Apollo Munich Health Insurance, a joint venture between Apollo Hospitals and Munich Health has launched a new insurance plan. Titled “Optima Restore” the plan is a one of a kind health insurance plan with two unique features. Here is a look at the plan in detail, covering its features, benefits and exclusions.
Optima Restore- What Sets it Apart
What sets the plan apart from other plans are its two unique benefits.
The Restore Benefit
The restore benefit is an innovative benefit in health insurance. It aims to reinstate the basic sum assured of the policy holder, in case it has been exhausted during the policy year. For example, let us say you have a policy with a sum assured of Rs. 3 lakh and the entire amount is claimed by way of some illness or hospitalization. In such a case, Apollo Munich restores the Rs. 3 lakh sum assured, and this could be used for some other illness or for other members of the family(in case of a floater plan).
The Multiplier Benefit:
Almost all health insurance providers offer a No Claim Bonus (NCB) for claim free policy years. Optima Restore offers the same benefit but with a difference. For the first claim free year the NCB is 50% of the basic sum assured. If the second year also goes claim free, the basic sum assured gets doubled. So, by the third policy year your sum assured stands doubled, if you have had claim free policy years.
Policy Features
Eligibility:
The policy comes with a cover amount between Rs. 3, 00,000 to Rs. 15,00,000; a policy term between 1 year till 2 years; and entry age from 91 days till 65 years of age.
Policy types:
Two types of policies are available- Individual and Family Floater. The family floater covers the individual, his spouse, dependent children and dependent parents.
Tax benefits:
Premiums paid up to Rs. 15,000 for individuals and Rs. 20,000 for senior citizens is allowed as a deduction under section 80D of the Income Tax Act.
Renewability:
There is no restriction and renewals are permitted for life time.
Discount: A discount of 10% is available if you buy an individual plan for 2 or more members. For a 2 year plan, you could avail an additional discount of 7.5%.
Scope of Policy
| WHAT IT OFFERS | WHAT IT DOES NOT OFFER |
| Cashless treatment across 4000 hospitals across 800 cities in India | Pregnancy is not covered |
| Extended benefits covering 60 days pre and 180 days post hospitalization | Pre-existing disease is covered after 3 years waiting period |
| Day care events, domiciliary treatment | Dental treatment |
| In-patient treatment, organ contributor | Specific diseases like cataract, hernia has a 2 year waiting period |
| Emergency ambulance up to Rs. 2,000 | Psychiatric conditions, mental disorders, Parkinson’s disease, Alzheimer’s disease and obesity-related treatments |
| No sub-limits on room rent | Cosmetic, plastic or experimental surgery |
| Surgical equipment’s, for any specific disease and for anesthesia charges | General weakness, convalescence, rest cure, long-term nursing care, rehabilitation etc |
| Cost of medicines, drugs and consumables | Cost of contact lenses, spectacles, hearing aids, wigs, diabetic test strips and similar products |
| Diagnostic procedures like X-ray, CT Scan, and MRI Scan | Involvement in military, air force, naval operations |
| | Dangerous sports like racing, diving, hand-gliding, parachuting, scuba-diving, rock-climbing etc |
| | Abuse of drugs, alcohol, hallucinogens, intoxicant |
| | HIV, AIDS and related diseases |
| | Congenital diseases |
Reviewing the Policy
Let us review the policy under the various aspects.
Benefits:
Undoubtedly the USP of the plan is the Restore benefit and the Multiplier benefit, something which other plans do not offer. However what one must remember here is that 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. Nevertheless, these two benefits together would definitely appeal to almost all policy holders.
Premiums:
The premiums on Optima Restore are on par with what other health insurance players in the market quote. But with the plan loaded with benefits, it definitely is worth every rupee of premium it charges. For 2 adults of age 35 years and one child, the premium of a floater policy with 3 lakh sum assured would be Rs 8281. Also there is no loading on premiums if any claims arise, which keeps the policy constant for the same age group.
The policy could be renewed for lifetime and policy holders could continue the same plan without switching over to new policies. And with the wide coverage across hospitals and cities, Optima Restore is a value for money health insurance plan and is definitely worth a buy.
Author
Ramya Ramachandran
