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APOLLO MUNICH

INTRODUCTION
Apollo Munich Health Insurance Company Limited was previously known as Apollo DKV
Insurance Company Limited. The company started as a joint venture between Apollo Group of
Hospitals and DKV AG, Europe's largest private health insurer (Deutsche Krankenversicherung
AG) on the 8th of August, 2007. Apollo DKV started on a journey to re-define the health
insurance sector in India. The stake holding of the two companies were in the ratio of 74:26
(Apollo Group of HospitalsDKV AG).
Apollo DKV changed the focus of the market and customers from curative to preventive
healthcare. The brand identity of Apollo DKV, in the form of the joyful and healthy man,
depicted the innovative stand of the company. Since Apollo DKV started on the journey with the
prime aim of helping people stay healthy regardless of medical care expenses, the Happy Man
also illustrated the companys Lets Stay Healthy philosophy.
Apollo DKV was the only health insurance provider in the country that was backed by an
integrated healthcare group and one of the largest pure health insurance providers in the
international market. The mission of the company was to constantly provide customers with
innovative healthcare solutions to meet their healthcare needs.
products launched by Apollo DKV:
Apollo DKV launched a number of health insurance products, which are till date, among the best
medical insurance policies in the nation. The plans launched by Apollo DKV were:

Easy Health Individual Health Insurance Plan

Easy Health Family Health Insurance Plan

Insure Health

Maxima

Easy Travel Insurance Plan

Personal Accident Insurance Plan

Apollo DKV to Apollo Munich:


In December 2009, Apollo DKV was renamed as Apollo Munich Health Insurance. The company
continues to bring out innovative products. Apollo Munich offers a large number of customer
care services to help people stay healthy and fit always. The journey of uncomplicating health
insurance in the country has just begun and has a long way to go.
Objectives
An individual spends approximately 17 years studying, 34 years earning and the rest of the life
retiring. As a student you prepare to earn, and as a breadwinner you prepare to retire. Retirement
is that big change in life, for which you cannot be under-prepared. The best time to start
preparing is while you still enjoy good health and drawing a salary. So get started before you
touch 50. Presenting Optima Plus. Because the real currency of your retired life is good health.
Indias only Top-up Health plan with an option of converting into a full-fledged nil deductible
Health Insurance plan when you retire. When it operates as a Top-up, theres a deductible
applied, when it converts into full-fledged plan, all deductibles are waived.
We have analysed four health insurance policies in this article - 2 from the public sector
and 2 from the private sector - Mediclaim 2012 Policy from New India Assurance Company Ltd,
Happy Family Floater Policy from Oriental Insurance Company Ltd, Optima Restore Family
Floater from Apollo Munich and Family Floater Heartbeat Gold plan from Max Bupa. Lets look
at some features of these 4 policies. Coverage: All policies cover the spouse and the dependent
children of the policy holder. Oriental Insurance policy covers parents in laws too. The Heartbeat
Family Floater variants allow coverage for self, spouse and upto 4 children in various
combinations.
Entry age and age on renewal: The higher the maximum entry age and maximum age on
renewal, the better it is for you, as this gives coverage in old age when the medical expenses are
the highest. Of the plans compared, the maximum age is highest at 65 years for New India
Assurance and Apollo Munich policies. However, 65 years is not very high. Nevertheless, a
positive in New India Assurance policy is that there is no maximum age for renewal. Sum
Assured: In todays age of rising medical expenses, a high cover is preferred by many families.
Private players like Apollo Munich and Max Bupa offer a higher sum assured option. Max Bupa

Family Floater Gold plan offers a sum assured as high as Rs. 50 lakhs. The maximum sum
assured option is lowest for Mediclaim 2012 policy. Premium per annum: For a lower sum
assured option, the premium is lower for the public sector policies and higher for the other two
policies.
However, the benefits available in the Optima Restore policy and Family Floater
Heartbeat policies are also higher. Co-payment requirements: Lower the co-pay requirement; the
better it is for you as this is the amount you will have to give from your pocket in case of a claim.
This is the highest in the New India Assurance policy, with co-pay clause applicable on age as
well as location specifications (Refer the table below). Max Bupas plan has a tapering copayment feature which provides an option of reduced and subsequently zero co-payment, subject
to continuous renewal for a period of 4 years. Co-payment feature is absent in the Apollo Munich
Plan and the Gold variant of the Happy Family Floater plan of Oriental Insurance. NoClaim Benefits: The public sector policies we have analysed in this discussion come with
no-claim discounts on premium with a ceiling of 15% for New India Assurance 20% for Oriental
Insurance policies. Apollo Munich policy gives a 50% enhancement on the basic sum assured for
every year you do not claim, upto 100%. The Max Bupa plan offers a health relationship loyalty
programme, wherein the policy holder can choose one of the two options - (a) Earn points worth
10% of the last paid annual premium on renewal of the policy (b) An increase of 10% of the Sum
Insured every year of expiring base sum assured, accumulated upto 50% of renewal base sum
insured. The loyalty program is irrespective of the claim. Other Benefits: The pre and post
hospitalization time periods are the highest for the Optima Restore policy by Apollo Munich. The
Max Bupa policy (Gold variant) covers upto 20% of Base Sum Insured under this head. The Max
Bupa policy offers maternity benefits, which is generally disallowed by most health insurance
policies.
Health check up benefits is another positive in Max Bupa. The two private sector
policies also offer day care procedures as a part of the claim even though the hospitalization is
for less than 24 hours and also cover organ transplant costs. The Apollo Munich policy has the
benefit of automatic re-instatement of the basic sum insured, if the basic sum insured and
multiplier benefit has been exhausted during the policy year, which is beneficial too. The extent
of benefits is lower for the public sector policies. Which policy should be chosen? The most

