Apollo Munich Optima Super – Eligibility, Features & Benefits

Updated: 26-06-2024 07:40:49 AM

Apollo Munich Optima Super plan provides an insured amount at a very low cost as required. The customers do not require exceeding the deductible limits. It can be aggregated over various hospitalizations throughout the policy period. This plan is a convertible upgrade plan that has no deductible until retirement. This plan is best for people with group coverage and insured low-sum policies.

Eligibility Criteria 

• This policy applies to people among the ages of 91 days and 65 years
• Dependent children may be covered between 91 days and 5 years if both parents are covered by the same policy
• Policy period of the plan is of 1 year or 2 years

Features of Apollo Munich Optima Super

Mentioned below are the features of the plan:

• No renewal age ceasing maximum coverage
• Including self, partner, dependent children and dependent parents, optima super policy may be issued to an independent or family. Family discount of 10 % is offered if two or more members of the family are covered by the same policy
• The family float policy includes a limit of 2 adults and 2 children in one policy
• A single policy includes a maximum of 6 members, 4 adults including self, spouse, father or mother and a maximum of 5 children
• The policy period is of 1 or 2 years and a discount of 7.5% offered if policy is for two years. The policy period is 1 or 2 years and a 7.5% discount are offered if the policy is taken for two years

Benefits 

There are some of the major benefits of Apollo Munich Optima Super plan as mentioned below:

• In – Patient Hospitalization: Medical expenses covered for more than 24 hours hospitalization.
• Pre – Hospitalization: The medical cost sustained during the 60 days before one is hospitalized for consultations, investigations and medicines.
• Post – Hospitalization: The medical cost sustained in consultations, investigations and medicines within 90 days of one’s hospital discharge.
• Day – Care Procedures: Medical cost for 144 day-care procedures is covered, that does not require hospitalization for 24 hours due to technological advances.
• Organ Donor: The organ donor’s treatment costs at the time of organ transplant.
• Ambulance Service: Expenses incurred when ambulance services are used for hospitalization in hospitals up to Rs. 2000.

Other Benefits

• Waiver of Deductible Benefit: The possibility to convert the plan to a full – fledged health insurance plan without a subscription or medicine is only available for renewal between 55 and 60 years if one has registered with the plan before the age of 50 and have continuously renewed without a break with the plan.
• Cashless Service: One must obtain a pre – consent for all planned acceptance within 48 hours of actual admission or establishment of any ‘emergency’ admission within 24 hours of admission. The process details and the testimonial needs are set out in the guide book together with the policy.
• Portability: One can port to this plan on renewal even if one is insured with another company’s health insurance. The policy on portability is customer – friendly and directs to transfer most of the accumulated benefits and make due payments for waiting periods.
• Tax Benefits: With the Optima Super Health Insurance Plan, one can currently benefit from the tax benefits in accordance with Section 80D of the Income Tax Act.

Value Added Services

The plan offers a variety of value – added services to help one’s well – being, avert illnesses as well as make hospitalization stress – free for the patient and their family.

• Healthline: One can call the experts to get their help in initial consultation, health – related counseling, individual referrals, health related information, nutrition and diet by providing their customer ID. No extra payment is required from the customers to avail the services on the Healthline. One is constantly expanded to cover additional health and well – being areas to include customized health and well-being solutions.
• Health Risk Assessment:Each and every customer of Apollo Munich Health Insurance has access to a health risk assessment tool that helps to improve the health status of each member on their website. After evaluation, members are provided personalized wellness recommendations for diet, lifestyle and nutrition regimen.

