Apollo Munich Maxima Health Plan Review

by Gopal Gidwani on November 5, 2010 · 21 comments

in Others,Uncategorized

Introduction
Does your health insurance policy cover treatment costs for things like sore throat, cracked lips, running nose, wisdom tooth, broken finger, itchy eyes etc????? Chances are not. Most of the policies issued by Health Insurance Companies do not cover the treatment costs for these small-small illness for which we consult a doctor or visit the Out Patient Department (OPD) of a hospital. Most of the policies issued by Health Insurance Companies cover treatment cost for major illness wherein a patient gets hospitalised. How about a Health Policy, which apart from major hospitalisation instances, also takes cares of treatment costs of small illness, visits to a doctor for consultation, pharmacy expenses, annual health check-up, dental treatment, spectacles etc????? Would you be interested in knowing more about this Health Policy ……. then read on ……….

Features of Apollo Munich Maxima
Apollo Munich Maxima is a health insurance policy that covers major hospitalisation events along with OPD expenses for small-small treatments.

  • 3 Variants: The policy comes in 3 variants. The policy can be taken by

      i. One Adult (Individual) or
      ii. Two Adults (Family Floater) or
      iii. Two Adults and Two Children (Family Floater)

  • The policy comes with a cover of Rs 3,00,000 (sum insured) for an individual for in-patient hospitalisation, pre and post hospitalisation and 140 day care procedures. If 2 adults or 2 adults and 2 children have taken the policy then the cover of Rs 3,00,000 becomes a floater for them.
  • Additional Critical Illness Cover: An individual can also opt for additional critical illness cover of Rs 3,00,000 against 8 specified critical illnesses if required. This is optional and comes with additional premium payment depending on the age of the insured. In case of a floater policy additional critical illness cover can be availed on an individual basis.
  • Doctor Consultations: The policy offers 4/6/8 doctor consultations for the individual and the covered family members, based on the plan opted for and the number of family members covered.
  • Maximum entry age is 75 Years
  • Life Long Renewal: The individual can renew the policy year after year during his / her entire lifetime. There is no maximum age for maturity of the policy.
  • No Claim Bonus: For every claim free year for in-patient treatment, the company offers 10% cumulative bonus on the in-patient sum insured. However the additional sum insured is limited to 50% of the in-patient sum insured.
  • Income Tax Benefit: Under Section 80D of the Income Tax Act, the individual can avail deduction from taxable income for the premium paid for the policy. The deduction is upto Rs 15000 for individuals below 65 Years of age and upto Rs 20,000 for Senior Citizens.
  • Maternity Expenses: Maternity Expenses are covered but there is a waiting period of 4 Years.

What all does Maxima Cover?
Apart from treatment costs for regular hospitalisation, there are a whole host of other things which Maxima health policy covers. Some of these are:

  • Pharmacy Expenses: Your pharmacy bills are covered
  • Diagnostics: Cost of diagnostic tests taken by you or anyone covered in your family are paid
  • Specialist Services: Dental treatment, Spectacles and Contact Lenses are covered upto a certain limit.
  • Health Check-up: The company provides an annual health check-up facility. A person above 45 years of age can avail this benefit from the second year.
  • Pre-existing illnesses under OPD Benefits: Medicines or Doctor’s consultation for any pre-existing illnesses are covered without any waiting period.

All the above benefits are available on a cashless basis in the Apollo Munich network and on reimbursement basis outside the network.

Policy Premium:

  • If the policy with sum insured of Rs 3,00,000 is taken for 2 adults aged between 18 Years and 45 Years the premium comes to Rs 21,105 (inclusive of taxes).
  • On this the individual can save net income tax of Rs 4635 under Section 80D of the Income Tax Act.
    Rs 15000 premium * 0.309 (30% tax rate) = Rs 4635
  • The individual also gets OPD Entitlement Certificates worth Rs 14,900 which he can use for things like Doctor Consultation, Diagnostic Tests, Pharmacy, Annual Health Check-up, Dental Treatment, Spectacles, Contact Lenses etc.
  • So effectively the cover of Rs 3,00,000 comes only for Rs 1570.