striking feature in the comparison below is that the premium for the 2 public sector policies for a
lower sum assured is much lower than their private sector counterparts. So if you are concerned
about paying a high premium, are not particular about extensive benefits and do not mind the copay clause, you can pick these two policies. However, remember that you cannot opt for a very
high Sum Assured amount and the New India Assurance policy has an entry load if you are
above 45 years.
Among the two private sector policies analysed, the premium as you can see if higher for
the Family Floater Heartbeat plan of Max Bupa. You can take it if you want a high Sum Assured
option or the extra benefits listed. The Apollo Munich plan does not have the co-pay clause and
comes with restoration of Sum Assured and multiplier benefit as well. These can be positives in
times of rising healthcare costs. Nevertheless, keep in mind the higher premium. You can opt for
either of the public sector policies if you wish to take a lower Sum Assured. On the other hand, if
you want a higher cover, you can opt for the private sector policies. Your specific needs
determine the choice of the policy. A detailed comparison is available below. For more details,
refer to individual companys prospectus. Kindly note that this analysis covers major offerings
from the insurers only & this is not an all-product comprehensive comparison. The analysis is
valid

on

HEALTH INSURANCE

the

date

being

published.

Insurance that essentially covers your medical expenses. A health insurance policy like
other policies is a contract between an insurer and an individual / group in which the insurer
agrees to provide specified health insurance cover at a particular premium subject to terms and
conditions specified in the policy. What a Health Insurance policy would normally cover A
Health Insurance Policy would normally cover expenses reasonably and necessarily incurred
under the following heads in respect of each insured person subject to overall ceiling of sum
insured (for all claims during one policy period). a) Room, Boarding expenses b) Nursing
expenses c) Fe e s o f s u r g e o n , a n e s t h e t i s t , p h y s i c i a n , consultants, specialists d)
Anesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines, drugs,
diagnostic materials, X-ray, Dialysis, chemotherapy, Radio therapy, cost of pace maker, Artificial
limbs, cost or organs and similar expenses.
With the increasing cost of health services and medical bills which a common man can
not afford, this class of insurance has a growing market. It is estimated that a family spends an
average of 10% of its monthly income on health care. In India where there is no Social Insurance
for the public the individual has to take care of himself and his family. A prolonged illness or
disability can spell havoc for the family budget and upset all the planning. While the importance
of Health Insurance cannot be denied, it is unfortunate that so far in India the Health Insurance
policy is being purchased by families and individuals who can afford to pay the medical bills.
But the Govt. of India is putting all its efforts to encourage people to buy health insurance and
specialized insurance companies are promoted which are exclusively dealing in health insurance.
The life insurance companies are also permitted to issue the health insurance policy.
OBJECTIVES
At the end of this lesson, you will be able to: z Know the meaning of Personal Accident
Insurance. z Know the meaning of Health Insurance. z To understand buying methods of Health
Insurance Policy. z Settle the claim under Health Insurance. z Know the practise of Health
Insurance in India. z Know what is not covered under Health Insurance policy.

FEATURES/COVERAGES OF HEALTH INSURANCE POLICY

Any health insurance policy should cover the following the expenses: 1) The policy should
provide for reimbursement of hospitalisation / domiciliary hospitalisation expenses for
illness/disease suffered or accidental injury sustained during the policy period. Hospital/Nursing
Home: It means any institution in India established for indoor care and treatment of sickness and
injuries, which z Has been registered either as a hospital or nursing home with the local
authorities and is under the supervision of a registered and qualified medical practitioner. z
Should comply with the minimum criteria as under: a) It should be equipped with atleast 15 inpatient beds. b) Fully equipped operation theatre of its own where the surgical operations are
carried out. c) Availbility of fully qualified nursing staff round the clock. Fully qualified
doctor(s) should be in charge round the clock. The term Hospital / Nursing Home shall not
include an establishment which is a place of rest, a place for the aged, a place for drug addicts or
place for alcoholics, a hotel or a similar place.
EXCLUSIONS THAT THE HEALTH INSURANCE POLICY DOES NOT COVER
All diseases / injuries which are pre-existing when the cover incepts for the first time. b) Any
disease other than those stated in clause (c) below, contracted by the insured person during the
first 30 days from the commencement date of the policy. This exclusion shall not, however, apply
if in the opinion of Panel of Medical Practitioners constituted by the company for the purpose,
the insured person could not have known of the existence of the disease or any symptoms or
complaints thereof at the time of making the proposal for insurance to the company. This
condition shall not however apply in case of the insured person have been covered under this
scheme or group insurance scheme with any of the Indian Insurance Companies for a continuous
period of preceding 12 months without any break. c) During the first or more years of the
operation of the policy the expenses on treatment of diseases such as Cataract, Benign Prostates
Hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital
Internal Disease, Fistula in anus. Piles, Sinusitis and related disorders. If these diseases are
preexisting at the time of proposal they will not be covered even during subsequent period of
renewal. d) Circumcision unless necessary for treatment of a disease not excluded hereunder or
as may be necessitated due to an accident, vaccination or inoculation or change of life or
cosmetic or aesthetic treatment of any description, plastic surgery other than as may be
necessitated due to an accident or as a part of any illness. e) Cost of spectacles and contact