Renewal Process of Apollo Munich Optima Super

• The customers are offered lifelong renewability in Optima Super policy. In this policy, there is no maximum coverage ceasing age
• This policy provides a grace period of 30 days for the renewal of the policy
• The waiting periods mentioned in the policy formulation are decreased by 1 year for every continuous renewal of the Optima Super Insurance policy
• The renewal premium may be changed with IRDA’s prior approval. Any changes in benefits or premiums will be made with the approval of the IRDA and not later than 3 months in advance

Exclusions under the plan

• All treatments except for accidental injury in the initial 30 days of coverage
• Any pre – existing condition is covered after waiting for 4 years
• For particular diseases like cataracts, hernia, joint replacement surgery, hydrocele surgery, the customer has to wait for 2 years
• HIV and AIDS expenditure and related illness
• Congenital diseases, mental disorder, cosmetic surgery and weight control treatments
• Abuse of intoxicants or hallucinogens such as alcohol and drugs
• Hospitalization due to war, nuclear, chemical, or biological weapon and any kind of radiation
• Dental treatment, external aids and appliances, pregnancy
• Items of personal comfort and convenience

Surrender of the plan

A customer can terminate the policy at any time by giving a written notice. The cancelation will be effective from the date on which the written notice is received.

Refund Rules: 1 Year Policy

Length of time policy in force	Refund of Premium
Up to 1 month	75.00%
Up to 3 months	50.00%
Up to 6 months	25.00%
Exceeding 6 months	Nil

Refund Rules: 2 Year Policy

Length of time policy in force	Refund of Premium
Up to 1 month	87.50%
Up to 3 months	75.00%
Up to 6 months	62.50%
Up to 12 months	48.00%
Up to 15 months	25.00%
Up to 18 months	12.00%
Exceeding 18 months	Nil

Filing claim under the Apollo Munich Optima Super 

Policyholders can register for claims at any branch office or customer service centre of Apollo Munich Health by letter/phone/email. Individuals can also call on: 1800-102-0333 or can email at customerservice@apollomunichinsurance.com

Following are the details required while filing a claim with the claims department:

1. Contact details
2. Name of the insured
3. Policy number
4. Date and time of the incident
5. Nature if the incident
6. Location of the incident

Documents required to file claim

Below mentioned is the complete list of documents required to file the claim under the plan:

1. Claim form duly filled and signed for on the behalf of insured person
2. Original bill summary
3. Original payment receipts
4. Original medical reports
5. Discharge summary
6. FIR Copy
7. Previous treatment reports

Contact Details

Policyholders now can enquire about claims/renewal/surrender of the plan via:

Email: customerservice@apollomunichinsurance.com

Toll-Free: 1800-102-0333

Website: www.apollomunichinsurance.com

FAQs

Q1. What are the criteria for optima super policy?

The policy is applied to people between the ages of 91 days and 65 years. The dependent children may be covered between 91 days and 5 years if both parents are covered by the same policy.

Q2. What are the plan benefits of optima super?

The optima super plan benefits include in – patient hospitalization, pre – hospitalization, post – hospitalization, day – care procedures, organ donor, ambulance service.

Q3. What are the renewal benefits of optima super?

The customers are offered lifelong renewability in Optima Super policy. In this policy, there is no maximal coverage ceasing age. This policy provides a grace period of 30 days for the renewal of the policy. The waiting periods referred in the policy formulation are reduced by 1 year for every uninterrupted renewal of the Optima Super Insurance policy. The renewal premium may be changed with IRDA’s prior approval. Any changes in benefits or premiums will be made with the approval of the IRDA and not more than 3 months in advance.

Q5. How can a customer terminate the policy?

A customer can terminate the policy at any time by providing a written notice. The cancellation will be effective from the date on which the written notice is received.

Features
Claim Type (In-House or TPA)	In-House
Pre-Hospitalization	60 days immediately before the hospitalization
Network Hospital Count	4500+
Post-Hospitalization	90 days immediately after discharge from the hospital
Room Eligibility	No limit
Share Claim Payments	Claims paid when medical expenses exceed deductible amount(as per policy year)
Restoration of Cover	No
No Claim Bonus
Ambulance Charges	Expenses up to Rs. 2000 per hospitalization
Worldwide Coverage
Maternity Cover	No
Hospitalization at Home	No
Day Care Treatment	yes
Non-Allopathic Treatment Coverage	No
Emergency Ambulance	Yes
Health Check-up