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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
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.
  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
Disclaimer
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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