lenses, hearing aids. (These may be termed as normal maintenance expenses.) f) Dental treatment
or surgery of any kind unless requiring hospitalisation. MODULE - 4 Practice of General
Insurance Notes 79 Health Insurance DIPLOMA IN INSURANCE SERVICES g)
Convalescence, general debility, run down condition or rest cure, congenital external disease, or
defects or anomalies, sterility, venereal disease, intentional self injury and use of intoxicating
drugs / alcohol. h) Various conditions commonly referred to as AIDS. i) Charges incurred at
hospital or nursing home primarily for diagnostic. X-Ray or laboratory examinations or other
diagnostic studies not consistent with the positive existence or presence of any ailment, sickness
or injury for which confinement is required at a Hospital / Nursing Home or at Home under
Domiciliary Hospitalisation as defined. j) Expenses on vitamins and tonics unless forming part of
treatment. k) Treatment arising from childbirth including Caesarean section (can be deleted, if
maternity benefit is covered). l) Voluntary medical termination of pregnancy (abortion) during
the first 12 weeks from the date of conception. m) Naturopathy treatment.
MISCELLANEOUS CONDITIONS/BENEFITS
a) Age Limit: This insurance is available to persons between the age of 5 years to 80 years.
Children between the age of 3 months to 5 years can be covered provided one or both parents are
covered concurrently. b) Family Discount: This discount of 10% in the total premium is allowed
to a family comprising the insured and any one or more of the following: i) Spouse ii) Dependent
children (i.e. legitimate or legally adopted) iii) Dependent parents c) Cumulative Bonus: The sum
insured is increased by certain percentage, say 5% for each claim from the year of insurance
subject to a maximum accumulation of 10 years. In the event of a claim, the increased percentage
will be reduced to a certain percentage, say the double of the bonus rate by 10% of the sum
insured at the next renewal but the basic sum insured will remain the same. Some companies do
not allow this cumulative bonus but instead of this allow a discount in the premium on the next
renewal if no claim is reported during the currency of the previous policy. d) Cost of Health
Checkup: The insured shall be entitled to reimbursement of medical check up, generally once in
every four underwriting years, subject to no claim preferred during this period. The cost shall not
exceed MODULE - 4 Practice of General Insurance Notes 81 Health Insurance DIPLOMA IN
INSURANCE SERVICES 1% of the average sum insured during the block of four years. e)

Extension of Cover: The health cover is available for Indian Territories but it can be extended to
Nepal and Bhutan with prior permission.

CLAIM SETTLEMENT PROCEDURE


If any claim arises in health insurance policy, the same can be settled in any of the following
ways: 1. Reimbursement of expenses. 2. Cashless facility for planned hospitalization 3. Cashless
facility for emergency hospitalization 1. Reimbursement of expenses: If a policyholder falls sick
and hospitalized in non-empanelled hospital then he should follow the following procedure: z
Intimation to the insurer/ Third Party Administrator (TPA) along with the name of the person
who has fallen sick z Policy number z Name of the hospital z Name of the doctor The above
information should be sent within 7 days of the hospitalization. Within 30 days final claim form
should be furnished along with the following documents: z Hospital receipts/ original bills. z
Cash memos. z Various reports and tests. z Hospital admission and discharge slip. z Case history.
z Any other documents desired by TPA or hospital.
TYPES OF HEALTH INSURANCE POLICY
Floater Health Insurance Policy: It means that a single sum insured will be available for all
family members. For example, a family consists of self, spouse and two children purchases
health insurance of Rs 1.00 lakh. Under the floater policy, any family member can avail the
medical claim of Rs 1.00 lakh. The coverage and other terms & conditions are the same as are
explained above in para 5.1 to 5.3. The premium will be applicable to the highest aged member
of the family. MODULE - 4 Practice of General Insurance Notes 83 Health Insurance DIPLOMA
IN INSURANCE SERVICES b) Critical Illness Insurance Policy: Critical illness insurance or
critical illness cover is an insurance product, where the insurer is contracted to typically make a
lump sum cash payment if the policyholder is diagnosed with one of the critical illnesses listed in
the insurance policy. The policy may also be structured to pay out regular income and the
payment may also be on the policyholder undergoing a surgical procedure, for example, having a
heart bypass operation. The contract terms contain specific rules that define when a diagnosis of
a critical illness is considered valid. It may state that the diagnosis need be made by a physician
who specializes in that illness or condition, or it may name specific tests, e.g. EKG changes of a

