Step 1 – the policyholder chooses the Sum Assured, the term of the plan and the members covered.
Step 2 – the policyholder might also choose additional riders or optional coverage features.
Step 3 – 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 4 – 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 – Ravi’s wife faces a covered critical illness. The plan pays Rs.5 lakhs in lump sum when his wife is diagnosed with the illness.
Option 2 – Ravi is also hospitalized for an accident the medical bills of which come to Rs.2.5 lakhs. The plan pays the claim of Rs.2.5 lakhs fully.
Option 3 – The tenure of the plan comes to an end but Ravi does not make any claim. He gets a cumulative bonus of 10% increase in Sum Insured which becomes Rs.5.5 lakhs.
|Coverages||Sum Insured Rs.1-5 lakhs. Rs.7.5,10,15 lakhs|
|Day care treatments||Covered|
|Post hospitalization||90 days|
|Organ Donor expenses||Covered|
|Daily Cash for Shared Accommodation||Rs.500/day up to Rs.3000|
|AYUSH Coverage||Up to Rs.20,000|
|Ambulance cover||Up to Rs.2000|
|Health check-ups||Up to 1% of Sum once every 4 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.1 lakh||Rs.15 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
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.
Under AYUSH coverage, in-patient treatments taken according to alternative medicine like Ayurveda, Unani or Siddha treatments would be covered up to the specified limit.How does the Stay Active benefit work?
The policyholder has to download the Stay Active App which would be triggered when the policy is issued. The app then tracks the number of steps taken in a year.What is the Sum Insured limit of Critical Illness Rider?
The minimum Sum Insured is Rs.1 lakh and the maximum is Rs.10 lakhs.Do Value Added Benefits require an additional premium?
No, there is no additional premium for availing the Value Added Benefits. These benefits come free of cost.Can I increase the Sum Insured under the plan?
Yes, the Sum Insured can be increased at the time of renewing the plan. This enhancement would be given if there had been no claims in the policy year so far. If the enhancement of the Sum Insured is in the next grid, the company would not insist on fresh medical check-ups. If, however, the enhancement puts the Sum Insured above 2 or 3 grids, fresh medical check-ups would be required.