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| Top Up Health Insurance Policies from Companies in India |
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| 3- Apollo Munich Optima Plus Top Up Health Insurance Policy |
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10th Floor, Building No. 10, Tower B, DLF City Phase II, DLF Cyber City, Gurgaon-122002 |
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| Eligibility |
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- This Policy covers persons in the Age group 91 days to 65 years.
- The maximum entry Age is restricted upto 65 years.
- Child between 91 days to 5 years can be insured only when either parent is getting insured under this Policy.
- The Policy offers coverage on individual Sum Insured basis.
- This Policy can be issued to an individual and/or family.
- The family includes self, spouse, Dependent children and Dependent parents.
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| Policy Period |
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| The Policy will be issued for 1 year /2 years period |
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| Benefits |
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| The Policy pays for the benefits mentioned below,in excess of the Deductible opted by You. |
• In-patient Treatment - Covers Medical Expenses for Hospitalisation due to an Illness or Accident. We will pay for the Medical Expenses for room rent, boarding expenses, nursing, Intensive Care Unit, Medical Practitioner(s), anaesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines, drugs and consumables, diagnostic procedures, cost of prosthetic & other devices or equipments if implanted internally during a surgical procedure.
• Pre-Hospitalisation - The Medical Expenses incurred due to an Illness in 60 days immediately before the Insured Person was Hospitalised.
• Post-Hospitalisation - The Medical Expenses incurred in 90 days immediately after the Insured Person was discharged post Hospitalisation.
• Day care Procedures - The Medical Expenses for 140 day care procedures which do not require 24 hours Hospitalisation due to technological advancement in medical science.
• Organ Donor - The Medical Expenses on harvesting the organ from the donor.
• Emergency Ambulance - Expenses upto Rs. 2000 per Hospitalisation for utilizing ambulance service for transporting Insured Person to Hospital.
• Domiciliary Treatment - The Medical Expenses incurred by an Insured Person for availing medical treatment at his home which would otherwise have required Hospitalisation. |
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| Waiver of Deductible |
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We will offer the Insured Person an option to waive the Deductible and opt for 5 Lac indemnity health insurance Policy (without any Deductible) with Us provided that:
- Insured Person has enrolled with Us for first time under this Policybefore the Age of 50 years and has renewed with Us continuously and without interruption,
- This option can be exercised by the Insured Person in the age group 58 - 60 years at the time of renewal only,
- Insured Person will be offered continuity of coverage in terms of waiver of waiting periods to the extent of benefits covered in this Policy.
- Will be subject to underwriting guidelines of that product,
In all other cases, No benefitsshall accrue to any Insured Person by virtue of continuity of coverage in the event of discontinuation of this Policy and shifting to any other Health Insurance Policy with Us. |
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| Key Definitions |
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Pre-existing Condition means any condition, ailment or injury or related condition(s) for which Insured Person had signs or symptoms, and / or were diagnosed, and / or received medical advice/ treatment, within 48 months prior to the commencement of his first being covered under an Optima Plus Policywith Us.
Any One Illness means continuous period of Illness and it includes relapse within 45 days from the date of last consultation with the Hospital/nursing home where treatment may have been taken. Occurrence of same Illness after a lapse of 45 days as stated above will be considered as fresh Illness for the purpose of this Policy.
Deductible means a cost-sharing requirement under a health insurance policy that provides that the insurer will not be liable for a specifiedrupee amount (as mentioned in Policy Schedule) of the covered expenses, which will apply before any benefits are payable bythe insurer. A Deductible does not reduce the Sum Insured. |
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| Exclusions |
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a) Deductible - We are not liable for any payment unless the Medical Expenses exceed the Deductible. Deductible shall be applicable for each and every Hospitalisation except claims made for any one Illness.
b) Waiting Periods - We are not liable for any treatment which begins during waiting periods except if any Insured Person suffers an Accident.
c) 30 days Waiting Period - A waiting period of 30 days will apply to all claims unless:
i) The Insured Person has been insured under an Optima Plus Policy continuously and without any break in the previous Policy Year, or
ii) The Insured Person was insured continuously and without interruption for at least 1 year under any other individual health insurance policy (top-up policy with high Deductible) for the reimbursement of medical costs for in-patient treatment in a Hospital, and he establishes to Our satisfaction that he was unaware of and had not taken any advice or medication for such Illness or treatment.
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