myocardial infarction, that confirm the diagnosis. c) Group Health Insurance Policy: The Group
Health Insurance Policy is available to any Group / Association / Institution / Corporate body of
more provided it has a central administration point and subject to a minimum number of persons
to be covered. The group policy is issued in the name of the Group / Association / Institution /
Corporate Body (called insured) with a schedule of names of the members including his/her
eligible family members (called insured persons) forming part of the policy. The details of
insured person is required to furnish a complete list of Insured Persons in the prescribed format
according to sum insured. Any additions and deletions during the currency of the policy should
be intimated to the company in the same format. However, such additions and deletions will be
incorporated in the policy from the first day of the following month subject to pro-rata premium
adjustment. No change of sum insured for any insured person will be permitted during the
currency of the policy. No refund of premium is allowed for deletion of insured person if he or
she has recovered a claim under the policy. The coverage under the policy is the same as under
Individual Mediclaim Policy with the following differences:a) Cumulative bonus and Health Check up expense are not payable. b) Group discount in the
premium is available c) Renewal premium is subject to claims made during the previous policy .
d) Maternity benefit extension is available at extra premium. Option for maternity benefits has to
be exercised at the inception of the policy period and no refund is allowable in case of insured
cancellation of this option during currency of the policy. A waiting period of 9 months is
applicable for payment of any claim relating to normal delivery or caesarean section or
abdominal operation for extra uterine pregnancy. The waiting period may be relaxed only in case
of delivery , miscarriage, or abortion induced by accident or other medical emergency. Claim in
respect of delivery for only first two children will be considered in respect of any one insured
person. Those insured persons who already have two or more living children will not be eligible
for this benefit. Expenses incurred in connection with voluntary medical termination of
pregnancy during the first 12 weeks from the date of conception are not covered. d) Overseas
Medical Policy: This policy was originally introduced in 1984 to provide for payment of medical
expenses in respect of illness suffered or accident sustained by Indian residents during their
overseas trips for official or holiday purpose. The insurance scheme, since 1984 has been
modified from time to time to provide for additional benefits such as in-flight personal accident,
loss of passport etc. In 1991, Employment and Study Policy was introduced. This policy is meant

for Indian citizens temporarily working or studying abroad. Eligibility: (a) Indian Residents
undertaking bonafide trips abroad for: (i) Business and official purposes. (ii) Holiday purpose
MODULE - 4 Practice of General Insurance Notes 85 Health Insurance DIPLOMA IN
INSURANCE SERVICES (iii) Accompanying spouse and children of the person who is going
abroad will be treated as going under holiday travel. (iv) Foreign Nationals working in India for
Indian employers of Multi-National Organisation getting their salary in Indian Rupees, covering
their official visits abroad provided they are undertaken on behalf of their employers.
Period of Insurance
The Insurance is valid from the first day of insurance and expires on the last day of the number
of days specified in the policy schedule or on return to India whichever is earlier. Extension of
the period of insurance is automatic for the period not exceeding 7 days, and without extra
charge, if necessitated by delay of public transport services beyond the control of the insured
person.
COVERAGE Section A - Personal Accident
This insurance will pay upto the limit as shown in the Schedule if the insured person sustains
accidental bodily injury and such bodily injury within 12 months of the date of the injury is the
sole and direct cause of death or loss of eye(s) or limb(s). Not more than US $ 2,000 is payable
in respect of death if the insured persons age is under 16.
Section B - Medical Expenses and Repatriation
This insurance will pay up to the limit shown in the Schedule in total for the insured person in
respect of covered medical related expenses, incurred outside the Republic of India by the
insured person suffering bodily injury, sickness, disease or death during the period of insurance.

COMPANY PROFILE
Apollo Munich Health Insurance offers the best health insurance plans in India today, for men
and women of any age. Apollo Munich offers individual health insurance plans, family floater
health insurance plans and group health insurance policies for corporates. Ranging from Easy
Health to Optima Restore to Energy, these health insurance policies will not only guard you
against the present and future spiraling healthcare costs, but will also guide you on the path to
wellness

for

the

long

term.

Apollo Munich Health Insurance has received numerous positive reviews and ratings for its
health insurance plans and policies, which have been ranked as the best plans in the health
insurance industry by several of Indias most popular publications such as The Economic
Times and The Hindustan Times. The company offers its products through a network of 50+
offices, well trained sales partners and directly through its call center, website and in-house sales
force.
Let's Uncomplicate With Best-In-Class Benefits

Wide Sum Insured Options - Choose from a wide choice of Sum Insured starting from
Rs. 1 lakh to Rs. 15 lakhs and enjoy best health insurance benefits at affordable premium.

Pre-Hospitalization and Post-Hospitalization Cover - Our health insurance plans come


with Pre-Hospitalization and Post-Hospitalization cover that takes care of medical
expenses incurred for treatment before and after hospitalization. It gives you relief from
the medical expenses incurred before and after the hospitalization, that can sometimes
prove to be as costly as the hospitalization expenses itself.

Quick Claims Approval - Our empanelled hospitals, cashless procedures, wide presence
across India all make the claims approval process quick and easy. We have a specialized
in-house claims processing team of doctors that processes your claim compassionately,
yet professionally. When it comes to claim settlement, Apollo Munich is one of the fastest
in the industry to honor every genuine claim. About 98% of our claims are settled within
15 days.

Portability Apollo Munich health insurance offers customer-friendly health insurance


policies that ensure that you avail most of the accrued benefits when you port your plans
to Apollo Munichs health insurance plans. The waiting period or any another
accumulated benefit will be carried forward without any trouble Thats our promise to
you!

Tax Benefits - Get tax benefits on our health insurance plans for the premium amount
under Section 80D of the Income Tax Act.

