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Customer Service > FAQs > General Queries

What is Stay Active?

Stay Active is a renewal discount offered under Easy Health and Optima Restore in which you can earn upto 8% disc ount on your renewal premium by meeting the average step count target as per the grid below..

Average step count target for the year

% discount applicable on renewal premium

5000 or below

0%

5001-8000

2%

8001-10000

5%

10001 and above

8%



In order to help you earn more discount, the average steps would be calculated each time for a fixed time duration and a pro-rata discount would be credited to you against your stay Active discount. This allows you the opportunity to improve your average step count for the next time period and earn a higher discount.

How will the Stay Active discount be calculated?

In an individual policy, ‘Stay Active’ discount would be calculated for each adult member covered in the policy, basis the average steps taken by him for each quarter and cumulated at the end of the policy period.

Individual Plan
Customer A buys a policy on 1st December 2017 for a tenure of 1 year. His Stay active discount calculation basis the steps taken during the tenure of his policy is as under:

 

Time Durations

 

Policy start date- 90 Day

91-180 days

181-270 days

271-300 days

Time interval from Risk Start Date of policy

1st Jan-31st March

1st April-29th June

30th June- July-27th Sept

28th Sept -28th October

No. of days per time interval

90

90

90

30

Total Steps walked in each time interval

904050

771840

932040

300030

average steps taken each time interval

10045

8576

10356

10001

Date on which discount is credited

1st April

30th June

28th Sept

29th November

Pro-rata Stay active discount % applicable as per the grid

2%

1.25%

2%

2%

Cumulated renewal discount % earned by the customer at the end of policy tenure

7.25%



In an individual policy, the average step count would be calculated per adult member

Floater Policy
In a floater policy, ‘Stay Active’ discount would be calculated on the average step count of all the Adult members per quarter and cumulated at the end of the policy period
Customer A buys a floater policy on 1st December 2017 for a tenure of 1 year for himself and his spouse. In a floater policy the Stay Active discount will be calculated per policy. The Stay active discount calculation basis the steps taken during the tenure of the policy by the customer and his spouse is as under:

 

Time Durations

 

Policy start date- 90 Day

91-180 days

181-270 days

271-300 days

 

 

 

 

 

Time interval from Risk Start Date of policy

1st Jan-31st March

1st April-29th June

30th June- July-27th Sept

28th Sept -28th October

No. of days per time interval

90

90

90

30

Total Steps walked in each time interval by Customer A

904050

771840

932040

300030

average steps taken each time interval by customer A

10045

8576

10356

10001

Total steps walked by Customer A`s spouse

900000

720000

810000

330000

Average steps taken by Customer A`s spouse

10000

8000

9000

11000

Combined total of customer A and spouse

1804050

1491840

1742040

630030

Combined Average of Customer A and spouse

10023

8288

9678

10501

Date on which discount is credited

1st April

30th June

28th Sept

29th November

Pro-rata Stay active discount % applicable as per the grid

2%

1.25%

1.25%

2%

Cumulated renewal discount % earned by the customer at the end of policy tenure

6.5%




Please Note: The above illustration is for a one year tenure policy. In case of 2 year policies , there would be 8 time intervals and pro-rata discount as per 8 time intervals would be applicable

How do I track my steps for Stay Active benefit ?

The steps can be tracked on our Mobile app ‘Health Jinn’ which is currently available on android and IOS platform. if you are an android phone user please search for 'Health Jinn' App in google play store. For apple users the app can be downloaded from App Store. Windows/Blackberry users, please contact our Customer Care at customerservice@apollomunichinsurance.com or 1800 102 0333 for information on how to avail Stay Active benefit.

Can I claim for individual diagnostic tests under Health Checkup Benefit offered in my policy?

No, only preventive health check up packages offered by medical establishments that are undertaken for general assessement of health status is covered under health checkup benefit in your policy. Any particular diagnostic tests done for evaluation of a disease or illness is not covered. A preventive health check up is defined as package of medical test(s) undertaken for general assessment of health status, it does not include any diagnostic or investigative medical tests for evaluation of illness or a disease.

