Apollo Munich Maxima Plan

Product Overview

Apollo Munich Optima Maxima Health Insurance is a unique plan that covers not only in-patient medical expenses but also out-patient expenses of your regular illnesses and little niggles. The plan also covers pre-existing illnesses, that come under OPD benefits, without any waiting period.

Unique Features of Apollo Munich Maxima Plan

• Maternity expenses covered-The maternity expenses incurred both before and after child birth procedures are covered after a waiting period of 4 years.
• Coverage for specific dental treatments, spectacles & contact lenses upto a certain limit.
• Pre & Post hospitalisation expenses are covered up to 30 & 60 days.
• Treatment expenses for the organ donor at the time of organ transplant.

Critical features of Apollo Munich Maxima Plan

• Room rent:
  Limits imposed towards room and ICU rent expenses
  No Sub limits on room rent and ICU
• Co-Pay:
  Specific % of admissible claim amount to be borne by Insured
  This plan does not have co-payment clause
• No Claim Bonus:
  Health Insurance policies may offer Cumulative Bonus wherein for every claim free year, the Sum Insured is increased by a certain percentage at the time of renewal
  10 % of Basic Sum Insured per year upto a maximum of 50% for each unclaimed year in case opted for (The cumulative bonus is reduced by 10% of sum insured once a claim is made)
• Pre-Existing Diseases:
  Means any condition, ailment or injury or related condition(s) for which you had signs or symptoms, and / or were diagnosed, and / or received medical advice/ treatment, within 48 months prior to the first policy issued by the insurer
  This plans has a waiting period of 3 years is case of pre-existing diseases

Eligibility Criteria

• Minimum Age of Entry:- 91 days
• Maximum age of Entry:- 65 years
• Renewal Age:- Life Long Renewal
• Sum Insured:- 3 Lakhs
• Policy Tenure:- 1 & 2yrs
• Family Definition:- Individual Plan & Family Floater - spouse, dependent children, dependent parents
• Premium Calculated on Basis of:- Age, (i.e. sum Insured Chosen)

Add-ons

• Critical Illness Rider:
  Additional cover for Critical Illness which covers for 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.

Waiting Period

• Covered from Day 1:
  Accidental Injuries.
• Covered after 30 Days:
  All incidences apart from specified surgeries, Permanent exclusion & Pre-existing diseases (if any)
• Covered after 2 Years:
  Arthritis if non infective; calculus diseases of gall bladder and urogenital system; cataract; fissure/fistula in anus, hemorrhoids, pilonidal sinus, gastric and duodenal ulcers; gout and rheumatism; internal tumors, cysts, nodules, polyps including breast lumps (each of any kind unless malignant); osteoarthritis and osteoporosis if age related; polycystic ovarian diseases; sinusitis and related disorders and skin tumors unless malignant, benign ear, nose and throat (ENT) disorders and surgeries (including but not limited to adenoidectomy, mastoidectomy, tonsillectomy and tympanoplasty); dilatation and curettage (D&C); hysterectomy for menorrhagia or fibromyoma or prolapse of uterus unless necessitated by malignancy; joint replacement; myomectomy for fibroids; surgery of gallbladder and bile duct unless necessitated by malignancy; surgery of genito urinary system unless necessitated by malignancy; surgery of benign prostatic hypertrophy; surgery of hernia; surgery of hydrocele; surgery for prolapsed inter vertebral disk; surgery of varicose veins and varicose ulcers; surgery on tonsils and sinuses; nasal septum deviation

Exclusions

Any claims arising out of or attributable to any of the following is not covered

• 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
• Items of personal comfort and convenience
• Experimental, investigative and unproven treatment devices and pharmacological regimens.
• Medical Expenses relating to any hospitalisation primarily and specifically for diagnostic, X-ray or laboratory examinations and investigations

 

Note: Please refer policy T & C for detailed list of exclusions.

Tax Benefits

When you pay the premium for your health insurance policy, you are liable to get a tax rebate under section 80D of the Income Tax Act, 1961.

Claim Process

In case you would like to know about the Claim Process or would like to register a Claim please click the link below

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