Product Review – Medical Insurance – Apollo Munich Optima Restore

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When it comes to medical insurance, you need to ensure that you get hooked onto the policy which has best possible features, needless to mention, competitive claim settlement ratios.

We find that Apollo Munich’s Optima Restore medical insurance policy offers one of the best policy features at a competitive price.

Room Rent Capping – There is no room rent capping here. A room rent capping can result in creating a big hole in your pocket as all hospitalisation expenses tend to be jacked up on the room category. For example, if an insurance policy covers room rent upto Rs. 2500 per night and you end up being in a room category which has room rent of Rs. 5000 per night, you can safely assume that you won’t be paid 50% of your hospital bills.

No Claim Bonus or Multiplier – Different companies use different terms. Essentially for each claim free year, the sum assured increases by 50%, upto a max of 100% of the policy sum assured. For example, if you have taken a cover of Rs. 5 lakh and have no claim in first year, the policy sum assured will increase by 50% to 7.5 lakh. With another claim free year, the sum assured will increase by another 50% to 10 lakh. There won’t be any further increase in subsequent claim free years and the policy will continue to enjoy 10 lakh coverage with the premium payable at original 5 lakh level.  

If there is a claim, the policy sum bonus will be reduced by 50% or in our above example drop from 10 lakh to 7.5 lakh. However, with another claim free year, it will again go upto 10 lakhs

Restore Benefit – To explain it better, lets assume that A & B obtain a family floater cover. A is hospitalised and uses the entire cover for the ailment. If A is again hospitalised in the same year for a different ailment or if B is hospitalised, the entire sum assured is re-instated without any further premiums.

No Geographical Loading of Premium – Unlike a few policies in the market, this one will not charge higher premium or reject a % of the claim if the insured choose to opt for hospitalisation in a different city, more importantly  in metros such as Delhi or Mumbai.

Pre & Post Hospitalisation period – With 60 days pre-hospitalisation and 180 days post hospitalisation cover, this policy brags for amongst the best # of days coverage. These days come handy where ailments require significant amount of expenses post hospitalisation. For example, a fracture may require several months of physiotherapy expenses. Most of the policies on the street cap the pre & post hospitalisation to 30 & 60 days respectively;

Ambulance Cover – Re-imbursed upto Rs. 2000 per hospitalisation. Note it is not per year, but per hospitalisation;

Health Checkup – Depending upon the amount of coverage, the policy features a preventive health checkup from Rs. 1500 upto Rs. 10,000.

Pre-existing Diseases – If one has any pre-existing diseases, most of the products on the street cap exclude ailments associated with them to 4 years. This policy features 3 years exclusion so that you can be provided coverage a year earlier.

Some other standard policy features include :

  1. Providing coverage for Organ donor;
  2. Air ambulance for higher sum-assured
  3. Electronic second opinion in case of critical illness – once a year;
  4. Maximum entry age at the time of taking the cover is 65 years post that the policy will continue to be renewed for life;
  5. If you take multi-year policy, additional 7.5% discount if offered on the overall policy premium;
  6. First 30 days no cover is offered, unless it is owing to an accident;
  7. First 2 years exclusion applies to specific ailments such as cataract, hernia, hysterectomy, joint replacements, etc.
  8. Pregnancy, dental treatments and hearing aids are not covered
  9. You can move your existing insurance policy to Apollo using the standard portability process.

Conclusion – We believe that the policy offers amongst the richest features in the medical insurance product space and could be considered by the insurance seekers. In addition, Apollo Munich enjoys a healthy Claim settlement ratio of approx 84% which is amongst the best and competitive in the industry.

For detailed policy terms and condition, please visit the website of the Company. If you need any further guidance, please feel free to contact us via our website – CLICK HERE

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