Standalone health insurer Apollo Munich today added two new plans under their Optima series - Optima Vital and Optima Super. While Optima Vital is a critical illnesses plan that covers up to 37 critical conditions, Optima Super is a high-deductible, also called top up, health plan. What's new is that this top-up plan comes with an option of 'Waiver of Deductible' that lets you convert it into an full -fledged indemnity plan without new underwriting, an industry first.
"Optima Super is based on customer feedback that addresses customers' need to mitigate their increased medical expenses at affordable rates. This benefit is very useful for the people who are covered under a group health insurance policy by their employer. The customers have an option of converting the plan into a full-fledged policy without any underwriting or consideration of his then current health status at two occasions," says Antony Jacob, CEO, Apollo Munich health insurance.
This is an interesting option for those looking to enhance their employer group health cover. You can buy the top-up with high deductible to bump up your health insurance cover size at a nominal cost and convert it to a regular comprehensive plan, with no deductible, when you do not have your employer benefit.
The switch is like porting your plan. So the policy will be based on the old underwriting, meaning, you do not have to serve the waiting period again and will be able to carry forward other accrued benefits. You will be issued a fresh policy of same sum insured in lieu of Optima Super but the deductible will cease. "The customer can choose either of Easy Health or Optima Restore while using his flip benefit which will come without any waiting period and underwriting requirements," adds Jacob.
However, you will have to pay a higher premium since this plan won't have the threshold. For instance, for, say, a 30-year-old who has a 10 lakh cover with Rs 2 lakh deductible it would cost Rs. 2,780 for a year. When you opt to switch benefit and choose Optima Restore, the annual premium will increase to Rs. 8,004. That is almost a 170% hike.
Also, unlike the standard top-up plans that are available in the market presently, you do not have to cross the deductible limits at every claims incidence but can aggregate them during a policy period over multiple hospitalizations, another pro-customers move, especially in case of a higher thresholds where you rarely cross the limit in a single hospital bill.
The plan offers a single cover for your entire family (family floater option). Also, rather than a regular one-year contract, you can get a two year policy and avail off discounts in premium. You get a 10% cut in premium, if 2 or more family members are covered under the plan and an additional discount of 7.5% if you choose a 2 year policy and pay the premium at the beginning of the policy. The policy also offers an income tax benefit under Section 80 D.
CAVEAT: Though Optima Super offers a life-long renewal, the 'Waiver of Deductible' option can be exercised by you only at the time of renewal between the age of 55 and 60 years or at the beginning of 6th policy year; provided that it has been bought before 50 years of age and the policy was renewed continuously and without any interruption.
Then off course there are regular exclusions such as congenital diseases, mental disorder or insanity, cosmetic surgery and weight control treatments. The waiting period for pre-existing conditions is 4 years and a cooling-off period of 30 days for all treatments.