| 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 |
- Treatment of nasal concha resection; circumcisions (unless necessitated by Illness or injury and forming part of treatment); laser treatment for correction of eye due to refractive error; aesthetic or change-of-life treatments of any description such as sex transformation operations, treatments to do or undo changes in appearance or carried out in childhood or at any other times driven by cultural habits, fashion or the like or any procedures which improve physical appearance.
- Plastic surgery or cosmetic surgery unless necessary as a part of medically necessary treatment certifiedby the attending Medical Practitioner for reconstruction following an Accident, cancer or burns.
- Experimental, investigational or unproven treatment, devices and pharmacological regimens.
- Measures primarily for diagnostic, X-ray or laboratory examinations or other diagnostic studies which are not consistent with or incidental to the diagnosis and treatment of the positive existence or presence of any Illness for which confinement is required at a Hospital.
- Convalescence, cure, rest cure, sanatorium treatment, rehabilitation measures, private duty nursing, respite care, long-term nursing care or custodial care.
- Any non allopathic treatment.
- All preventive care, vaccination including inoculation and immunisations (except in case of post- bite treatment); any physical, psychiatric or psychological examinations or testing; enteral feedings (infusion formulae via a tube into the upper gastrointestinal tract) and other nutritional and electrolyte supplements, unless certifiedto be required by the attending Medical Practitioner as a direct consequence of an otherwise covered claim.
- Charges related to a Hospital stay not expressly mentioned as being covered, including but not limited to charges for admission, discharge, administration, registration, documentation and filing.
- Items of personal comfort and convenience including but not limited to television (wherever specificallycharged for), charges for access to telephone and telephone calls, internet, foodstuffs (except patient’s diet), cosmetics, hygiene articles, body care products and bath additive, barber or beauty service, guest service as well as similar incidental services and supplies, and vitamins and tonics unless vitamins and tonics are certifiedto be required by the attending Medical Practitioner as a direct consequence of an otherwise covered claim.
- Treatment rendered by a Medical Practitioner which is outside his discipline or the discipline for which he is licensed; treatments rendered by a Medical Practitioner
- Treatment rendered by a Medical Practitioner which is outside his discipline or the discipline for which he is licensed; treatments rendered by a Medical Practitioner who shares the same residence as an Insured Person or who is a member of an Insured Person’s family, however proven material costs are eligible for reimbursement in accordance with the applicable cover.
- The costs of any procedure or treatment by any person or institution that We have told You (in writing) is not to be used at the time of renewal or at any specifictime during the Policy Period.
- The provision or fittingof hearing aids, spectacles or contact lenses including optometric therapy, any treatment and associated expenses for alopecia, baldness, wigs, or toupees, medical supplies including elastic stockings, diabetic test strips, and similar products.
- Any treatment or part of a treatment that is not of a reasonable charge, not medically necessary; drugs or treatments which are not supported by a prescription.
- Artificial limbs,crutches or any other external appliance and/or device used for diagnosis or treatment (except when used intra-operatively).
- Any exclusion mentioned in the Schedule or the breach of any specific condition mentioned in theSchedule
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| Requirement |
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| Completed proposal form |
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| Sum Insured (Rs.) |
500,000 |
500,000 |
500,000 |
500,000 |
500,000 |
| Deductible (Rs.) |
100,000 |
200,000 |
300,000 |
400,000 |
500,000 |
| 18-45 Yrs |
Nil |
Nil |
Nil |
Nil |
Nil |
| 46-55 Yrs |
Cat 2 |
Cat 2 |
Cat 2 |
Cat 2 |
Cat 2 |
| 56-60 Yrs |
Cat 3 |
Cat 3 |
Cat 3 |
Cat 3 |
Cat 3 |
| 61-65 Yrs |
Cat 5A |
Cat 5A |
Cat 5A |
Cat 5A |
Cat 5A |
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| Category |
Tests |
| Cat 2 |
ME, RUA, FBS, ECG |
| Cat 3 |
ME, RUA, FBS, ECG, CBC, TC |
| Cat 5A |
ME, RUA, FBS, CBC, Lipids, TMT, SGOT, Total Proteins, Sr Creat, PSA (males), USG Abd (females) |
| ME- Medical Examination (Report), CBC- Complete Blood Count, ECG- Electro Cardio Gram, FBS- Fasting Blood Sugar, Lipids- Lipid Profile,Sr Creatinine- Serum Creatinine, |
| PSA- Prostate Specificantigen, RUA- Routine Urine Examination, TMT- Treadmill Test, USG- Ultrasonogram, SGOT- Serum Glutamic Oxaloacetic Transaminase, TC- Total Cholesterol |
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| We will reimburse 50% of the expenses incurred per Insured Person on the acceptance of the proposal. The medical reports are valid for a period of 90 days from the date of Pre-Policy Checkup. |
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