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.
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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
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
- 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)
- 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.
- Covered from Day 1:
- 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
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.
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.
In case you would like to know about the Claim Process or would like to register a Claim please click the link below