Rs 21,105 (Premium) – Rs 4635 (Net Tax Savings) – Rs 14,900 (OPD Entitlement Certificates) = Rs 1,570 (Net Effective Premium)

Things to Remember

  • During the first 30 days the policy covers only medical expenses arising out of accidental emergency conditions
  • Cataract and some other specific diseases are covered after two consecutive years
  • Pre-existing illnesses will be covered from the 4th year onwards
  • HIV AIDS and related diseases are not covered. Non-allopathic treatments and cosmetic treatments are not covered.
  • For other finer details about the policy please refer the company website or get in touch with the company personnel.

 
About Apollo Munich Health Insurance
Apollo Munich Health Insurance Company Limited is a joint venture between the Apollo Hospital Group and Munich Health. Apollo Hospitals has 50 Hospitals, 8000 Doctors, 1068 Pharmacies spread over India. Munich Health has 5000 Experts across 26 locations worldwide and Customers spread across 100 Countries. For its Health Insurance venture Apollo Munich has tied up with 4500 Network Hospitals across 800 cities for offering cashless treatment facility for its customers.

For more details please read the policy wordings available on the company website on what is covered and what is not covered.

The company Toll Free Number is 1800-103-0555.

Note: Readers please note that all the above information has been sourced from the company website. So please make sure you refer the company website or company contact person before deciding on whether to take the policy or not.

Please let us know your views on the article by commenting in the comments section below or by writing to us at gopal_gidwani@yahoo.com

{ 21 comments… read them below or add one }

Saurav Sinha November 10, 2010 at 6:37 pm

I tried the website http://www.apollomunichinsurance.com but it asks for applicants city which does not cover Jamnagar, the place I live in. Pease help.

Reply

Gopal Gidwani November 11, 2010 at 7:09 am

Hi Saurav,

If Jamnagar is not there in the list of cities then Apollo Munich must not have started operations there still. You will have to look out for some other health insurer. Max Bupa also does not have operations in Jamanagar at the moment. And right now these 2 are the only health insurance companies in the market that are offering life long renewal. I hope other insurers also follow them very soon.

Reply

Prashant February 10, 2011 at 10:50 am

Hi,
I am interested in buying this policy , you can contact me on this no 9869313924

Reply

Gopal Gidwani February 13, 2011 at 12:07 pm

Hi Prashant,
I dont sell any financial products of any company. I just write reviews. In case you are from Pune then you can contact Kishore at 9096410568. He is an agent of Apollo Munich and he will guide you on how to go about buying the policy.

Reply

San August 5, 2011 at 12:49 am

Hi Any Drawback.

Reply

Sudha August 19, 2011 at 7:13 am

Hi Gopal

Stumbled upon your blog and found it good, especially since its an independent view. I am trying to choose between Max Bupa and Apollo Munich for medical insurance. We are four persons, my father law who is 67, mother in law 60 and my husband and myself are 38, 36. We are already covered under my hubby’s corporate policy for 5 lac. And my in-laws also have a small insurance cover. But I want to have an independent cover in case he changes jobs.

Which one do you suggest based on features and track record? Thanks!
p.s I know that Apollo won’t insure my father in law since he is over 67 years. But keep that aside.

Reply

Gopal Gidwani August 20, 2011 at 11:50 am

Hello Sudha,
Max Bupa (HeartBeat) and Apollo Munich (Easy Health) are both very good policies as they cover a person life long and the second good thing is there is no loading in both the policies in case of claims also.

But what differentiates the two is their pricing mechanism.

Apollo follows an age slab premium mechanism. So they have one age slab of 15-45 years. So all people following in this age bracket will have the same premium for the same amount of cover. When a person turns 46 and moves to the next age bracket of 46-55 the premium changes according to the premium applicable to this slab. Apollo has all the premiums for all the age slabs transparent in writing on all their promotional literature. Also they mention they will not change premiums midway without IRDA Approval. So that was about Apollo.

