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Apollo Munich’s Easy Health is a group of health insurance plans and Premium is one such variant. Easy Health Premium plan provides a comprehensive scope of coverage with multiple coverage benefits and the premiums are also affordable. The plan is available both as an individual basis and on a family floater basis.
Step 1 – the policyholder chooses the Sum Assured, the term of the plan and the members covered.
Step 2 – If the covered member (s) face any medical contingency and the related expenses are covered by the plan the expenses incurred are paid by the plan.
Step 3 – if the plan matures and no medical contingencies occur, no benefit is paid.
Rohit and his wife buy Apollo Munich Easy Health Premium for a Sum Insured of Rs.10 lakhs. The plan duration is 2 years.
Option 1 – Rohit’s wife becomes pregnant after 3 years of buying the plan. Since the waiting period for maternity benefits has elapsed, Rohit’s health plan pays Rs.25, 000 for normal delivery and Rs.40, 000 for Cesarean delivery. It also includes pre and post-natal expenses of Rs.2500. Since Rohit does not opt for new born baby cover, no new born benefit is available.
Option 2 – if the plan matures and Rohit or his wife doesn’t suffer any medical emergency, no benefit is paid.
|Coverages||Sum Insured Rs.4,5 lakhs||Sum Insured Rs.7.5,10 lakhs||Sum Insured Rs.15,20,25 or 50 lakhs|
|Room rent, Boarding expenses, nursing charges||Covered||Covered||Covered|
|Day care treatments||Covered||Covered||Covered|
|Pre-hospitalization||60 days||60 days||60 days|
|Post hospitalization||90 days||90 days||90 days|
|Organ Donor expenses||Covered||Covered||Covered|
|Daily Cash for Shared Accommodation||Rs.500/day up to Rs.3000||Rs.800/day up to Rs.4800||Rs.1000/day up to Rs.6000|
|Daily cash for accompanying insured child||Rs.300/day up to Rs.9000||Rs.500/day up to Rs.15,000||Rs.800/day up to Rs.24,000|
|AYUSH Coverage||Up to Rs.25,000||Up to Rs.25,000||Up to Rs.50,000|
|Recovery benefit||Not available||Not available||Rs.10,000 if hospitalization exceeds 10 days|
|Maternity benefit||Normal delivery – Rs.15,000
Cesarean – Rs.25,000
|Normal delivery – Rs.25,000
Cesarean – Rs.40,000
|Normal delivery – Rs.30,000
Cesarean – Rs.50,000
|Pre and post-natal expenses||Rs.1500 included in maternity benefit||Rs.2500 included in maternity benefit||Rs.5000 included in maternity benefit|
|New born baby cover (at an additional premium)||Rs.2000 included in maternity benefit||Rs.3500 included in maternity benefit||Rs.5000 included in maternity benefit|
|Ambulance cover||Up to Rs.2000||Up to Rs.2000||Up to Rs.2000|
|Air Ambulance Cover||Not covered||Not covered||Rs.2.5 lakhs per hospitalization up to a maximum of Sum Insured|
|Outpatient dental treatment||Up to 1% of Sum Insured to a maximum of Rs.5000||Up to 1% of Sum Insured to a maximum of Rs.5000||Up to 1% of Sum Insured to a maximum of Rs.10,000 for family floater and Rs.7500 for individual plans|
|Spectacles, contact lenses, hearing aids||Up to Rs.5000||Up to Rs.5000||Up to Rs.10,000|
|e-opinion for critical illness||Covered||Covered||Covered|
|Health check-ups||Up to 1% of Sum Insured to a maximum of Rs.5000 once every 2 years||Up to 1% of Sum Insured to a maximum of Rs.5000 once every 2 years||Up to 1% of Sum Insured to a maximum of Rs.5000 once every 2 years|
|Age at entry (in completed years)||5 years
Dependent Children - 3 months
|Adults - 65 years|
|Plan tenure||1 year||2 years|
|Premium paying options||Single pay|
|Sum Assured||Rs.4 lakhs||Rs.50 lakhs|
Illnesses suffered during the first 30 days of the plan commencement are not covered.
Critical Illnesses suffered during the first 90 days of the plan commencement are not covered.
Pre-existing illnesses or conditions are not covered by the plan in the first 3 years of the policy
Maternity related benefits have a waiting period of 4 years. If the Sum Insured is Rs.15 lakhs and above the waiting period is 3 years.
Outpatient dental treatments have a waiting period of 3 years. Spectacles, lenses and hearing aids are covered in the 3rd year.
Specific illnesses are not covered in the first two years of the plan.
Illnesses or accidents caused due to genetic disorder or stem cell surgery, substance abuse, participation in adventure sports or hazardous activities, criminal acts, attempted suicide, war and hazardous substances, etc. are not covered.
Treatments like cosmetic treatments, artificial life support, weight loss treatments, non-allopathic treatments or due to HIV/AIDS, etc. are not covered.
Below are the sample rates of premium payable by a non-smoking male living in Mumbai for different combinations of age and members covered. The Sum Insured is Rs.10 lakhs and the policy is taken for 1 year.