Apollo Munich Health On-Health Insurance

Features and Benefits:

1. Lifelong Renewal – Renew your cover lifelong and stay covered forever.
2. No sublimit on Room Rent – You can get the room you like and the treatment you
deserve without a hassle
3. Cashless Transactions – This plan enables you to get treated on a cashless basis across
4000 hospitals in over 800 cities
4. No claim loading –No loading on your renewal premium even if you claimed after
taking our policy
5. Quick Turnaround time – 90% of pre-authorization is done within 2 hours
6. Quick claim payment – When it comes to claim payment, we’re one of the fastest in
the industry to honor every genuine claim
7. Certified Associates – We are equipped with well-trained field partners and sales
executive
8. Easy Upgrade – You can upgrade your cover to the next slab at the time of your
renewal.
9. No medicals on enrolment – Upto 50 years and/or for sum assured upto Rs 15 lakhs
10. Claim can be done through cashless or reimbursement of bills

Coverage available for:

1. In-patient Treatment - Covers hospitalisation expenses for period more than 24 hrs.
2. Pre-Hospitalisation - Medical expenses incurred in 60 days before the hospitalisation.
3. Post-Hospitalisation - Medical expenses incurred in 180 days after the hospitalisation.
4. Day-Care procedures - Medical expenses for day care procedures.
5. Domiciliary Treatment - Medical expenses incurred for availing medical treatment at
home which would otherwise have required hospitalisation.
6. Organ Donor- Medical expenses on harvesting the organ from the donor for organ
transplantation.
7. Emergency Ambulance - Upto Rs. 2,000 per hospitalisation for utilizing ambulance
service for transporting insured person to hospital in case of an emergency.
8. Daily Cash for choosing shared accommodation - Daily cash amount if hospitalised in
shared accommodation in network hospital and hospitalisation exceeds 48 hrs.
9. E-Opinion in respect of a Critical Illness - Second opinion by a Medical Practitioner
from Our panel, for a Critical Illness suffered during the policy period.

Restore Benefit
Restore Benefit automatically re-instates the basic sum insured, if the basic sum insured and
multiplier benefit has been exhausted during the policy year.

Basic sum insured will be re-instated only once in a policy year.

Restore Sum Insured can be used for only future claims made by the Insured Person and not against
any claim for an illness/disease (including its complications) for which a claim has been paid in the
current policy year.

If the restore sum insured is not utilised in a policy year, it shall not be carried forward to any
subsequent policy year.

No additional premium would be required in case the Restore Benefit is triggered.

Basic sum insured will be re-instated only once in a policy year. The Restore benefit can be
reinstated once every year and there would be no policy lifetime limit.

Eg of restore benefit:

Consider a Health On policy with

Base Sum Insured: 3 lacs
Multiplier Benefit: 1.5 lacs
Hence total cover in the given year is 4.5 lacs
Restore
Amount of cover under the policy for remainder of the
Scenarios Benefit
year
Triggered
Scenario 1: A
3 lacs (Restore benefit is triggered and the base sum insured
claim of 4.5 lacs Yes
is reinstated)
is incurred
1.5 lacs (Restore benefit not triggered as the Restore Benefit
Scenario 2: A will be triggered as the Restore Benefit will be triggered
claim of 3 lacs in No only if the insured person completely exhaust the total cover
incurred eligible for the year i.e. Base Sum Insured and Multiplier
Benefit)
2.5 lacs (Restore benefit not triggered as the Restore Benefit
Scenario 3: A
will be triggered only if the insured person completely
claim of 2 lacs in No
exhaust the total cover eligible for the year i.e. Base Sum
incurred
Insured and Multiplier Benefit)

Health On Individual

Basic Sum Insured

per Insured Person
3.00 , 5.00, 10.00, 15.00 20.00, 25.00, 50.00
per policy Year (Rs.
In Lakh)
1a) In-patient
Covered Covered
Treatment
1b) Pre-
Covered, upto 60 Days Covered, upto 60 Days
Hospitalization
1c) Post-
Covered, upto 180 Days Covered, upto 180 Days
Hospitalization
1d) Day Care
Covered Covered
Procedures
1e) Domiciliary
Covered Covered
Treatment
1f) Organ Donor Covered Covered
Upto Rs.2,000 per
1g) Ambulance Cover Upto Rs.2,000 per Hospitalisation
Hospitalisation
1h) Daily Cash for
Rs.1000 per day, Maximum
choosing Shared Rs.800 per day, Maximum Rs.4,800
Rs.6,000
Accommodation
1i) E-Opinion in
respect of a Critical Covered Covered
Illness
Equal to 100% of Basic Sum Equal to 100% of Basic Sum
2) Restore Benefit
Insured Insured
Covered
20,25 and
Sum Insured (In 3 & 5 10 & Sum Insured (In Rs.)
50 lacs
Rs.) Lac 15 Lac
3) Health Checkup Annual Health
Annual Health
checkup per insured 10,000
checkup per policy 2500 5000
(In Rs.)
(in Rs.)
Bonus of 50% of the Basic Sum Bonus of 50% of the Basic Sum
Insured for every claim free year, Insured for every claim free year,
maximum upto 100%. In case of maximum upto 100%. In case of
4) Multiplier Benefit
claim, bonus will be reduced by claim, bonus will be reduced by
50% of the Basic Sum Insured at the 50% of the Basic Sum Insured at
time of renewal the time of renewal

