We will issue Policy only after getting Your consent.
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