Apollo Munich Maxima Health Insurance Policy

*Please note that the quotes shown will be from our partners

Introduction:

This plan offers coverage for regular illnesses, including stomach aches to chronic ailments.

Key Features:

Outpatient Benefits

  • Doctor Consultation, medicine bills and laboratory/diagnostic tests of you or your family members (as per plan opted) is covered.
  • Looking after your daily needs: Looks after dental check-ups (excluding cosmetic treatment), spectacles and contact lenses (one pair been prescribed by eye specialist) offering you a personal experience.
  • Annual Health Check-up Benefit - Any person above the age of 18 years can undergo an annual health check-up (Above 45 years can opt for this benefit from second year)

Plan Benefits

  • In-Patient Hospitalisation –It covers you if you are hospitalised for more than 24 hours.
  • Post-Hospitalisation - It covers expenses you incur in the 60 days immediately after release from the hospital
  • Day-Care Procedures - It covers you even when you are not in the hospital but at the ease of your home (140 day-care procedures) and domiciliary treatment.
  • Organ Donor - It covers you and your donor.
  • Daily Cash for Choosing Shared Accommodation - A lump sum amount given for selecting a shared room in a network hospital.
  • Emergency Ambulance - Expenses incurred on ambulance services, up to Rs. 2000.
  • Daily Cash for Accompanying an Insured Child (less than 12 years) –Your child is not left alone; as the plan provides cash to even the accompanying adult.
  • New Born Baby –It takes care for even your future needs and policy can be extended to even your baby.
  • Maternity Expenses - The maternity expenses incurred both before and after child birth procedures are covered after a waiting period of 4 years.

Additional Cover for Critical Illness (optional) –It provides an additional cover for ailments which includes Cancer of specified severity, Open Chest CABG, First Heart Attack of specified severity, Kidney Failure requiring regular dialysis, Major Organ/Bone Marrow Transplant, Multiple Sclerosis with Persisting Symptoms, Permanent Paralysis of Limbs, Stroke resulting in Permanent Symptoms. This benefit if opted is applicable to all family members on Individual Sum Insured Basis equivalent to Rs.300, 000.

Additional Benefits:

Renewal Benefits for Inpatient Treatment - A cumulative bonus of 10% for every claim free year up to a maximum of 50% of the in-patient sum insured. In the event of a claim, the cumulative bonus is reduced by 10% on the next renewal.

Renewal Benefit for Out-Patient Treatment –You have the advantage of carrying forward 50% of any unutilized entitlement certificates to the next policy year (excludes the Annual Health Check-up).

Cashless Service - You need to obtain a pre-authorization for all planned admissions at least 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.

Portability – Shifting to the policy from another company is hassle free and due allowances are provided for delay and transfer of most of the accrued benefits.

Tax Benefits - Avail tax benefits for the premium amount under Section 80D of the Income Tax Act.

 

Eligibility Criteria:

  • Starting age: 91 days Maximum: 65 Years
  • Policy covering a period of one year.
  • Individual or family plan. For family (spouse, dependent children upto 2 and dependent parents)
  • Premium is charged as per the age of the eldest member assured.
  • Online health assessment.
  • Expert opinion on diet, exercise and yoga.
  • E- Storage facilities to store medical reports and other documents and access it anytime, anywhere.
  • Timely and customized offers & discounts on heath products & services.
  • Alerts to remind you of check-ups and appointments.
  • Exclusive health newsletter & helpline services.

Health Line Services & Discounts at listed partner’s network are available for all sum insured. You just need to contact the customer support and quote your customer ID to reach the experts and avail their help in primary consultation, health-related counselling, individual referrals, health information, nutrition and diet.

Policy Details:

Sum insured: In-patient Sum Insured per policy of `300,000. Out-patient Sum Insured per policy as mentioned in Schedule of benefits and Critical Illness (Optional Benefit) Sum Insured per Insured `300,000/-.

