Apollo Munich Health Wallet

• Enjoy options to cover yourself, your spouse, kids and even your parents
• Enjoy access to 10,000+ hospitals for cashless treatment
• Reduce your taxable income by up to Rs. 50,000 deduction under section 80D**

The Health Wallet is a new-age health insurance plan for individuals and families that offers extensive benefits that would certainly be worth the money paid. The plan does not simply offer benefits to support an individual to pay his/her medical bills but save up the benefits for the future as well. If one maintains good health and does not raise a claim, he/she is provided with a bonus amount over and above the sum insured. The features and add-ons make the policy a unique medical insurance plan.

Eligibility for Health Wallet

The eligibility criteria set by the insurance company are as given below:

• Individuals between ages 91 days and 65 years can be covered under the policy.
• The minimum and maximum entry ages for adults are 18 years and 65 years.
• Children between ages 91 days and 5 years can be covered only if either of the parents is covered under the same policy.
• No cover ceasing age is specified for renewals.

Features of Health Wallet

The plan offered by Apollo Munich has extensive features as mentioned below:

• The policy is provided for a period of one year and the benefits are applicable on a yearly basis.
• The plan is available for individuals and families.
• The family floater can include 2 adults and 5 children in a single policy.
• The insurer may request for a pre-policy check-up based on the age of the insured and the sum insured chosen. Once the proposal is accepted, 100% of the expenses incurred on the health check-up will be reimbursed.
• Every year, on renewal of the policy, a certain fixed amount is paid to the insured towards the preventive health check-up expenses incurred.
• The Multiplier Benefit provides a 50% increase of the basic sum insured at the time of renewal, provided no claims are made in a policy year.
• The company offers a special feature known as the Reserve Benefit. It allows policyholders to save a benefit amount of the policy for future uses. The Reserve Benefit sum insured can be carried forward to the following policy year along with a 6% bonus that accrues every year.
• Another special feature offered by the company is the Restore Benefit. In case the sum insured and the Multiplier Benefit are both exhausted, 100% of the base sum insured is reinstated for usage for the rest of the year. The Restore Benefit cannot be carried forward to the following year.
• An optional deductible feature is offered which allows policyholders to share the medical expenses incurred. While he/she pays up to the deductible limit, the rest is paid by the insurer.
• The Switch Option waives the deductibles and allows the policyholder to enjoy the complete benefits offered by the plan.
• The initial waiting period for all illnesses is 30 days.
• For specific illnesses mentioned in the policy, the waiting period is 24 months.
• Pre-existing diseases have a waiting period of 36 months.
• Policyholders have a 30-day grace period to pay the renewal premium to renew the policy.
• An initial 15-day free-look period is provided to the policyholder to review the terms and conditions. If he/she has any objections, he/she may return the policy and receive a refund of the premium amount paid at the inception of the policy.
• The policy can be cancelled post the free-look period as well. A written notice is required to be submitted to the insurer in such cases.
• The insurer, too, can cancel a policy on grounds of misrepresentation of facts, fraud, non-disclosure of facts, or non-cooperation of the policyholder. In such cases, the insurer will give a 30-day notice prior to cancellation.
• The premiums paid towards the policy qualify for tax deductions under Section 80D of the Income Tax Act, 1961.

Benefits of Health Wallet

The plan offers a range of benefits. Here are the details of the same:

Exclusions of Health Wallet

The plan has a few exclusions that cannot be covered under the policy whatsoever. Some of the exclusions applicable are:

• All illnesses until completion of the first 30 days of the policy. However, this exclusion does not apply in the case of injuries caused by accidents.
• Specific health conditions mentioned in the policy until completion of 24 months of the policy.
• Pre-existing conditions until completion of 36 months of the policy.
• Treatments caused by self-injury, attempt to suicide, war-like situations, hazardous activities, and activities that amount to the breach of law.
• Health conditions caused by the use of alcohol or drugs.
• Weight loss programmes and treatments for obesity.
• Treatment to correct the refractive error of the eye.
• Cosmetic or aesthetic surgeries unless necessitated by a condition covered under the policy.
• Non-allopathic treatment.
• Experimental or unproven treatments.
• External congenital diseases or genetic disorders.
• Treatment for infertility, sterility, assisted conception or such related treatments.

Claim Procedure

The policyholder is required to follow the claim settlement procedure laid out by the company.

Notification

Insured individuals are expected to intimate the company about the hospitalisation within 7 days from the date of discharge from the hospital. For cashless hospitalisation, however, the person is required to inform the insurer 48 hours in advance in the case of planned hospitalisation and within 24 hours after admission in the case of unplanned hospitalisation. Cashless services are provided only in network hospitals.

Documents

The documents required by the company to process the claim are:

• Claim form - duly filled and signed
• Diagnosis of treatment
• Original bills, along with receipts or prescriptions
• All medical and investigation reports
• Document stating detailed break-up of services provided
• Doctor’s certificate
• Copy of settlement letter
• Discharge summary
• For accident cases, copy of Medico Legal Case (MLC) and First Investigation Report(FIR)
• Regulatory and KYC requirements such as proof of identity and address
• Legal heir certificate