• Apollo Munich Maxima Health - Health Insurance Plan

    Car Insurance
    • Premiums as low as Rs12/day for coverage of Rs.4 Lakhs*
    • 10,000+ hospitals for cashless treatment
    • Claim up to Rs. 55,000 deduction under section 80D**

    Most of the regular hospital visits in a person’s life can be attributed to minor health issues like fever, sore throat, headache, etc. While this may not be as expensive as hospitalisation treatment, these expenses could accumulate over a period of time and drain out your savings. Outpatient treatment coverage is not a feature of most health insurance policies in the market. Apollo Munich Maxima Health is a health insurance plan that has a portion of its benefits dedicated just for outpatient treatment expenses. The benefits of this plan come in two different parts, and they provide coverage for OPD treatment as well as hospitalisation.

    Eligibility for Apollo Munich Maxima Health

    People who meet the following eligibility criteria can enroll themselves in Apollo Munich Maxima Health:

    • The proposer of the policy cover must be between 18 years and 65 years.
    • The maximum entry age of policyholders is capped at 65 years.
    • Dependent children can be enrolled in this cover from their 91st day of birth.
    • Lifelong renewability option is available for those who have entered within the entry age limit.
    • Up to 2 adults and 2 children can be covered in the same policy.

    Features of Apollo Munich Maxima Health

    Some of the key features of Apollo Munich Maxima Health can be listed as follows:

    • This policy is available on an individual basis and a family floater basis.
    • The maximum sum insured amount available for hospitalisation expenses is Rs.3 lakh.
    • Pre-existing illnesses can be covered after 3 years of continuous policy coverage.
    • Some specific conditions like cataract, hernia, hydrocele, joint replacement surgery, etc. have a waiting period of 2 years. The complete list of these conditions can be found in the policy document.
    • Outpatient consultations for pre-existing conditions are covered under this policy without any waiting period.
    • Pre and post hospitalisation expenses are covered for up to 30 days and 60 days respectively under this cover.
    • Yearly health checkup is available for people over the age of 18 years. For people over 45 years of age, this benefit is available from the second year onwards.
    • A cumulative bonus of 10% (in-patient hospitalisation) is available for every claim-free year subject to a maximum of 50%. Once a claim is made, this cumulative bonus will get reduced by 10%.
    • About 50% of unutilized outpatient treatment benefits (entitlement certificates) can be carry forwarded to the next year.
    • In line with the IRDAI regulations, Apollo Munich offers a free look period of 15 days for policyholders to review this policy’s terms and conditions.
    • A grace period of 30 days from the date of expiry is offered for policyholders to renew this policy. However, there will be no coverage for the days during which premium charges are not paid.
    • The premium charges paid for this policy cover is eligible for income tax relief as per Section 80D of the Income Tax Act.

    Benefits of Apollo Munich Maxima Health

    The benefits available under Apollo Munich Maxima Health can be divided into two different parts. The outpatient coverage includes a wide range of benefits including pharmacy drugs, diagnostic tests, doctor consultations, external medical aids, etc. Hospitalisation benefits are also available for a range of medical expenses incurred during hospital stay. The range of benefits available under this cover can be given as follows:

    Part A: Outpatient Benefits

    Benefits Extent of Coverage
    Outpatient consultations 1 member - 4 consultations per year 2 members - 6 consultations per year 2 adults and 2 children - 8 consultations per year
    Coverage for pharmacy expenses, diagnostic tests, dental treatments, spectacles, contact lens, etc. 1 member - up to Rs.5,000 2 members - up to Rs.5,000 2 adults and 2 children - up to Rs.7,000
    Entitlement certificates for annual health checkup 1 member - 1 2 members - 2 2 adults and 2 children - 2

    Part B: Inpatient Hospitalisation

    Benefits Extent of Coverage
    In patient hospitalisation expenses Up to the sum insured limit
    Day care treatment cover Up to the sum insured limit
    Daily cash benefit for choosing shared accommodation Rs.500 to Rs.3,000 per day (based on the chosen limit)
    Daily cash benefit for accompanying an insured child Rs.300 to Rs.9,000 per day (based on the chosen limit)
    Maternity expenses coverage (after a waiting period of 4 years) Normal delivery - up to Rs.15,000 Caesarean delivery - up to Rs.25,000
    Critical illness cover (optional) Rs.3 lakh

    Exclusions of Apollo Munich Maxima Health

    Some of the major exclusions listed under Apollo Munich Maxima Health can be given as follows:

    • Any kind of self-inflicted injuries or suicide attempt
    • Expenses incurred for non-allopathic treatment procedures
    • Experimental or investigative treatment methods
    • Injuries or illnesses arising out of war or warlike activities
    • Treatment expenses for HIV or AIDS
    • Treatment for congenital diseases, anomalies, or birth defects
    • Expenses related to mental treatments or insanity
    • Any kind of cosmetic or aesthetic treatments
    • Expenses incurred for weight loss or obesity treatments
    • Any non-medical expenses incurred during hospital stay

    Claim Procedure

    The claim procedure for hospitalisation treatment begins with intimation to the company about the event that may give rise to a claim. Cashless treatment follows the standard procedure that involves getting authorisation from the company before treatment. For reimbursement claims, the insured must submit the medical bills, diagnostic reports, prescriptions, physician certificate, etc. collected during hospital stay.

    Outpatient treatment typically does not involve a lot of documentation. Hence, cashless treatment is not possible here. Following a hospital visit that may involve less than 24-hours of hospitalisation, you may make a claim under this policy with the bills and receipts obtained from the hospital. If you have any doubts regarding the claim process, you may contact the company’s customer care department. After verification of the submitted documents, the company will reimburse the claim amount to the insured person.

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