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.
People who meet the following eligibility criteria can enroll themselves in Apollo Munich Maxima Health:
Some of the key features of Apollo Munich Maxima Health can be listed as follows:
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|
Some of the major exclusions listed under Apollo Munich Maxima Health can be given as follows:
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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