I am unable to connect to Google fit/Apple health kit suggested on the Health Jinn app. How do I do it?

In order to integrate with google fit, you must have the google fit app on your phone.  This app has to be downloaded from Google Playstore. Once you have downloaded and connected on google fit, you will be able to connect the Health Jinn app to it. Similarly Apple health is to be downloaded from the App store

Are cosmetic treatments or medical attention for cosmetic purposes covered?

Plastic surgery or cosmetic surgery is excluded unless necessary as a part of medically necessary treatment certified by the attending medical practitioner for reconstruction following an accident, cancer or burns

Are there any charges by the hospital, which are not reimbursable and hence have to be paid by me even after “Cashless Service” has been authorized for treatment in the network hospitals?

Yes, there are quite a few charges, which are not reimbursable and have to be paid by you even though you have been authorized for “Cashless Service” at the Network Hospitals. Some of those charges are enumerated below: 
  •  Registration/Admission charges.
  •  Attendant/Visitor pass charges.
  •  Special nursing charges not authorized by the attending doctor.
  •  Service charges not forming a part of the room rent.
  •  Charges for extra bed for attendant etc.
  •  Bed retaining charges.
  •  Charges for TV, Laundry etc. 
  •  Telephone/Fax charges.
  •  Food and Beverages for attendants and visitors, toiletries etc.
  •  Purchase of Medicines not related to the treatment.
  •  Stationery, xerox or certifying charges.
The above list is only indicative and not exhaustive.

Does Easy Health policy offer benefits if one suffers illness/disease or contract injury through accident either in India or outside India?

Easy Health policy only covers medical treatment taken within India and payments under this policy shall only be made in Indian Rupees within India.

How do I avail cashless facility?

For any emergency Hospitalisation, your designated TPA must be informed no later than 24 hours after hospitalization. For any planned hospitalization, kindly seek cashless authorization from your designated TPA atleast 48 hours prior to the hospitalization. TPA will check your coverage as per the eligibility and send an authorization letter to the provider. In case there is any deficiency in the documents sent, the same shall be communicated to the hospital within 6 hours of receipt of documents. Please pay the non-medical and expenses not covered to the hospital prior to the discharge. In case the ailment /treatment is not covered under the policy a rejection letter would be sent to the provider within 6 hours. Rejection of cashless in no way indicates rejection of the claim.

How do I find out which Hospitals are part of a given insurance network?

You can refer to the list of empanelled hospitals on our website www.apollomunichinsurance.com (insert direct link here) or the list provided in the guidebook or welcome kit. You can also call our Toll Free Line at 1800-102-0333 or email us at customerservice@apollomunichinsurance.com or call you respective TPA if you have any queries. 

How does one get reimbursement for pre- and post-hospitalization expenses under this scheme?

Your policy allows reimbursement of medical expenses incurred 30 days before and 60 days after discharge from hospitalisation towards pre and post hospitalisation expenses. The Insured is required to send all invoices in original with supporting documents/prescriptions along with a copy of the discharge summary to the respective TPA. TPA will scrutinize the claim and settle the invoices subject to the overall limit of the policy. The invoices must be sent to TPA within 15 days from the date of completion of treatment. Pre and post hospitalisation benefit will be enhanced to 60 and 90 days respectively if we are provided with medical documents with all details about the Illness and the date and the place of the proposed Hospitalisation at least 5 days before the hospitalisation:

How does one get reimbursements in case of treatment in non-network hospitals?

The insured person or someone claiming on behalf of the insured person is required to submit all the relevant medical documents related to the treatment for which the claim is being filed to us within 15 days of discharge from the hospital or completion of treatment. Some of the documents to be submitted are as below:
  • Our claim form, duly completed and signed for on behalf of the insured person.
  • Original bills (including but not limited to pharmacy purchase bill, consultation bill, diagnostic bill) along with prescriptions in support of the amount claimed.
  • All reports including medical reports, case histories, investigation reports, treatment papers, discharge summaries.
  • A precise diagnosis of the treatment for which a claim is made.
A detailed list of the individual medical services and treatments provided and a unit price for each.

Prescriptions that name the insured person and in the case of drugs: the drugs prescribed, their price and a receipt for payment. Prescriptions must be submitted with the corresponding doctor’s invoice. 

This is not an exhaustive list and we may ask for additional documents on a case to case basis.

How to make intimation?

You can make claim intimation by informing us on our / TPA’s toll-free number or in writing to us / TPA at any of our offices. You will be entitled for the benefit of 60 days pre hospitalisation and 90 days of post hospitalization, if you intimate us/TPA 5 days in advance of the treatment and provide medical documents with all details about the Illness and the date and the place of the proposed hospitalisation.

How will the payment of claim be made?

All claims will be payable to policyholder in Indian Rupees within India currency by cheque/DD or through bank transfer.

Is Health check up covered under this policy?

Yes, at the end of a block of every continuous 2/3/4 years (As per variant opted) during which you have been insured with us. Our maximum liability will be subject to 1% of the sum insured for this policy year or the subsequent policy years (whichever is lower).

Should the claim be submitted with the insurance company or with TPA?

Preferably with the TPA.

What are the benefits of your health card?

You need to display your health card at the time of admission into the hospital. It mentions the contact details and the contact numbers of the TPA along with your policy details. In case of a medical emergency, you can call on these numbers for queries, clarifications and for seeking any kind of assistance

What are the Non payable items?

Click here for the list

What if I also have or intend to buy a medical policy of any other insurance company?

It’s your choice, but you would have to intimate us of the same and the concerned insurance company.

What is a ‘cashless’ claim?

In a cashless claim the insured is required to intimate the TPA to avail cashless facility. After authorizing it, the TPA directly settles the claim to the network hospital and the insured is not required to pay any charges except non-medical expenses and other expenses not covered under the policy. Insured person is entitled for cashless only in our network hospitals. 

What is a reimbursement claim?

In a reimbursement claim the insured has to pay upfront for the services of the provider and seek reimbursement from the Insurer for the covered services

What is Pre-Authorization?

In a pre-authorization process, the insured or the service provider seeks an approval and guarantee of payment from the insurer or it’s TPA for the covered services before the Hospitalization / service for planned treatment and during the course of Hospitalization / service for emergency treatment

What is TPA?

TPA stands for Third Party Administrator. 
TPA means the third party administrator that we appoint from time to time as specified in your schedule. All claims under the policy will be processed and settled by specified Third Party Administrator (TPA) licensed by IRDA.

Under what conditions/circumstances can my premium increase at renewal?

Your policy premium at renewal can increase under the following conditions
· Change in Age Band- Renewal premium is calculated on the basis of age of the insured on the renewal date. If the insured moves to a higher age band, renewal premium applicable will be calculated as per the new age band.
Eg : Customer A bought a health insurance policy on 10th December 2015  when his completed age was 34 years ( Date of Birth: 30th September 1981), his renewal premium calculation would be as under.

  Date Completed Age ( in yrs) Age band ( in yrs) Premium to be paid
Policy Inception 10th December 2015 34 18-35 5887
1st renewal 10th December 2016 35 18-35 5887
2nd renewal 10th December 2017 36 36-45 6662

· Change in Govt taxes, duties  and/or cess- Any increase in the Govt taxes, duties or cess will result in higher premium at renewal. As per the last govt guideline ,service tax is being charged at 15% effective 1st June 2016.

· Change in Product Pricing- Your renewal premium may increase as a result of an overall premium revision in the product which we may undertake from time to time as a result of increasing medical inflation. The premium revision would come into effect only after approval from the Regulator.
Last Revision
Please Note: Our products Easy Health (UIN : IRDAI/HLT/AMHI/P-H/V.III/1R/2016-17) and Optima Restore (UIN: IRDAI/HLT/AMHI/P-H/V.III/1/2016-17) have been revised with new premium and enhanced benefits effective 20th October 2016  for new business and 16th December 2016 for renewals]. For any additional information please write  to customerservice@apollomunichinsurance.com

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