Now coming to Max Bupa. Well; they dont have any age slab/s. They say they will increase the premium slightly every year on renewal as the age of the person increases. How much will be this annual increase in terms of amount or percentage and how they arrive on this number is not disclosed by the company. So there is some ambiguity on that front. You dont know how and by how much the company will increase your premium next year. So that was about Max Bupa

Due to this anomaly I am slightly tilted in favour of Apollo. But then that does not take away anything from the good points offered by Max Bupa.

So that’s the major difference between the two companies on the pricing mechanisms. Well there may be some other small – small differences also.

Reply

Vikas Ranjan October 10, 2011 at 11:36 am

Hi Gopal,

Was surfing internet regarding i term policies and came across your website. I read your reviews related to term/iterm/health policies. It is very good that you are helping people to choose policy as people generally get confused when they have a range of offering infront of them.

I am having ICICI Pru life hospital care and have already completed 4 claim free years. Now, since i got married 5 months ago, i needed a family floater. I finally zeroed on Appolo Munich family floater ‘Exclusive’ plan of Rs.4 lac with same amount of critical illness rider with annual premium of Rs. 8,663/-. I will have to carry ICICI Pru plan till next three years so that i am eligible for pre-exiting clause of Appolo Munich. I need your views on this.

Also, i am having two ULIP policies {Bharti Axa – Rs.12000/- annum (sum assured is Rs. 3 Lac) and HDFC Young Star II – Rs.20000/- (sum assured Rs. 3 lac) and one term ploicy of Rs. 15 lac from HDFC where premium is around Rs. 5060/- per year (completed 4 years). Also, i am having home loan of Rs. 20 lac and i understand i need to have more insurance. In case of ULIP, i did not want Bharti ULIP (with 7 year lockin) as it was taken just because of compulsion as one of my friends sold it to me.

Now, i am thinking of taking around Rs. 75 lakh i term ploicy (Rs.25 lac & Rs. 50 lac) each from India First and Aviva. Icici Pru has recently increased it premium rates. Should i carry HDFC term further (till end of term) or should i carry along with ‘i term plans’? Please Suggest.

I want to consolidate my investment where i want to do away with ULIPs (after lockin period). I just want to keep term plans for insurance purpose and direct my investment into MF SIPs and Blue Chip stock investment with long term view.

Regards,

Vikas

Reply

Gopal Gidwani October 13, 2011 at 7:36 pm

Apollo Munich ‘Easy Health’ and ‘Maxima’ are good products. Also now that health insurance is portable, you can transfer your existing health insurance policy to another health insurance and carry forward the same benefits of your old policy.
Regarding your existing term insurance policy, if the difference between the premium for the online term policy and the existing term policy is high then it makes sense for you to first go for the new term insurance policy and then close the existing term plan.

Reply

Pankaj December 10, 2011 at 6:09 pm

Hi

What is your opinion on National and Oriental Family Floaters. National even has an option to cover pre-existing hypertension and diabetic related illnesses. What bout the network hospital reach and ease of claims?

Reply

Vaibhav December 31, 2011 at 10:07 am

Hi Gopal,

I’m looking forward a health insurance plan to cover myself (single, 31) & my parents (63 & 64). Please give me some suggestions, pointers to direct my decision.

Should I go for 2 separate policies or is there a single policy that would provide me essential cover (3- 5 lakhs)?

Thanks,
-Vaibhav

Reply

Gopal Gidwani January 9, 2012 at 12:53 pm

Hi Vaibhav,

A family floater policy can cover a family. In your case you can buy a single policy covering you and your parents.

Reply

swapan February 16, 2012 at 11:31 am

hi Gopal, i am plannimg to have a family flotter medical insurance. my family consists of 4 members (me 36yrs. wife 30yrs. 2 kids 1.6yrs each) and i have shortlisted Oriental health insurance and apollow munich optima restore.. it seems both the company are good with all the benefits…. which one should i opted for?? pls help..

