FAQs for Health Wallet

Age 65 years

Age 25 years

Age 18 years

Age 91 days (provided either of the parents are covered)

Self, Spouse, Dependent Children & Dependent Parents or parents in law

A maximum of 6 members can be added in a single individual policy. In an individual policy, a maximum of 4 adults and a maximum of 5 children can be included in a single policy. The 4 adults can be a combination of Self, Spouse, Father, Father in law, Mother or Mother in law.

A maximum of 6 members can be added in a single family floater policy. A maximum 2 adults and a maximum of 5 children can be included in a single policy. The 2 adults can be a combination of Self, Spouse, Father, Father in law, Mother or Mother in law. In a family floater the age of the eldest member will be considered while computing premium for the family.

One year

Lifelong renewals/No cover ceasing age

3, 5, 10, 15, 20, 25, 50L

Yes, product offers optional deductible which can be opted NIL, 2, 3, 5, 10 L

Medical expenses like

• Doctor’s consultation Fee
• Diagnostic Charges
• Medicine Bills

Emergency Worldwide care benefit covers emergency treatment for illnesses contracted or accidents sustained while insured is travelling overseas, where as Critical advantage covers 8 listed CI’s for a planned overseas treatment

Yes, product offers “Multiplier Benefit” of 50% for each claim free year subject to maximum of 100% of sum insured. In case of a claim it is reduced by same percentage.

Yes, Preventive Health Check-up is offered under the plan, the eligibility is based on reserve benefit sum insured applicable as per grid below

Any member who was NOT insured under the previous policy year would not be entitled for this benefit.

This benefit is not available for expenses incurred on a preventive health check-up in the first policy year. Benefit will NOT be carried forward if it is not claimed and would not be provided if the Health Wallet is not renewed further.

Reserve benefit is an additional sum insured available under the plan, sum insured for reserve benefit is dependent of combination of sum insured and deductible opted.

Reserve benefit is an additional sum insured available under the plan, sum insured for reserve benefit is dependent of combination of sum insured and deductible opted.

i. Out-patient expenses. This includes

• Diagnostic Tests
• Vaccinations
• Pharmacy
• Consultations with a Medical Practioner , Physiotherapist ,Dietician, Speech therapist, Psychologist
• Dental expenses
• Spectacles, contact lenses,
• Hearing aids
• Medical devices like C-PAP, Bi-PAP, Blood Pressure monitors, Blood sugar monitors and supplies, Heart rate monitors, Portable ECG’s, Pulse Oxymeters , Prosthetics etc.
• Special health foods and supplements (food for diabetics/hypertensive and special health conditions, proteins and supplements etc)

ii. Incidental medical expenses. This includes

• Co-payment and / or Deductible for any health insurance claim
• Standard non-payable items under any health insurance claim
• Other Medical Expenses not covered under any medical insurance (For example cosmetic treatment, Alzheimer’s etc.)

Residual RB sum insured amount would be rolled over to next policy year with addition of 6% bonus.

Yes, Reserve Benefit sum insured can be utilized irrespective of claims made under base sum insured

Reserve benefit amount can be reimbursed for previous years at any given time provided that there was sufficient sum insured at the time those expenses were incurred.

As under our other plans and company philosophy in such cases insured should opted for a higher sum insured rather than opting to buy additional policies.

No

The declined conditions at the entry level are

• Cancer or Tumor
• Type 1 & 2 Diabetes
• Heart attack, Bypass, Stroke
• Renal/Kidney failure
• Epilepsy, Paralysis

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.

Yes, waiting period applicable under the plan are as below

• 30 Days waiting period, except for hospitalisations resulting from an accident
• 2 year waiting period for specified illness
• 36 months waiting period for any pre-existing conditions

Pl Note: Waiting periods as specified in the terms and conditions will be reduced by the number of continuous preceding years of coverage of the Insured Person under Health Wallet policy, for any enhanced sum insured waiting periods shall start afresh.

Yes, product support both inward and outward portability. Portability would be limited to the extent of previous sum insured + CB (if any), due wavier of 30, days, 2 years and PED waiting period would be waived as per coverage with previous insurer. Each proposal would be underwritten based on age and SI opted.

In cashless claim the insured is required to intimate Apollo Munich to avail cashless facility. On authorisation by the Apollo Munich, the company directly settles the claim to the network hospital and insured is not required to pay any charges except non-medical and expenses not covered under the policy. Insured person is entitled for cashless only in our network hospitals.

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.

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

This policy only covers medical treatment taken within India except for hospitalisation under “Worldwide Emergency Care” benefit and payments under this policy shall only be made in Indian Rupees within India.

Your policy allows reimbursement of medical expenses incurred 60 days before and 90 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 Apollo Munich. Apollo Munich will scrutinize the claim and settle the invoices subject to the overall limit of the policy. The invoices must be sent to the company within 15 days from the date of completion of treatment. Medical documents with all details about the Illness; and the date and the place of the proposed Hospitalisation.

• Step 1: Submit original bills/receipt and the duly filled and signed reimbursement form (annexure) at any of Apollo Munich Branch Office or courier to
  

  Claims Department, - For Canara Bank Health checkup reimbursement) Apollo Munich Health insurance Co. Ltd Ground floor, Srinilaya – Cyber Spazio, Suite # 101,102,109 & 110, Ground Floor, Road No. 2, Banjara Hills, Hyderabad-500 034

• Step 2: If there is any deficiency in the documents/information submitted by you, Apollo Munich will send the deficiency letter within 7 days of receipt of the documents.
• Step 3: On receipt of the complete set of documents, Apollo Munich will process the admissible amount within 15 days.

• Step 1: Submit original bills/receipt and the duly filled and signed reimbursement form (annexure) at any of Apollo Munich Branch Office or courier to
  

  Claims Department, - For Canara Bank Health checkup reimbursement) Apollo Munich Health insurance Co. Ltd Ground floor, Srinilaya – Cyber Spazio, Suite # 101,102,109 & 110, Ground Floor, Road No. 2, Banjara Hills, Hyderabad-500 034

• Step 2: If there is any deficiency in the documents/information submitted by you, Apollo Munich will send the deficiency letter within 7 days of receipt of the documents.
• Step 3: On receipt of the complete set of documents, Apollo Munich will process the admissible amount within 15 days.

Critical Advantage is an optional rider which can be opted where base sum insured opted is 10 L or greater. Rider covers overseas hospitalisation due to listed 8 critical conditions on cashless basis.

• Cancer Treatment
• Coronary Artery by-pass surgery
• Heart Valve replacement or repair
• Neurosurgery
• Live-donor organ transplant
• Bone Marrow Transplant
• Aorta Graft Surgery
• Pulmonary artery graft surgery

$ 25,000 & $ 50,000

$ 25,000 & $ 50,000