Compare Apollo Munich Optima Restore Plan

Apollo-Munich-Health-Insurance

Apollo Munich Optima Restore Plan

About Apollo Munich Optima Restore

Apollo Munich’s Optima Restore is a comprehensive health insurance plan which provides some unique benefits. There is a Stay Active benefit which rewards you for maintaining a healthy lifestyle, the No Claim Bonus doubles the Sum Insured in two claim-free years and there are no sub-limits in the plan. Thus, the plan has some great features.

Key features of the plan

  • The Stay Active benefit of the plan rewards you a discount in renewal premiums if you take regular walks.
  • The Sum Insured is restored up to 100% if it is exhausted in any policy year.
  • Free health check-ups are allowed once in every 2 claim-free years if the chosen Sum Insured is Rs.5 lakhs and above. If the Sum Insured is Rs.10 lakhs and above, annual health check-ups are allowed.
  • Through the Multiplier Benefit of the plan, the No Claim Bonus increases the Sum Insured by 50% in each claim-free year. Thus, the benefit doubles the Sum Insured within 2 years only.
  • There are no sub-limits or claim-based loading on premiums.
  • An optional Critical Advantage Rider is available under the plan if Sum Insured is Rs.10 lakhs and above. The rider covers 8 major illnesses and pays the Sum Insured if the insured is diagnosed with any such illness.
  • Both individual and family floater variant of the plan is available.

How does the plan work?

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.

Example

Akshay and his wife buy Optima Restore Family for a Sum Insured of Rs.10 lakhs. They also opt for a Critical Advantage Rider.

Option 1 – Akshay’s wife suffers from a covered critical illness. The plan pays critical illness benefits when the illness is diagnosed.

Option 2 – Akshay meets with an accident and is hospitalized. His hospital bills amount to Rs.12 lakhs. The plan pays Rs.10 lakhs and the Sum Insured is restored again and the remaining Rs.2 lakhs is also paid by the plan.

Option 3 – if the plan matures and Akshay or his wife doesn’t suffer any medical emergency, no benefit is paid.

Plan benefits

  • Medical benefits – the list of medical expenses covered by the plan and their extent is as follows:
    Coverages Sum Insured Rs.3 lakhs Sum Insured Rs. 5 lakhs

    Sum Insured Rs.10 lakhs

    Sum Insured Rs.15 lakhs

    Sum Insured Rs.20, 25 or 50 lakhs

    Room rent, Boarding expenses, nursing charges Covered Covered

    Covered

    Covered

    Covered

    Day care treatments Covered Covered

    Covered

    Covered

    Covered

    Pre-hospitalization 60 days 60 days

    60 days

    60 days

    60 days

    Post hospitalization 180 days 180 days

    180 days

    180 days

    180 days

    Domiciliary hospitalization Covered Covered

    Covered

    Covered

    Covered

    Organ Donor expenses Covered Covered

    Covered

    Covered

    Covered

    Daily Cash for Shared Accommodation Rs.800/day up to Rs.4800 Rs.800/day up to Rs.4800

    Rs.800/day up to Rs.4800

    Rs.800/day up to Rs.4800

    Rs.1000/day up to Rs.6000

    E-opinion for critical illness Once per policy year Once per policy year

    Once per policy year

    Once per policy year

    Once per policy year

    Ambulance cover Up to Rs.2000 Up to Rs.2000

    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

    Rs.2.5 lakhs per hospitalization up to a maximum of Sum Insured

    Rs.2.5 lakhs per hospitalization up to a maximum of Sum Insured

    Restoration of Sum Assured Up to 100% of Sum Insured Up to 100% of Sum Insured

    Up to 100% of Sum Insured

    Up to 100% of Sum Insured

     

    Health check-ups Not available Up to Rs.2500 for family floater and Rs.1500 for individual plan

    Up to Rs.5000 for family floater and Rs.2000 for individual plan

    Up to Rs.8000 for family floater and Rs.4000 for individual plan

    Up to Rs.10,000 for family floater and Rs.5000 for individual plan

  • No Claim Bonus – if the policyholder does not make a claim in any policy year he earns a cumulative bonus of 50% increase in the Sun Insured subject to a maximum of 100%.
  • Premium discounts – premium is discounted by 7.5% if a 2-year policy term is chosen. Moreover, a 10% discount is given if 2 or more family members are covered under the plan.
  • Stay Active Benefit – this benefit also discounts the premium if the insured takes a specified number of steps during a policy year. If the insured has walked 5001 to 8000 steps, the discount is 2%, for 8001 to 10, 000 steps, the discount is 5% and for steps above 10, 001, the discount is 8%.

Eligibility Criteria

  Minimum Maximum
Age at entry (in completed years) Children - 3 months Adults - 65 years
Plan tenure 1 year 2 years
Premium paying options Single pay
Sum Assured Rs.3 lakhs Rs.50 lakhs

What is not covered by the plan?

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.

Premium Illustration

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.

Apollo-Munich-Health-Insurance

FAQs

What happens to the No Claim Bonus in case a claim is made?

In case of claim, the bonus is reduced by 50% of the basic Sum Insured but it never falls below the basic Sum Insured.

How to avail free health check-ups?

The policy allows free check-ups once every two claim-free years for Sum Insured levels of Rs.5 lakhs. In case the Sum Insured is Rs.10 lakhs and above, free health check-ups are allowed annually.

What cover is provided by Critical Advantage rider?

The rider covers travel costs of the insured and the accompanying relative, accommodation expenses, second opinion and post hospitalization expenses incurred with respect to the illness.

Can minor children be covered under the plan?

Children aged 91 days to 5 years can be covered if any of the parents are covered under the plan.

How does the Stay Active Benefit track steps taken?

The insured is provided with a mobile app in which he registers. The mobile app then tracks the number of steps taken during a policy year.


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