Reply

Gopal Gidwani February 16, 2012 at 6:55 pm

Hello Swapan,
Some benefits that Apollo Munich plans have are:
1) Apollo Munich plans have life long renewal facility
2) There is no loading on claims which is there in case of most health insurance plans of most companies

Coming specifically to Optima Restore, the plan has some good features like Restore Benefit (if the entire cover is exhausted in the middle of the year then the company automatically reinstates the basic sum assured). Multiplier Benefit feature enhances your cover by 50% on renewal if there is no claim for 1 year. If there is no claim for 2 years, then at the time of renewal the cover is enhanced by 100% of the basic sum assured. There are no sub-limits on room rentals. The plan also allows you to upgrade your cover to a higher amount, provided there are no claims in the past.

Keeping these things in mind, decide which plan you want to go for. Or in case you are not able to decide, I will suggest you approach some health insurance specialist organisation like MediManage. Based on your requirement, they will suggest you the best plan that suits your requirement.

Reply

Aashish March 19, 2012 at 12:22 pm

Apollo Munich boasts about amazing services, but don’t revert for months on a genuine claim…they then reject the claim under a false clause…then they don’t revert again for months…..do they think their

clients are fools? I recommend that you don’t buy their medical policy and get into their trap….they are not the company for you to depend upon for something as important as your health…..ironically, it is basically spoiling your health taking this policy….AVOID THEM AT ANY COST….

Reply

Gopal Gidwani March 23, 2012 at 7:14 pm

Hello Ashish,
I don’t know the reason for which Apollo Munich has rejected your claim, so I cannot comment anything on that. It is very unfortunate what has happened between you and Apollo Munich. I will suggest you approach their Grievance Redressal Officer if you are not happy with the decision given by the company. You can also approach the Insurance Ombudsman or IRDA. They will help you out with a fair decision

Reply

sourav April 3, 2012 at 6:27 pm

hi gopal,
i have gone through all of your suggestion. I have also one prob. I am 27 years and I want to take health policy of 3 to 5 lacs for me and my father(63 years). He is already a dibetic patient. which health policy will be fruitfull and what will be the premium per anum?

Reply

Gopal Gidwani April 5, 2012 at 6:18 pm

Hello Sourav,
At present Apollo Munich and Max Bupa are offering life long renewals. So I would suggest you go for a health plan from any one of the two health insurers. You have mentioned that your father is suffering from Diabetes. In that case some company may not offer cover or some company may put Diabetes under permanent exclusion while some company may cover it after few years but at a higher premium. This differs from company to company. With regards to how much will be the premium, well it depends on one of the above mentioned conditions on which the cover is offered.

I suggest you approach MediManage. They are experts in health insurance and understand it a lot better than many others. They should be able to help you out with a proper policy that suits your requirement.

Reply

Manoj M June 28, 2012 at 7:20 pm

I am planning for a family floater policy for my family…
My father age is 56 and Mother’s age is 54
My age is 23…I am looking for a medical policy of around 3 lacs…..
I am confused between oriental insurance and national insurance….
I have avoided private insurance companies as their premium is very high (esp.apollo munich and bajaj allianz) can you please tell me which of the two insurance company will be suitable for medical insurance based on claim settlement and services……

Reply

Gopal Gidwani June 29, 2012 at 9:01 am

Hello Manoj,
I am not an expert in health insurance. I suggest you get in touch with some health insurance expert like MediManage. They are the health insurance experts and the right people to guide you on health insurance

Reply

Ashok Ghosh June 20, 2013 at 10:59 am

my father has arthritis from last 2 yrs ,age 58
i was aware it was pre Existing disease,
so i have no problem if Religare can take it an pre existing desease ,
i will agree to serve waiting period of 4 yrs,
can i get Religare care plan of 5 lacs

Reply

Leave a Comment

Previous post:

Next post: