Apollo Munich Easy Health Individual Plan

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Introduction/Overview

The Easy Health Individual Plan protects you not only from unforeseen emergency expenses but also offers a comprehensive cover for medical treatment of illnesses and accidents requiring in-patient hospitalization. The Plan offers coverage on individual sum insured basis & also offers an add-on optional cover for listed Critical Illnesses.

This plan does not cover maternity expenses, new born baby coverage and recovery benefit.

Key Features

  • There is no maximum cover ceasing age on renewals of the subject policy.
  • The policy will be issued for a period for 1 or 2 years period, the sum insured & benefits will applicable on policy year basis.
  • This policy can be issued to an individual and/or family.
  • The policy offers option of covering on individual sum insured basis – Easy Health Individual Health Insurance Plan and on family floater basis – Easy Health Family Floater Insurance Plan.
  • The family includes spouse, dependent children, dependent parents, parent-in-law, grandparents and grandchildren.
  • A maximum of 6 members can be added in a single policy, whether on an Individual or Family floater basis.
  • In a family floater policy, a maximum of 2 adults and a maximum of 5 children can be included in a single policy. The 2 adults can be a combination of Self, Spouse, Father, Father-in-law, Mother or Mother-in-law, Grand Father, Grand Mother.
  • In an individual policy, a maximum of 4 adults and a maximum of 5 children can be included in a single policy. The 4 adults can be a combination of Self, Spouse,

Father, Father-in-law, Mother or Mother- In-law, Grand Father, Grand Mother.

  • The Sum Insured of the dependent insured members should be equal to or less than the Sum Insured of the Primary Insured member. In case where two or more

Children are covered, the sum insured for all the children must be same. Sum insured of all Dependent Parents and Dependent Parent in law must be same.

 

Benefits

Sum insured per insured person per policy year (Rs In Lakh)

1 lakh, 2lacs, 3lacs, 4lacs, 5 Lacs

 

In patient treatment

Covered

 

Pre- hospitalization

Covered

Post- hospitalization

Covered

Day care procedures

Covered

Domiciliary treatment

Covered

Organ Donor

Covered

Emergency Ambulance

Up to Rs.2000 per hospitalization

Ayush Benefit

Up to Rs. 20,000

 

Daily Cash for choosing shared accommodation

Rs. 500 per day

Maximum Rs.3000

Daily Cash for accompanying an insured child

Not Covered

New born baby

Not Covered

Recovery benefit

Not Covered

Maternity expenses

Not Covered

Outpatient dental treatment

Waiting period 3 years

Not Covered

Spectacles, contact lenses, hearing Aid

Every third year

Not Covered

E-opinion in respect of critical illness

Not Covered

Critical illness rider

Optional, if opted then critical illness sum insured 50% or 100% of in- patient sum insured subject to minimum of Rs.100,000

Health Check up

Up to 1% of sum insured per insured person, only once at the end of a block of every continuous four claim free years.

 

Details about Premium

Annual premium in Rupees

Individual Sum Insured

Age Band

1 lakhs

2 lakhs

3 lakhs

4 lakhs

5 lakhs

0-17

1,802

2,689

3,362

4,168

4,572

18-35

2,226

3,213

4,016

4,980

5,462

36-45

2,865

3,636

4,545

5,636

6,181

46-50

4,125

5,319

6,648

8,244

9,042

51-55

5,061

6,725

8,406

10,423

11,432

56-60

5,749

8,681

10,852

13,456

14,758

61-65

7,983

12,056

15,070

18,686

20,495

66-70

11,016

16,635

20,793

25,784

28,279

71-75

13,308

20,097

25,121

31,150

34,164

76-80

15,970

24,116

30,145

37,380

40,997

>80

18,365

27,733

34,667

42,987

47,147

 

The premium is also given on the floater basis consisting of following categories:

  • Floater (1 adult-1 children)
  • Floater (1 adult-2 children)
  • Floater (1 adult-3 children)
  • Floater (2 adult-0 children)
  • Floater (2 adult-1 children)
  • Floater (2 adult-2 children)
  • Floater (2 adult-3 children)

 

Policy Details

Sum Insured: 1Lakh to 5 Lacs

Coverage type: Individual/ family

Grace period: Grace Period of 30 days for renewing the policy is provided under this policy.

