Apollo Munich has a unique health insurance with innovative features called – “Optima Restore”. The best feature of this plan is the restore feature of Sum Insured and NCB multiplier work simultaneously. The product also offers no claims based loading and, hence, the premium is the same for the same age group.
Salient Features of the Apollo Munich’s Optima Restore
1- The health plan is available as individual as well as family floater.
2- The sum assured offered in the health plans are 3, 5, 10 and 15 lakhs in both the above categories.
3- The health plan also gives 10% family discount if two or more members are covered under individual plan.
4- The health plan also gives additional 7.5% discount on premium, if you pay two years premium at a time (But avoid using this if your premium comes above Rs. 15,000 as the tax benefit is restricted to Rs. 15,000 in a year).
5- Other benefits like- life-time renewal, no co-pays, no sub-limits and no additional loading at renewal are also present in the plan.
6- The health plan is also eligible for tax benefit u/s 80-D of the Income Tax Act.
7- Pre-and Post Hospitalization Coverage of 60 and 180 Days
What is not covered in Apollo Munich Optima Restore Health Insurance Policy?
1. Restoration of the basic sum insured cannot be used for any illness, disease or complications for which a claim has been paid in the current year
2. If Restoration Benefit is not used in the same year, then it does not get carried forward in the next year or thereafter
3. Any treatment within first 30 days of cover, except in case of accidents
4. Pre-existing diseases or conditions for first 3 years
5. Psychiatric conditions, mental disorders, Parkinson’s disease, Alzheimer’s disease and obesity-related treatments
6. Pregnancy, childbirth or miscarriage related treatments
7. Dental treatment and surgery of any kind unless requiring hospitalisation
8. Cosmetic, plastic or experimental surgery
9. General weakness, convalescence, rest cure, long-term nursing care, rehabilitation etc
10. Cost of contact lenses, spectacles, hearing aids, wigs, diabetic test strips and similar products
11. Involvement in military, air force, naval operations
12. Dangerous sports like racing, diving, hand-gliding, parachuting, scuba-diving, rock-climbing etc
13. Abuse of drugs, alcohol, hallucinogens, intoxicant
14. HIV, AIDS and related diseases
15. Congenital diseases (conditions existing at birth)
16. 2 year waiting period for cataract, ENT, osteoporosis, arthritis, certain gynaecological, gastrointestinal and urogenital treatments
Points to Remember
What is a Restore Benefit?
The insurer will restore (at no additional cost) the basic sum insured in case insured’s health cover is exhausted, due to claims made and paid during the Policy Year or made during the Policy Year and accepted as payable. If again insured falls ill with another illness after using his/her coverage in an individual policy, entire sum insured will be reinstated for him/her to use, at no further cost.
The claim restore benefit can only be use after the basic sum assured inclusive of bonuses are fully utilized in that year. E.g. If you have Rs. 5 lakh restore plan and first claim is utilized by taking Rs. 4.5 lakh in one case and subsequently new claim comes for another Rs.1.5 lakh during same policy period. In this case you will not be able claim the restore benefit as you have not fully utilized the Rs. 5 lakhs sum assured in 1st claim. You will get only Rs. 50,000 in second claim which is the balance from 5 lakhs basic sum assured and have to pay the balance of Rs. 1 lakh from your pocket. Now you have fully exhausted the sum assured and are eligible to claim the third claim under restore benefit if it comes during that policy year.
Important Points : Restore Benefit
a) The Restore Sum Insured will be enforceable only after the Basic Sum Insured inclusive of the Multiplier Bonus (if any) have been completely exhausted in a policy year.
b) The Restore Sum Insured can be used for only future claims made by the Insured Person and not against any claim for an illness/disease
(including its complications) for which a claim has been paid in the current policy year.
c) No Multiplier Bonus will apply to the Restore Sum Insured.
d) The Restore Sum Insured will only be applied once for the Insured Person during a Policy Year.
e) If the Restore Sum Insured is not utilised in a Policy Year, it shall not be carried forward to any subsequent Policy Year.
f) If the Policy is a Family Floater, then the Restore Sum Insured will only be available in respect of claims made by those Insured Persons who were Insured Persons under the Policy before the Sum Insured was exhausted.
What is a Multiplier Benefit?
With Multiplier Benefit insured’s basic sum insured will increase by 50%, in case he had a claim free year. It’s similar to no claim bonus (NCB), but the percentage is higher than normal NCB. The maximum bonus will not exceed 100% of the Basic Sum Insured in any Policy Year.
E.g. If you have Rs. 5 lakh under restore health plan and no claim in the first year, your sum insured with go up by 50% in the renewal and will be 7.5 lakh. And if you go another year without claim, your sum insured will be Rs. 10 Lakhs. If you claim in the third year, your sum insured will be reduced by 50% of basic sum insured, which is 2.5 Lakhs to Rs. 7.50 Lakhs. In short, at any stage, there will be no loading on your premium, neither any effect on your core cover, due to a claim.
Important Points : Multiplier Benefit
a) If no claim has been made under the Policy and the Policy is renewed (without any break), then insured will get a bonus to the next Policy Year by automatically increasing the Basic Sum Insured for the next Policy Year by 50% of the Basic Sum Insured for this Policy Year. The maximum bonus will not exceed 100% of the Basic Sum Insured in any Policy Year.
b) In relation to a Family Floater, the bonus so applied will only be available in respect of claims made by those Insured Persons who were Insured Persons in the claim free Policy Year and continue to be Insured Persons in the subsequent Policy Year.
c) If a bonus has been applied and a claim is made, then in the subsequent Policy Year We will automatically decrease the multiplier bonus by 50% of the Basic Sum Insured in the following Policy Year.
However this reduction will not reduce the Sum Insured below the basic Sum Insured of the policy.
The Bottom Line
With the additional features like Restore Benefit, Multiplier Benefit, Lifelong Renewal, No Loading on Claims, more no of days for Pre-and Post Hospitalization – the plan looks very promising. The premium is high as compared to the other available health plans, but you would also get double basic sum insured in case of two claim free years. We would recommend to go for this plan. But first understand – how the restore benefit going to work?