Renewal Benefit:
1. Multiplier Benefit - 50% increase in your basic sum insured for every claim free year,
subject to a maximum of 100%. In case a claim is made during a policy year, the limit
under this benefit would be reduced by 50% of the basic sum insured in the following
year. However this reduction will not reduce the Sum Insured below the basic Sum
Insured of the policy.
2. Health Check-up - At the end of a block of every continuous 2 policy years. We will
pay upto the stated percentage of the Sum Insured towards cost of the medical check-
up.

Waiting Period:
1. 30 days for all illnesses (except accident) in the first year and is not applicable in
subsequent renewals
2. 24 months for specific illness and treatments in the first two years and is not
applicable in subsequent renewals
3. Pre-existing Diseases will be covered after a waiting period 36 months.
Policy Exclusion
War or any act of war, nuclear, chemical and biological weapons, radiation of any kind, breach of law
with criminal intent, intentional or attempted suicide, participation or involvement in naval, military
or air force operation, racing, diving, aviation, scuba diving, parachuting, hang-gliding, rock or
mountain climbing, abuse of intoxicants or hallucinogenic substances such as intoxicating drugs and
alcohol, treatment of obesity and any weight control program, Psychiatric, mental disorders,
congenital internal or external diseases, defects or anomalies, genetic disorders; sleep apnoea,
expenses arising from HIV or AIDs and related diseases, sterility, treatment to effect or to treat
infertility, any fertility, sub-fertility, surrogate or vicarious pregnancy, birth control, circumcisions,
treatment for correction of refractive error, plastic surgery or cosmetic surgery unless required due
to an Accident, Cancer or Burns, any non allopathic treatment.

Tax Benefit
For premium paid on policies as per section 80D of the Income Tax Act. Tax benefits are subject to
income tax laws.

Age of Entry:
Minimum entry age is 91 days. Children between 91 days and 5 years can be
Minimum
insured provided either parent is getting insured under this policy

Maximum entry is age is 65 years with no cover ceasing age

Maximum

No of members that can be covered:

A maximum of 6 members can be added in a single policy, whether individual or floater basis. In an
individual policy a maximum of 4 adults and maximum of 5 children can be covered. The 4 adults can
be a combination of self, spouse and either set of dependent parents or parents in law. In a family
floater policy, a maximum of 2 adults and a maximum of 5 children can be covered.

Maximum 6 members only can be insured.

Multiplier Benefit:
Multiplier Benefit is a no claim benefit and will be offered as renewal incentive.
Under Multiplier benefit, a Bonus of 50% of the basic sum insured will be provided for every claim
free year accumulating up to 100%. In the event of a claim, the bonus will be reduced by 50% of the
Basic Sum Insured at the time of renewal. However this reduction will not reduce the Sum Insured
below the basic Sum Insured of the policy.

Scenario: If client opts for Health On Policy with 5 Lacs Sum Insured & claimed in 3th year.
Multiplier Benefit will be functional as follows-:

  Year 1 Year 2 Year 3 Year 4 Year 5

Base Sum Insured 5 5 5 5 5
Multiplier Benefit NA 2.5 5 2.5 5
Total Amount (at the beginning of the year)   7.5 10 7.5 10

In Multiplier policy if customer has not claimed anything in

the first year then he will get bonus in the next year eg. If he
has 5 lakh SI then he will get 2.5 lakhs as multiplier benefit
then the next year no claim again he will get additional 2.5
lakhs so totally in 3rd year he will have 10 lakhs SI . In 3rd
year if customer claims any amount the next year his SI will
be 7.5 lakhs and not 10 lakhs ( imp point) as SI will go back
to the previous SI amount and not with multiplier benefit.
Eg: If 2nd year if customer claims the SI amount then his 3rd
year SI will be 5 lakhs and not 7.5 lakhs as he has already
claimed the amount.
Discounts Available
A family discount of 10% would apply if 2 or more family members are covered under same Policy.
Furthermore, a discount of 7.5% can be availed if insured person is paying 2 year premium in
advance