Lifelong Renewal - Enjoy the lifetime renewal benefit of a health insurance policy and
be secure against medical expenses. Our health insurance plans save you from the
financial burden and stress caused by a medical emergency and keeps you well prepared
to handle any situation.

Earn upto 100% No Claim Bonus* - If you have had a claim-free year, we increase
your basic sum insured by 50% at no extra charge. If you do not claim even in the second
year, we double the sum insured, making it 100% of the basic sum insured. For instance,
if you have a Rs. 5 lakhs health insurance plan and you do not make any claim in the first
year, we will increase your cover to Rs. 7.5 lakhs in the first year and Rs. 10 lakhs in the
second claim free year. Which means, at the end of the second claim free year you would
be paying for a Rs. 5 lakhs plan but receiving the benefits of a Rs. 10 lakhs plan.

RESTORE Benefit* - If you or your family member exhausts your sum insured during
the year, Apollo Munich will restore the full amount back for usage for any new illnesses
without any paperwork or any extra charge!

Health and Wellness Portal - As a customer, you can benefit from our Health Portal.
Explore healthy living, improve your lifestyle, never miss appointments, access reports
24X7 anywhere, chat with a health coach, and lots more.

*Applicable only for Optima Restore


How To Select The Best Health Insurance Plan

Health insurance provides financial security when you need it the most. While it is important to
make sure you are getting the best deal on health insurance, the truth is that buying health
insurance can be overwhelming and confusing. Which health insurance plan is right for you
depends on numerous factors, mainly your age, and in case you are employed, do you get
insurance from your employer or you need to buy it on your own. Regardless of your situation,
here are some easy-to-follow guides for what you need to consider to choose the best health
insurance policy.

Buy health insurance when young and healthy - Typically, people tend to consider
buying a health insurance policy in the middle of their life spans when they are in their
forties or fifties. By that time, health risks might have increased with growing age.
Further, all health insurance policies come with a waiting period for 2-3 years for certain
pre-existing diseases. Buying a health insurance cover early in life ensures that you finish
the waiting period by the time you get older and you are able to avail full benefits of your
health insurance plan. Also, the premium of a health insurance policy is dependent on
customers age and health status. Hence, buying a cover at a young age will be cheaper
than buying it at a later stage.

Choose an adequate sum insured - To make an informed choice, you should be aware
of your personal priorities, after which you would be able to select the best health
insurance plan that is in line with your needs. In addition to this, you also need to ensure
that your health insurance plan offers you with adequate health care coverage by giving
due consideration to factors like your age, age of all your family members, increased
health care costs, etc. For instance, on one hand a person belonging to middle or young
age group should opt for an indemnity cover with a range of INR three to five lakhs and
on the other, a married individual should be wise enough to opt for a family floater plan
that offers extended coverage to an individual and the spouse with sum insured between
INR five lakhs to seven and half lakhs.

Individual insurance policy Vs family floater policy - You must also consider whether
you want to buy individual policies for all family members or a family floater policy for
all. In case of a young nuclear family, it is better to opt for a family floater policy that

extents coverage to two adults and two children. Compared to individual plans, family
floater plans come at a marginally incremental premium.

Understand the limits and exclusions - In order to offer effective coverage, each health
insurance plan has certain broad exclusions along with waiting periods. Thus, you should
refer to your policy documents to determine which health care services are covered and to
what extent. Furthermore, you should make it a point to ask for sample policy wordings
so as to get in depth knowledge about certain definitions, terms and conditions,
exclusions and benefits being offered while comparing different insurance policies
offered by other companies.

Claim limitation related to treatment - You should carefully note the treatmentrespective limits in the health insurance plan you choose. Certain policies cap the amount
you can claim for a particular surgery. Such limits would restrict your claim, even if there
is a large sum insured under your policy. You need to evaluate this factor to choose the
best health insurance policy.

Hospital network of the insurance company - It is important to take time in obtaining


and reviewing the details of the hospital network of the insurance company. An insurer
with an extensive list of hospitals in its network across cities should be a prime
consideration.

Choose a policy with no sub-limits - When you opt for a health insurance plan, you
should be sure that the plan has no disease specific or expenditure specific sub-limit. In
few cases, you may find such plans to be expensive but they will help you to evade
greater financial risks as well as provide you with the freedom to opt for efficient medical
treatment, that too at the best health care provider. A policy with no sub-limits will help
you avoid unpleasant situations at the time of claims.

Opt for additional coverage - Add on covers like Maternity Cover, Critical Illness etc.
that can be bought along with standard health insurance plans give additional coverage
for your specific needs. Maternity coverage offers coverage for medical expenses

incurred at the time of pregnancy and delivery. Critical illness rider is yet another add on
cover meant for illnesses designated to be critical, such as heart attack, cancer, diabetes,
kidney failure, organ transplant or paralysis. In case any of these situations, you can
benefit from these riders over and above your existing health insurance policy.

Fill up the proposal form yourself - The questions asked in a proposal form are
comprehensive as well as personal in nature, thus one should make it a point to fill up a
health insurance proposal form on their own. Furthermore, for the insurer to be able to
underwrite the policy in an appropriate manner, it is required that you fill all details
correctly. You should never hide any information or overwrite on the proposal form.
Inadequate information or exclusion of medical conditions during the proposal time can
lead to issues of delayed or non-payment of claims during times of need.

