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Customer Service > FAQs > Pre-Sales Queries

Do I have to undergo a medical checkup every year?

No, if the insured renews the policy continuously without a break and there is no change in the policy terms and conditions.

Are all the major corporate hospitals on the network?

We have a network of over 4000 hospitals for you to choose from Network Locator. 

Do I have to undergo any medical examination?

Medical examination may be required in some cases, based on the sum insured and the age of the person.

Do you offer individual policies and group policies?

We offer both, group and individual policies.

How can I indemnify or claim benefits under the policy?

The expenses or benefits can be claimed or indemnified by reimbursement or by availing cashless services at the hospitals.

If I avail cashless facility, will you pay the entire amount or will I be required to bear part of the bill at the hospital?

Yes, we will pay the entire admissible amount for the medical expenses incurred subject to the sum insured. You might have to pay for the non-medical and expenses not covered to the hospital prior to your discharge from hospital 

In case of cashless treatments, in whose favour are cheques settled or who gets the payments?

The cheques are sent to the hospital to whom approvals for cashless are given.

How long is the policy valid for?

Apollo Munich offers policies with option of 1 and 2 years policy period which can be renewed every year

Is the premium exempted from Income Tax?

  • Yes, the premium paid for health insurance policies qualifies for deduction under Section 80D of the Income Tax Act.
  • An person is entitled to a deduction of Rs. 25000 in respect of medical insurance premium paid on the health of himself, his spouse and children.
  • In addition thereto, if he pays health insurance premium on the health of his parents( senior Citizen), he will be entitled to additional deduction of Rs. 30000/-
  • The health insurance premium that you pay must be from the taxable income applicable for the year you claim. Premium should not be from gifts received by you.
  • The premium may be paid by any mode of payment, other than cash.
 

Is cashless facility available across all hospitals?

The cashless facility is available only at the hospitals which are in our network.

What is a Family Floater plan?

In a Family Floater plan all insured members are covered on floater sum insured basis. The sum insured for a family floater is our maximum liability for any and all claims made by all the insured members.

Should the claim be submitted to Apollo Munich Health or to the responsible Third Party Administrator (TPA)?

The claim documents should be submitted to the responsible TPA, mentioned on the ID card and the User Guide.

What do you mean by Medical expenses?

Medical expenses, means all those reasonable and medically necessary expenses that an Insured Person has necessarily and actually incurred for medical treatment during the policy period on the advice of a medical practitioner due to illness or accident occurring during the policy period. These expenses should not be more than the expenses incurred had the Insured Person not been insured and should not be more than what other hospitals or doctors in the same locality would have charged for the same medical treatment. 

What do you mean by Pre and Post hospitalization?

Pre- and Post-hospitalization expenses cover all medical expenses incurred within 30 days prior to hospitalization and expenses incurred within 60 days post hospitalization provided the expenses were incurred for the same condition for which the Insured Person’s hospitalisation was required. 
For Example: A person may be required to undergo certain tests to confirm the disease for which he is eventually hospitalized. The Doctor's consultation fees for this, the expenses for tests and medicines 30 days prior to hospitalization for that particular disease are covered. Medical expenses for 60 days post-hospitalization after being discharged from the hospital, e.g. the subsequent follow-up consultations with specialists, medicines and test expenses are covered.

What do you mean by pre-existing disease or conditions?

By Pre-existing Condition we mean any condition, ailment or injury or related condition(s) for which you had signs or symptoms, and / or were diagnosed, and / or received medical advice/ treatment, within 48 months prior to the first policy issued by the insurer.

What is a waiting period?

A waiting period is the length of time the insured have to wait before being eligible for Health Policy benefits.

What is Co-Payment?

Co-payment means a cost-sharing requirement under a health insurance policy that provides that the insured will bear a specified percentage of the admissible costs. A co-payment does not reduce the sum insured, however it reduces the premium payable by the insured to the insurer. Co-Payment option is available for the Energy Policy and Optima Senior Policy

Who is our Health TPA?

For all retail policies, we have a competent in-house claim settlement team and for group policies our major TPA is Family Health Plan Limited (FHPL), but we also use some other TPAs depending on the company’s requirement.

What is the basic difference between individual and group health insurance coverage?

An individual policy is purchased by you directly from us. 
In a Group Health Insurance Policy, the employer or legally constituted group is the policyholder and the insurance company contracts with the employer or legally constituted group. Insurance certificates, issued to a participating member, acts as your policy. In addition, group health insurance often contains special coverage's that are not available or are very expensive on an individual basis. The purchasing power of the group makes this economically feasible.
Coverage under group ends once you cease to be a part of that group, moreover since the insurance contract is between insurer and employer or legally constituted policyholder there is no guarantee that policy would be renewed further.

What is the procedure for availing cashless benefit?

When you are admitted to the network hospital, you need to show the Apollo Munich Health Card to the treating doctor. The Network Hospital would contact the responsible TPA (Third Party Administrator, mentioned on the card) and fill up the pre-authorization form. Then it would send the same to TPA with estimation of expenses. The TPA will check the policy conditions and the sum insured and approve the estimate. 

Who pays for the medical examination?

The proposed member has to pay for the cost of Pre-Policy Check-up (PPC). We will co-ordinate the appointment with our empanelled doctor/diagnostic centre through our appointed TPA. On acceptance of your application and subsequent issuance of the policy, 50% of the expenses incurred per insured person will be reimbursed. The reimbursement has to be claimed from Apollo Munich Health Insurance Company Ltd. along with the original bill.

Who is a medical practitioner?

A Medical Practitioner is a person who holds a valid registration from the medical council of any state of India and is thereby entitled to practice medicine within its jurisdiction, and is acting within the scope and jurisdiction of his license. It includes physician, specialist or surgeon etc.

Why should I buy a critical illness cover?

With rapidly changing demographics and lifestyles prevalence of critical illness is on the rise in India. With rise in life expectancy and chronic nature of critical illness there is a requirement of additional funds to afford high medical costs for treating such critical illnesses. Our policy covers 8 most common critical illnesses were an insured member is compensated by a lumpsum payment.

Why should I buy Overseas Travel Insurance?

In some instances Overseas Travel Insurance is required to get a visa to travel to certain countries. Schengen country (many countries of Western Europe constitute the Schengen countries) consulates insist on having Travel Insurance with a minimum of $37,500 coverage. However even if insurance is not required for visa purposes, it is still prudent to purchase travel insurance for the following reason:

Health care costs in India are much less when compared to developed countries like the USA, Japan and European countries. In most of these countries medical care is not subsidized by the government, and medical bills can easily exceed thousands of dollars which patients have to pay by themselves. Most people in these countries have some form of Health Insurance; however these insurance policies are not available to visitors. Given this scenario, purchasing Travel Insurance can be viewed as a necessity.

Why should I take a Health Policy if I already have health insurance from my employer, or if my family and I are already covered by my corporate?

Your employer will cover your medical expenses only as long as you are in his services. Tomorrow, you may change your job, retire, or even start something on your own. In all such cases you and your family will be stranded if a medical emergency arises and you have not arranged for an alternative health insurance policy. It is at this point of time that Health Insurance policy will come to your rescue. 
Health Insurance policy can also act as a supplement to your existing medical cover in case the cost of medical treatment is higher than your existing cover level.

Will I get cashless at government institutions like AIIMS/TMH/ARMY Referral hospitals?

No, this facility does not extend to government hospitals.

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