Portability: Easy Health policy offers you transfer the accrued benefits and make due allowances for waiting periods as per guidelines on portability if you are insured continuously and without interruption under an indemnity based health insurance policy of any Indian non-life insurer and you want to shift to us on renewal.

If the Insured person transfers from any other insurer and enhances the sum insured, then the portability benefits will be offered only in respect to the previous sum insured.

Renewal Policies: The Easy Health policy offers lifelong renewability i.e. there is no maximum cover ceasing age in this policy

Policy termination: You may terminate the policy at any time by giving us a written notice. The cancellation shall be from the date of receipt of such written notice. Premium shall be refunded as per table below IF AND ONLY no claim has been made under the Policy

 

1 Year Policy

2 Year Policy

Length of Time Policy in force

Refund of premium

Length of Time Policy in force

Refund of premium

Up to 1 month

75%

Up to 1 month

87.5%

Up to 3 months

50%

Up to 3 months

75%

Up to 6 months

25%

Up to 6 months

62.5%

Exceeding 6 months

Nil

Up to 12 months

48%

 

 

Up to 15 months

25%

 

 

Up to 18 months

12%

 

 

Exceeding 18 months

Nil

 

Free look period: You have a period of 15 days from the date of receipt of the policy document to review the terms and conditions of the policy. If you have any objections to any of the terms and conditions, you have the option of cancelling the policy stating the reasons for cancellation and you will be refunded the premium paid by you after adjusting the amounts spent on any medical check-up, stamp duty charges and proportionate risk premium.

Additional Features or Riders

  • Sum Insured Enhancement - Sum Insured can be enhanced only at the time of renewal subject to no claim have been lodged under the policy. In cases where the sum insured increase is more than one grid up, the case shall be subject to medicals.
  • Tax Benefits - 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)
  • Discounts
    • Family Discount of 5% if 2 members are covered and 10% if 3 or more family members are covered under Easy Health Individual Health Insurance Plan.
    • 7.5% Discount on premium if Insured Person is paying premium of 2 years in advance as a single premium.

Exclusions

  • All treatments within the first 30 days of cover except any accidental injury.
  • Any pre-existing condition will be covered after a waiting period of 3 years
  • 2 years waiting period for specific diseases like cataract, hernia, joint replacement surgeries, surgery of hydrocele etc.
  • Expenses arising from HIV or AIDS and related diseases.
  • Congenital diseases, mental disorder or insanity, cosmetic surgery and weight control treatments
  • Abuse of intoxicant or hallucinogenic substances like intoxicating drugs and alcohol.
  • Hospitalization due to war or an act of war or due to a nuclear, chemical or biological weapon and radiation of any kind.
  • Pregnancy, dental treatment, external aids and appliances unless covered under the specific Easy Health Insurance Plan.

Documents Required

  • Our claim form, duly completed and signed for on behalf of the Insured person
  • Original bills with detailed breakup of charges (including but not limited to pharmacy purchase bill, consultation bill, and diagnostic bill) and any attachments like receipts or prescriptions in support of any amount claimed.
  • Original payment receipts
  • All reports, including but not limited to all medical reports, case histories, investigation reports, treatment papers, discharge summaries.
  • Discharge Summary containing details of date of admission and discharge.
  • Invoice/Sticker of the Implants.
  • A precise diagnosis of the treatment for which a claim is made.
  • A detailed list of the individual medical services and treatments provided and a unit price for each.
  • Prescriptions that name the Insured Person and in the case of drugs: the drugs prescribed, their price and a receipt for payment.
  • Previous treatment record along with reports, if any
  • Treating doctor’s certificate regarding the duration.
  • MLC/ FIR copy/ certificate regarding abuse of Alcohol/intoxicating agent, in case of Accidental injury

Eligibility

  • Minimum Age- 5 years
  • Maximum Age- 65 years
  • Child between 91 days and 5 years can be insured provided either parent is getting insured under this Policy.
  • Maximum 6 members can be added in a single policy. In an individual policy, a maximum of 4 adults and a maximum of 5 children can be included in a single policy. The 4 adults can be a combination of Self, Spouse & either set of parents or grandparents or parents in Law.