Read and understand the policy wordings - It is of utmost importance that you read the
policy wordings and other documents carefully so as to reap maximum benefits from
your respective health insurance policy. Every health insurer provides a policy wording
document that contains details about the policy. It will help you gain a thorough
understanding of the claim process, document requirement, payment options, special
conditions, coverage and exclusions.

Gradual increase in sum insured - In current times where medical inflation is


increasing rapidly, as a precautionary measure, it would be best to keep on increasing the
sum insured of your health insurance plan from time to time. You should compare various
policies available from the websites of different companies, and speak to your insurance
advisor to know what is the apt sum assured for you and your family.

Clear all your doubts before taking the final decision - Before making the final
decision of buying a health insurance policy, you should read all your policy documents
once again. Turn to your insurance advisor or the insurance company and ask as many
questions as you can to clarify all your apprehensions. It will clear any confusion or
doubts that may exist.

TYPES OF INSURANCE PLANS


Individual Health Insurance Plans
Optima Restore - The Unbelievable Health Plan

Sum Insured from 3-50 lakhs + Restore benefit to auto-reinstate your sum insured + Multiplier
benefit offers a no claim benefit of 50% every year + Pre& Post hospitalization coverage for 60
days & 180 days + All Day-care procedures + Domiciliary treatment + Expenses for Organ
Donor + Daily Cash for choosing shared accommodation + Emergency Ambulance + Health
Checkup ( for sum insured greater than 15 lacs) + E-opinion in respect of Critical illnesses +
Lifelong renewal + No additional loadings at renewal due to claims + No sublimits + No copayment + Critical Advantage Rider

Dengue Care Plan - Comprehensive & Exclusive Cover for Dengue Fever

Inpatient Treatment + Pre-hospitalization + Post-hospitalization + Shared Accommodation


Benefit + Outpatient Benefits + Same Premiums Across All Age + No Pre Policy Check-up +
Tax Benefits
Energy The Sweetest Thing for people living with Diabetes

Sum Insured from 2- 10 lacs + Hospitalization+ Pre-hospitalisation+ Post hospitalization+ 144


Day-care procedures + Expenses for Organ Donor + Emergency Ambulance + No sublimit +
lifelong renewal + No additional loadings at renewal due to claims +Personalized disease
management portal + Wellness discount & Incentives + Doctors consultation + Discounted
health offerings
Easy Health - Our Plan For Young Family

Sum Insured starting from 3 Lakhs to 50 Lakhs + Hospitalization + Pre-hospitalization + Posthospitalization + 144 Day-care procedures + Domiciliary treatment + Daily Cash + Expenses for
Organ Donor + Emergency Ambulance + Health Check-up + Maternity expenses + Coverage for
New Born Baby + Daily cash for accompanying an insured child + Critical Illness + Recovery
benefit + Critical Advantage Rider
Easy Health - Our Premium Plan

Sum Insured starting from 4 Lakhs to 50 Lakhs+ Hospitalization + Pre-hospitalization + Posthospitalization + 144 Day-care procedures + Domiciliary treatment + Daily Cash + Expenses for
Organ Donor + Emergency Ambulance + Health Check-up + Maternity expenses + Coverage for
New Born Baby + Daily cash for accompanying an insured child + Critical Illness + Dental
Treatment + Spectacles, contact lenses + E-opinion for critical illness + Recovery benefit +
Critical Advantage Rider

Easy Health - Our Most Popular Plan

Sum Insured starting from 1-5 Lakhs + Hospitalization + Pre-hospitalization + Posthospitalization + 144 Day-care procedures + Domiciliary treatment + Daily Cash + Expenses for
Organ Donor + Emergency Ambulance + Health Check-up + Critical Illness
Optima Cash - Daily Hospital Cash Plan

Sickness Hospital Cash + Sickness ICU Cash + Accident Hospital Cash + Accident ICU Cash +
Day-care Procedure Cash + Joint Hospitalization Cash (due to accident) + Convalescence Cash +
Child Birth + Parent Accommodation

Optima Plus - A Top Up Plan

Inpatient Treatment + Pre-hospitalization + Post-hospitalization + Day-care Procedures +


Domiciliary Treatment + Expenses for Organ Donor + Emergency Ambulance
Maxima - Our Comprehensive Plan That Covers For The Little Illnesses Too

Doctor Consultations + Pharmacy Expenses + Diagnostics + Dental treatment + Spectacles,


Contact lenses + Health Check-ups + Inpatient Treatment + Flexibility+ Tax benefits

Optima Super Aggregate Top up Plan

Inpatient Treatment + Pre-hospitalization + Post-hospitalization + Day-care Procedures +


Expenses for Organ Donor + Emergency Ambulance

Family Health Insurance Plans


Optima Restore - The Unbelievable Health Plan

Sum Insured from 3-50 lakhs + Restore benefit to auto-reinstate your sum insured + Multiplier
benefit offers a no claim benefit of 50% every year + Pre& Post hospitalization coverage for 60
days & 180 days + All Day-care procedures + Domiciliary treatment + Expenses for Organ
Donor + Daily Cash for choosing shared accommodation + Emergency Ambulance + Health
Checkup ( for sum insured greater than 15 lacs) + E-opinion in respect of Critical illnesses +
Lifelong renewal + No additional loadings at renewal due to claims + No sublimits + No copayment + Critical Advantage Rider
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Easy Health - Our Most Popular Plan