In-patient Module:

Cumulative Bonus - Cumulative bonus of 10% of the Sum Insured for every claim free year accumulating up to 50%. In the event of a claim, the Cumulative bonus will be reduced by 10% of sum insured on renewal.

Renewal Incentives:

• Out-patient Module

Carry Forward Bonus - If any available Entitlement Certificates are not used by Insured Person in a Policy Year, then50% of these Entitlement Certificates is carried forward to the next Policy Year except for Annual Health Check-Up.

Free Look Period: It is a period of 15 days from the date of receipt of the Policy document to review the terms and conditions of this Policy. If you have any objections to any of the terms and conditions, you can cancel the Policy stating the reasons and premium paid will be refunded after adjusting the amounts spent on any medical check-up, stamp duty charges and proportionate risk premium.

Premium Details

1 member between18-45 Years

2 members between18-45 Years

Maxima Premium (Incl. Tax)

15500

 

21500

Tax Benefit U/S 80D

4635

 

4635

Entitlement Certificates (for OPD)

10100

 

14900

Effective Inpatient Premium

765

 

1965

 

Premium Rates 

Annual Premium in INR [Excluding Service tax and applicable cess]

Base Product*

Age Group

1 member

2 members

2 Adults +2 children

0-17

12682

-

-

18-45

13795

19135

25810

46-60

16910

23585

30705

>60

24831

35778

42720

 

 

 

 

 

Optional Benefit Critical Illness* [On individual Sum Insured basis]

Age Group

Sum Insured = 3 Lac

0-17

92

18-45

785

46-60

3741

61-70

10983

 

Sum Insured Per Policy

1 Member

2 Members

2 Adults + 2 Children

Out-patient consultations*

4 Consultations

1 Consultations

8 Consultations

Diagnostic Tests#

5000

5000

7000

Pharmacy #

Outpatient Dental Treatments#

Spectacles, Contact Lenses#

Annual Health Check-up^

1 Entitlement Certificate

2 Entitlement Certificates

2 Entitlement Certificate

 

* The reimbursement against non-network Outpatient Consultations is restricted up to lower of actual expenses or 400.

 

In-patient Module

Sum Insured per policy

300000

300000

300000

In-patient treatment

Covered

30 days, can be  increased to 60 days

60 days, can be  increased to 90 days

Covered

Covered

Pre-hospitalization

Post-hospitalization

Day care products

Domiciliary treatment

Daily cash for choosing shared accommodation

 

Organ donor

Covered

Emergency ambulance

Up to  2000 per hospitalisation

Daily Cash for Accompanying an Insured child

300 per day; Maximum Rs 9,000

Maternity Expenses ** Waiting Period 4 years

Normal Delivery- Rs 15,000; Caesarean Delivery- 25,000 (Including Pre/Post Natal limit of 1,500 and Infant baby limit of 2,000)

New-born baby

Optional

Optional benefit

Critical illness

300000

 

*Above premium rates may vary. Please see the policy wordings for more information.

Renewal Policy:

  • Lifelong renewability: No maximum cover ceasing age in this policy
  • Grace Period of 30 days for renewal.
  • Waiting periods as mentioned in the policy wording gets reduced by 1 year on every continuous renewal of your Maxima Insurance policy.
  • Any change in benefits or premium (other than due to change in age) will be done with the approval of the IRDA and will be intimated at least 3 months in advance.

Exclusions:

  • All treatments within the first 30 days of cover excluding accidental injury.
  • Any pre-existing condition will be covered after a waiting period of 3 years.
  • Waiting period of 3 years 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.
  • Items of personal comfort and convenience.
  • Experimental, investigative and unproven treatment devices and pharmacological regimens

Documents Required:

  • Completed proposal form
  • Pre Policy Check-up (PPC) depending on the age and sum insured. For accepted PPC cases, we will reimburse 100% of the expenses incurred subject to maximum of INR 2,000/- per insured person.