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| OPD Coverage Health Insurance Plans |
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| 3- ApolloMunich Maxima Health Insurance Policy |
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| Schedule of Benefits |
| Sum Insured per Policy |
1 Member |
2 Members |
2 Adults + Upto 2 Children |
| a) Out-patient Consultations* |
4 Consultations |
6 Consultations |
8 Consultations |
| b) Diagnostic Tests# |
 5,000 |
5,500 |
7,000 |
| c) Pharmacy# |
| d) Outpatient Dental Treatment# |
| 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 Gynecologist. |
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1 Member |
2 Members |
2 Adults + Upto 2 Children |
| Part B- Inpatient Module |
| Sum Insured per Policy |
300,000 |
300,000 |
300,000 |
| 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 Rs.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 Rs 9,000 |
| j)Maternity Expenses ** Waiting Period 4 years |
Normal Delivery- Rs15,000; Caesarean Delivery- 25,000 (Including Pre/Post Natal limit of 1,500 and Infant baby limit of 2,000) |
| k) Newborn baby |
Optional |
| Optional Benefit |
| Critical Illness ** [Offered on Individual Sum Insured basis] |
300,000 |
| * *These benefits do not dip into inpatient Sum Insured |
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| Disclaimer |
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| This is only a summary of the product features. The actual benefits available are as described in the policy, and will be subject to the policy terms, conditions and exclusions. Please seek the advice of your insurance advisor if you require any further information or clarification. |
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