Sum Insured starting from 2-5 Lakhs + Hospitalization + Pre-hospitalization + Posthospitalization + 140 Day-care procedures + Domiciliary treatment + Daily Cash + Expenses for
Organ Donor + Emergency Ambulance + Health Check-up + Critical Illness
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Easy Health - Our Plan For Young Family

Sum Insured starting from 3 Lakhs to 50 Lakhs + Hospitalization + Pre-hospitalization + Posthospitalization + 140 Day-care procedures + Domiciliary treatment + Daily Cash + Expenses for
Organ Donor + Emergency Ambulance + Health Check-up + Maternity expenses + Coverage for
New Born Baby + Daily cash for accompanying an insured child + Critical Illness + Recovery
benefit + Critical Advantage Rider
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Easy Health - Our Premium Plan

Sum Insured starting from 4 Lakhs to 50 Lakhs+ Hospitalization + Pre-hospitalization + Posthospitalization + 140 Day-care procedures + Domiciliary treatment + Daily Cash + Expenses for
Organ Donor + Emergency Ambulance + Health Check-up + Maternity expenses + Coverage for
New Born Baby + Daily cash for accompanying an insured child + Critical Illness + Dental
Treatment + Spectacles, contact lenses + E-opinion for critical illness + Recovery benefit +
Critical Advantage Rider
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Optima Super Aggregate Top up Plan

Inpatient Treatment + Pre-hospitalization + Post-hospitalization + Day-care Procedures +


Expenses for Organ Donor + Emergency Ambulance
Travel Insurance Plans
Easy Travel - Individual

Coverage for Medical Treatment + Dental Treatment + Repatriation of mortal remains + Loss of
Passport + Personal Accident + Personal Accident (Common Carrier) + Personal Liability +
Hijack Daily Allowance + Total Loss of Checked-in Baggage + Delay of Checked in baggage +
Financial Emergency Cash + Trip Delay + Hospital Daily Allowance + Trip Cancellation + Trip
Curtailment + Missed Connection
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Easy Travel - Family

Medical Treatment + Dental Treatment + Repatriation of mortal remains + Loss of Passport +


Personal Accident + Personal Accident (Common Carrier) + Personal Liability + Hijack Daily
Allowance + Total Loss of Checked-in Baggage + Delay of Checked in baggage + Financial
Emergency Cash
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Easy Travel - Senior Citizen

Medical Treatment + Dental Treatment + Repatriation of mortal remains + Loss of Passport +


Personal Accident + Personal Accident (Common Carrier) + Personal Liability + Hijack Daily
Allowance + Total Loss of Checked-in Baggage + Delay of Checked in baggage + Financial
Emergency Cash
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Easy Travel - Annual Multi Trip Plan

Medical Treatment + Dental Treatment + Repatriation of mortal remains + Loss of Passport +


Personal Accident + Personal Accident (Common Carrier) + Personal Liability + Hijack Daily
Allowance + Total Loss of Checked-in Baggage + Delay of Checked in baggage + Financial
Emergency Cash + Trip Delay + Hospital Daily Allowance + Trip Cancellation + Trip
Curtailment
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Educare

Medical Treatment + Dental Treatment + Repatriation of mortal remains + Medical evacuation +


Medical Cover for trips back in India + Balance Period of Policy 30 days + Accidental covers +
Total Loss of Checked-in Baggage + Delay of Checked in baggage + Loss of Passport + Study
Interruption + Sponsor protection + Compassionate visit + Personal liability + Bail bond +
Personal Liability + Mental/Nervous disorder, Inc. alcohol & drug dependency + Inter-collegiate
sports injuries + Cancer screening and mammography examinations + HIV cover + Financial
Emergency Assistance

Personal Accident Plans


Premium Plan

Sum Insured : 5 lacs 5 crores + Accidental death + Permanent total disablement + Permanent
partial disablement + Emergency ambulance + Family transportation + Transportation of mortal
remains + Education fund + Temporary total disablement + Broken bones + Transportation of
imported medicines + Purchase of blood + Modification of residence / vehicle + Accident
hospitalisation (in-patient)

Standard Plan

Sum Insured: 1 50 lacs + Accidental death + Permanent total disablement + Permanent partial
disablement + Emergency ambulance + Family transportation + Transportation of mortal remains
+ Education fund + Temporary total disablement + Accident medical expenses

Optima Senior

In-Patient Hospitalisation - Covers medical expenses for hospitalisation for more than
24 hrs.

Pre-Hospitalisation - The medical expenses that you incur due to illness during 30 days
immediately before you are hospitalised.

Post-Hospitalisation - The medical expenses you incur in the 60 days immediately after
you are discharged from hospital.

Day-Care Procedures - The medical expenses for enlisted 140 day-care procedures,
which do not require 24 hours hospitalization due to technological advancement, are
covered.

Domiciliary Treatment - The treatment expenses involved in getting a treatment done at


home which otherwise would need hospitalization.

Organ Donor - Treatment expenses for the organ donor at the time of organ transplant.

Emergency Ambulance - Expenses incurred if ambulance service is used on the way to


hospital for hospitalization (up to Rs. 2000).

E-Opinion in Case of Critical Illness(optional) - A second opinion will be arranged


from a medical practitioner who is in the Apollo Munich panel (One opinion per policy
year).

Copayment applicable on room rent type & specific illness & surgeries.
Others Benefits

Cumulative Bonus - You get a Cumulative Bonus (CB) of 5% for every claim-free
policy year provided policy is renewed with us without a break.

Cashless Service - You need to obtain a pre-authorization for all planned admissions
atleast 48 hours prior to actual admission or regularize any emergency admission within
24 hours post the admission. The details of the process and the documentation
requirements are given in the guide-book sent along with the policy.

Sum Insured Enhancement - Sum Insured can be enhanced only at the time of renewal
subject to no claim have been lodged/ paid under the policy. If the insured increases the
sum insured one grid up, no fresh medicals shall be required. In cases where the sum

insured increase is more than one grid up, the case shall be subject to medicals. In case of
increase in the sum insured waiting period will apply afresh in relation to the amount by
which the sum insured has been enhanced. However, the quantum of increase shall be at
the discretion of the company.

Portability - If you are insured with some other companys health insurance and you
want to shift to us on renewal, you can. Our portability policy is customer friendly and
aims to achieve the transfer of most of the accrued benefits and makes due allowances for
waiting periods etc.

Tax Benefits - With Optima Senior Plan, you can presently avail tax benefits for the
premium amount under Section 80D of the Income Tax Act. (Tax benefits are subject to
changes in Tax Laws)

ANALYSIS
"Apollo Munich Health Insurance Company Limited : Company Profile and SWOT Analysis"
contains in depth information and data about the company and its operations. The profile
contains a company overview, key facts, major products and services, SWOT analysis, business
description, company history, mergers & acquisitions, key employees, company locations and
subsidiaries as well as employee biographies. Summary This report is a crucial resource for
industry executives and anyone looking to access key information about "Apollo Munich Health
Insurance Company Limited" The report utilizes a wide range of primary and secondary sources,
which are analyzed and presented in a consistent and easily accessible format. World Market

Intelligence strictly follows a standardized research methodology to ensure high levels of data
quality and these characteristics guarantee a unique report. Scope - Examines and identifies key
information and issues about "Apollo Munich Health Insurance Company Limited" for business
intelligence requirements. - Studies and presents the company's strengths, weaknesses,
opportunities (growth potential) and threats (competition). Strategic and operational business
information is objectively reported. - The profile also contains information on business
operations, company history, major products and services, key employees, and locations and
subsidiaries. Reasons To Buy - Quickly enhance your understanding of "Apollo Munich Health
Insurance Company Limited" - Gain insight into the marketplace and a better understanding of
internal and external factors which could impact the industry. - Increase business/sales activities
by understanding your competitors businesses better. - Recognize potential partnerships and
suppliers.

FINDINGS
It is designed according to the health needs of majority of people.
It is coupled with the best facilities and services.
It can be purchased at a cost-effective price.
There should be the facility of lifelong renewal.
It should have a simple policy issuance procedure, such that there are no hassles faced by
them.
Cashless hospitalization should be offered in a wide network of hospitals.

'Healthline facilities should be abetted by well qualified and experienced doctors so that one
can get the right guidance when required.
Terms and conditions of the plan should be free of jargons.
There should not be any sub-limits in case of coverage offered.
Claims process should be easy and simple.
Provider should have earned much positive reviews for its services
The plan offers an extensive coverage for:

Inpatient Hospitalization expenses

140 day-care procedures

Pre-hospitalization

Post-hospitalization

Emergency Ambulance

Surgical appliances

Operation theatre

Domiciliary treatment expenses

Cost of prosthetic devices

Intensive Care Unit

Purchase of Blood

Purchase of Oxygen

CONCLUSION
Apollo Munich Health Insurance Company Limited is the joint venture between Apollo
Hospitals Group and Munich Health. Apollo Hospitals Group is the Asias largest integrated
healthcare provider. Munich Health is a world leader in the field of health insurance.
Apollo Munich offers Health Insurance for Senior citizens, Individual Health Insurance policies,
Family floater health insurance policies and Group health insurance policies. Apollo Munich
Health Insurance Plans cover travel insurance, healthcare insurance and personal accident
insurance. It mainly targets on health insurance for best health care. Men and Women of any age
can take this Apollo Munich Health Insurance Plan. Dependent children and parents are also
covered based on the type of plan. As per your requirements you can select Apollo Munich
health insurance plan, since all these health products are tailor made satisfying the needs of
people.
Wide Sum Assured options: You can choose your sum insured which starts from 1 lakh to 15
lakhs. Choose as per your requirement and enjoy the best Apollo Munich health insurance plan
with reasonable premium.
Portability: If you (policyholder) are insured under another Insurers health insurance policy
you can transfer to Apollo Munich health insurance plan with all your accrued benefits after due
allowances for waiting periods.
Tax Benefits: You can get tax benefit on apollo munich health plans for premiums paid under
section 80 D as per IT (Income Tax) Act.
Lifelong Renewal: Get Apollo Munich Health Insurance Renewal for lifetime and be secure
against medical/hopitalization expenses.
Quick Claims Approval: Apollo Munich Network Hospitals across India, Cashless services,
reimbursement claim process etc. all these make the claims approval process quick and easy.